Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts in the treatment of acute malignant colorectal obstruction.

Science.gov (United States)

Kim, Honsoul; Kim, Seung Hyoung; Choi, Sun Young; Lee, Kwang-Hun; Won, Jong Yoon; Lee, Do Yun; Lee, Jong Tae

2008-12-01

To evaluate the technical feasibility and clinical effectiveness of fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for acute malignant colorectal obstruction. Radiologic images and clinical reports of 42 patients (22 men, 20 women; age range, 28-93 years; median age, 65.5 years) who underwent fluoroscopically guided colorectal stent insertion without endoscopic assistance for acute malignant obstruction were reviewed retrospectively. Eighteen patients received bare stents as a bridge to surgery. Twenty-four patients received 27 insertions of either a bare stent (n = 15) or a stent-graft (n = 12) for palliation. The obstruction was located in the rectum (n = 8), sigmoid (n = 17), descending colon (n = 8), splenic flexure (n = 3), and transverse colon (n = 6). Clinical success, defined as more than 50% dilatation of the stent with subsequent symptomatic improvement, was achieved in 41 of the 42 patients (98%). No major procedure-related complications occurred. Minor complications occurred in eight of the 45 procedures (18%). No perioperative mortalities occurred within 1 month after surgery. In the palliative group, the median stent patency was 62 days (range, 0-1,014 days). There was no statistically significant difference in stent patency between the bare stents (range, 0-855 days; median, 68 days) and stent-grafts (range, 1-1,014 days; median, 81 days). Fluoroscopically guided placement of self-expandable metallic stents and stent-grafts for the relief of acute malignant colorectal obstruction was technically feasible without endoscopic assistance-even in lesions proximal to the splenic flexure and transverse colon-and clinically effective in both bridge to surgery and palliative management.

MO-F-CAMPUS-I-02: Occupational Conceptus Doses From Fluoroscopically-Guided Interventional Procedures

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Damilakis, J; Perisinakis, K; Solomou, G [University of Crete (Greece); Stratakis, J [University of Crete, Heraklion, Crete (Greece)

2015-06-15

Purpose: The aim of this method was to provide dosimetric data on conceptus dose for the pregnant employee who participates in fluoroscopically-guided interventional procedures. Methods: Scattered air-kerma dose rates were obtained for 17 fluoroscopic projections involved in interventional procedures. These projections were simulated on an anthropomorphic phantom placed on the examination table supine. The operating theater was divided into two grids relative to the long table sides. Each grid consisted of 33 cells spaced 0.50 m apart. During the simulated exposures, at each cell, scatter air-kerma rate was measured at 110 cm from the floor i.e. at the height of the waist of the pregnant worker. Air-kerma rates were divided by the dose area product (DAP) rate of each exposure to obtain normalized data. For each projection, measurements were performed for 3 kVp and 3 filtration values i.e. for 9 different x-ray spectra. All measurements were performed by using a modern C-arm angiographic system (Siemens Axiom Artis, Siemens, Germany) and a radiation meter equipped with an ionization chamber. Results: The results consist of 153 iso-dose maps, which show the spatial distribution of DAP-normalized scattered air-kerma doses at the waist level of a pregnant worker. Conceptus dose estimation is possible using air-kerma to embryo/fetal dose conversion coefficients published in a previous study (J Cardiovasc Electrophysiol, Vol. 16, pp. 1–8, July 2005). Using these maps, occupationally exposed pregnant personnel may select a working position for a certain projection that keeps abdominal dose as low as reasonably achievable. Taking into consideration the regulatory conceptus dose limit for occupational exposure, determination of the maximum workload allowed for the pregnant personnel is also possible. Conclusion: Data produced in this work allow for the anticipation of conceptus dose and the determination of the maximum workload for a pregnant worker from any

MO-F-CAMPUS-I-02: Occupational Conceptus Doses From Fluoroscopically-Guided Interventional Procedures

International Nuclear Information System (INIS)

Damilakis, J; Perisinakis, K; Solomou, G; Stratakis, J

2015-01-01

Purpose: The aim of this method was to provide dosimetric data on conceptus dose for the pregnant employee who participates in fluoroscopically-guided interventional procedures. Methods: Scattered air-kerma dose rates were obtained for 17 fluoroscopic projections involved in interventional procedures. These projections were simulated on an anthropomorphic phantom placed on the examination table supine. The operating theater was divided into two grids relative to the long table sides. Each grid consisted of 33 cells spaced 0.50 m apart. During the simulated exposures, at each cell, scatter air-kerma rate was measured at 110 cm from the floor i.e. at the height of the waist of the pregnant worker. Air-kerma rates were divided by the dose area product (DAP) rate of each exposure to obtain normalized data. For each projection, measurements were performed for 3 kVp and 3 filtration values i.e. for 9 different x-ray spectra. All measurements were performed by using a modern C-arm angiographic system (Siemens Axiom Artis, Siemens, Germany) and a radiation meter equipped with an ionization chamber. Results: The results consist of 153 iso-dose maps, which show the spatial distribution of DAP-normalized scattered air-kerma doses at the waist level of a pregnant worker. Conceptus dose estimation is possible using air-kerma to embryo/fetal dose conversion coefficients published in a previous study (J Cardiovasc Electrophysiol, Vol. 16, pp. 1–8, July 2005). Using these maps, occupationally exposed pregnant personnel may select a working position for a certain projection that keeps abdominal dose as low as reasonably achievable. Taking into consideration the regulatory conceptus dose limit for occupational exposure, determination of the maximum workload allowed for the pregnant personnel is also possible. Conclusion: Data produced in this work allow for the anticipation of conceptus dose and the determination of the maximum workload for a pregnant worker from any

C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty.

Science.gov (United States)

Tam, Alda L; Mohamed, Ashraf; Pfister, Marcus; Chinndurai, Ponraj; Rohm, Esther; Hall, Andrew F; Wallace, Michael J

2010-05-01

/3 border of the vertebral body was measured, and 75% when distance from target to needle tip was measured. There were no major complications. Minor complications consisted of 3 cases (25%) of cement extravasation. C-arm CBCT with needle path overlay for fluoroscopic guided vertebroplasty is feasible and allows for reliable unilateral therapy of both lumbar and thoracic vertebral bodies. Extrapedicular approaches were performed safely and with good accuracy of reaching the targets.

Measuring radiation dose to patients undergoing fluoroscopically-guided interventions

International Nuclear Information System (INIS)

Lubis, L E; Badawy, M K

2016-01-01

The increasing prevalence and complexity of fluoroscopically guided interventions (FGI) raises concern regarding radiation dose to patients subjected to the procedure. Despite current evidence showing the risk to patients from the deterministic effects of radiation (e.g. skin burns), radiation induced injuries remain commonplace. This review aims to increase the awareness surrounding radiation dose measurement for patients undergoing FGI. A review of the literature was conducted alongside previous researches from the authors’ department. Studies pertaining to patient dose measurement, its formalism along with current advances and present challenges were reviewed. Current patient monitoring techniques (using available radiation dosimeters), as well as the inadequacy of accepting displayed dose as patient radiation dose is discussed. Furthermore, advances in real-time patient radiation dose estimation during FGI are considered. Patient dosimetry in FGI, particularly in real time, remains an ongoing challenge. The increasing occurrence and sophistication of these procedures calls for further advances in the field of patient radiation dose monitoring. Improved measuring techniques will aid clinicians in better predicting and managing radiation induced injury following FGI, thus improving patient care. (paper)

An exploration of fluoroscopically guided spinal steroid injections in patients with non-specific exercise-related lower-limb pain

Directory of Open Access Journals (Sweden)

Leon Neve

2010-09-01

Full Text Available Leon Neve1, John Orchard2, Nathan Gibbs3, Willem van Mechelen4, Evert Verhagen4, Ken Sesel5, Ian Burgess6, Brett Hines61VU University, Amsterdam, The Netherlands; 2School of Public Health, University of Sydney, Sydney, NSW, Australia; 3South Sydney Sports Medicine, Sydney, NSW, Australia; 4EMGO, VU University, Amsterdam, The Netherlands; 5Sydney X-ray Centre, Sydney, NSW, Australia; 6Mater Imaging, Sydney, NSW, AustraliaBackground: Fluoroscopically guided lumbar cortisone injections have been proven useful in cases of lower-limb pain caused by lumbar disc prolapse (with evidence levels ll-1/ll-2. These injections are also sometimes used clinically in sports medicine for patients with non-specific exercise-related lower-limb pain, where no prolapse or other obvious cause of nerve-impingement is diagnosed via magnetic resonance imaging (MRI or computed tomography (CT, even though this treatment scenario has not been adequately studied for this last diagnosis.Objectives: To explore whether fluoroscopically guided transforaminal lumbar cortisone injections may be a valid treatment method for non-specific exercise-related lower-limb pain.Study design: Retrospective case series.Methods: Patients were selected from databases at two sports clinics and divided into two groups: Group D, with back-related lower-limb pain and disc prolapse proven on CT or MR; and Group N, with non-specific exercise-related lower-limb pain. Patients were sent a questionnaire regarding: symptoms, improvement, effect of injections, satisfaction, side effects and other used treatments. Outcomes were compared between Group D and N.Results: 153 patients were eligible for the study (Group D: 93/Group N: 60. Eventually 110 patients responded (Group D: 67/Group N: 43. Twelve percent of Group D and 14% of Group N indicated that the injections had fully cured their symptoms. Altogether, 27% of Group D and 24% of Group N were certain the injections had improved their symptoms in the

Technique of Peritoneal Catheter Placement under Fluoroscopic Guidance

International Nuclear Information System (INIS)

Abdel-Aal, A.K.; Gaddikeri, S.; Saddekni, S.

2011-01-01

Peritoneal catheters are mainly used for peritoneal dialysis in patients with end-stage renal disease. Other uses of this catheter include intraperitoneal chemotherapy and gene therapy for ovarian cancer and draining of uncontrolled refractory ascites in patients with liver cirrhosis. Traditionally, surgeons place most of these peritoneal catheters either by laparoscopy or open laparotomy. We detail our percutaneous approach to placing peritoneal catheters using fluoroscopic guidance. We emphasize the use of additional ultrasound guidance, including gray scale and color Doppler ultrasound, to determine the safest puncture site and to guide the initial needle puncture in order to avoid bowel perforation and injury to epigastric artery. We present our experience in placing peritoneal catheters using this technique in 95 patients with various indications. Fluoroscopic guided percutaneous placement of peritoneal catheters is a safe, minimally invasive, and effective alternative to open surgical or laparoscopic placement.

Useful technique for submucous myomectomy under direct transcervical resectoscope observation

Directory of Open Access Journals (Sweden)

Tatsuji Hoshino

2017-08-01

Full Text Available The transcervical resectoscope (TCR is used for resecting a submucous myoma (SMM. Safe grasping of an SMM with forceps and its complete resection under transabdominal ultrasound (TAUS guidance is not always easy. SMMs are slippery, making them difficult to grasp. The SMM moves right to left and anterior to posterior when the surgeon tries to grasp it with placental forceps. Surgeons could use small Martin forceps (65% smaller to grasp SMMs safely and tightly under direct TCR (transcervical resectoscope observation. We present a case in which this operative procedure was used to remove an SMM with Figure and Video. The benefits of this procedure are enormous and could be immeasurably important to hysteroscopists and gynecologists.

Transcervical diverticulectomy for Killian–Jamieson diverticulum

Directory of Open Access Journals (Sweden)

Sze Li Siow

2017-07-01

Full Text Available Surgery for Killian–Jamieson diverticulum of the esophagus is scarcely reported in the literature owing to the rarity of this entity. This is a case report of such a diverticulum and a description of the transcervical diverticulectomy that we performed on a 49-year-old lady. The patient was investigated for symptoms of gastroesophageal reflux disease and was diagnosed with a left-sided Killian–Jamieson diverticulum.

Transcervical embryo recovery in Saanen goats | Lima-Verde ...

African Journals Online (AJOL)

In order to study the embryo recovery rate using the transcervical technique in Saanen goats raised in the tropics, 20 donors were submitted to an oestrus synchronisation treatment using intravaginal progestagen sponges for 11 days. On the ninth day of treatment, goats received intramuscular injections of 50 µg ...

Evaluation of the impact of a system for real-time visualisation of occupational radiation dose rate during fluoroscopically guided procedures

International Nuclear Information System (INIS)

Sandblom, V; Almén, A; Cederblad, A.; Båth, M; Lundh, C; Mai, T; Rystedt, H

2013-01-01

Optimisation of radiological protection for operators working with fluoroscopically guided procedures has to be performed during the procedure, under varying and difficult conditions. The aim of the present study was to evaluate the impact of a system for real-time visualisation of radiation dose rate on optimisation of occupational radiological protection in fluoroscopically guided procedures. Individual radiation dose measurements, using a system for real-time visualisation, were performed in a cardiology laboratory for three cardiologists and ten assisting nurses. Radiation doses collected when the radiation dose rates were not displayed to the staff were compared to radiation doses collected when the radiation dose rates were displayed. When the radiation dose rates were displayed to the staff, one cardiologist and the assisting nurses (as a group) significantly reduced their personal radiation doses. The median radiation dose (H p (10)) per procedure decreased from 68 to 28 μSv (p = 0.003) for this cardiologist and from 4.3 to 2.5 μSv (p = 0.001) for the assisting nurses. The results of the present study indicate that a system for real-time visualisation of radiation dose rate may have a positive impact on optimisation of occupational radiological protection. In particular, this may affect the behaviour of staff members practising inadequate personal radiological protection. (paper)

SU-E-I-42: Normalized Embryo/fetus Doses for Fluoroscopically Guided Pacemaker Implantation Procedures Calculated Using a Monte Carlo Technique

Energy Technology Data Exchange (ETDEWEB)

Damilakis, J; Stratakis, J; Solomou, G [University of Crete, Heraklion (Greece)

2014-06-01

Purpose: It is well known that pacemaker implantation is sometimes needed in pregnant patients with symptomatic bradycardia. To our knowledge, there is no reported experience regarding radiation doses to the unborn child resulting from fluoroscopy during pacemaker implantation. The purpose of the current study was to develop a method for estimating embryo/fetus dose from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all trimesters of gestation. Methods: The Monte Carlo N-Particle (MCNP) radiation transport code was employed in this study. Three mathematical anthropomorphic phantoms representing the average pregnant patient at the first, second and third trimesters of gestation were generated using Bodybuilder software (White Rock science, White Rock, NM). The normalized embryo/fetus dose from the posteroanterior (PA), the 30° left-anterior oblique (LAO) and the 30° right-anterior oblique (RAO) projections were calculated for a wide range of kVp (50–120 kVp) and total filtration values (2.5–9.0 mm Al). Results: The results consist of radiation doses normalized to a) entrance skin dose (ESD) and b) dose area product (DAP) so that the dose to the unborn child from any fluoroscopic technique and x-ray device used can be calculated. ESD normalized doses ranged from 0.008 (PA, first trimester) to 2.519 μGy/mGy (RAO, third trimester). DAP normalized doses ranged from 0.051 (PA, first trimester) to 12.852 μGy/Gycm2 (RAO, third trimester). Conclusion: Embryo/fetus doses from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all stages of gestation can be estimated using the method developed in this study. This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT)

SU-E-I-42: Normalized Embryo/fetus Doses for Fluoroscopically Guided Pacemaker Implantation Procedures Calculated Using a Monte Carlo Technique

International Nuclear Information System (INIS)

Damilakis, J; Stratakis, J; Solomou, G

2014-01-01

Purpose: It is well known that pacemaker implantation is sometimes needed in pregnant patients with symptomatic bradycardia. To our knowledge, there is no reported experience regarding radiation doses to the unborn child resulting from fluoroscopy during pacemaker implantation. The purpose of the current study was to develop a method for estimating embryo/fetus dose from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all trimesters of gestation. Methods: The Monte Carlo N-Particle (MCNP) radiation transport code was employed in this study. Three mathematical anthropomorphic phantoms representing the average pregnant patient at the first, second and third trimesters of gestation were generated using Bodybuilder software (White Rock science, White Rock, NM). The normalized embryo/fetus dose from the posteroanterior (PA), the 30° left-anterior oblique (LAO) and the 30° right-anterior oblique (RAO) projections were calculated for a wide range of kVp (50–120 kVp) and total filtration values (2.5–9.0 mm Al). Results: The results consist of radiation doses normalized to a) entrance skin dose (ESD) and b) dose area product (DAP) so that the dose to the unborn child from any fluoroscopic technique and x-ray device used can be calculated. ESD normalized doses ranged from 0.008 (PA, first trimester) to 2.519 μGy/mGy (RAO, third trimester). DAP normalized doses ranged from 0.051 (PA, first trimester) to 12.852 μGy/Gycm2 (RAO, third trimester). Conclusion: Embryo/fetus doses from fluoroscopically guided pacemaker implantation procedures performed on pregnant patients during all stages of gestation can be estimated using the method developed in this study. This study was supported by the Greek Ministry of Education and Religious Affairs, General Secretariat for Research and Technology, Operational Program ‘Education and Lifelong Learning’, ARISTIA (Research project: CONCERT)

Evaluation of methods to produce an image library for automatic patient model localization for dose mapping during fluoroscopically guided procedures

Science.gov (United States)

Kilian-Meneghin, Josh; Xiong, Z.; Rudin, S.; Oines, A.; Bednarek, D. R.

2017-03-01

The purpose of this work is to evaluate methods for producing a library of 2D-radiographic images to be correlated to clinical images obtained during a fluoroscopically-guided procedure for automated patient-model localization. The localization algorithm will be used to improve the accuracy of the skin-dose map superimposed on the 3D patient- model of the real-time Dose-Tracking-System (DTS). For the library, 2D images were generated from CT datasets of the SK-150 anthropomorphic phantom using two methods: Schmid's 3D-visualization tool and Plastimatch's digitally-reconstructed-radiograph (DRR) code. Those images, as well as a standard 2D-radiographic image, were correlated to a 2D-fluoroscopic image of a phantom, which represented the clinical-fluoroscopic image, using the Corr2 function in Matlab. The Corr2 function takes two images and outputs the relative correlation between them, which is fed into the localization algorithm. Higher correlation means better alignment of the 3D patient-model with the patient image. In this instance, it was determined that the localization algorithm will succeed when Corr2 returns a correlation of at least 50%. The 3D-visualization tool images returned 55-80% correlation relative to the fluoroscopic-image, which was comparable to the correlation for the radiograph. The DRR images returned 61-90% correlation, again comparable to the radiograph. Both methods prove to be sufficient for the localization algorithm and can be produced quickly; however, the DRR method produces more accurate grey-levels. Using the DRR code, a library at varying angles can be produced for the localization algorithm.

Fluoroscopically-guided transforaminal epidural steroid injection for the treatment of sciatica due to herniated nucleus pulposus

International Nuclear Information System (INIS)

Liu Xiao; Wang Jianhui; Duan Zhaohui; Xu Zhitao; Shu Xiaomin; Qiu Ronghua

2009-01-01

Objective: To discuss the therapeutic benefit of fluoroscopically-guided lumbar transforaminal epidural steroid injections (TFESI) in treating patients with sciatica due to a herniated nucleus pulposus. Methods: From October 2004 to November 2007, fluoroscopically-guided lumbar TFESI as performed in 79 patients (41 males and 38 females with a mean age of 45.75 years,ranged from 20 to 70 years) with sciatica due to a herniated nucleus pulposus. Patients had a symptomatic course of disease from 8 weeks to 22 years and showed no response to conservative treatment. The diagnosis was confirmed by computed tomography or magnetic resonance imaging. TFESI was performed at patient's request. Additional injections, up to 3 times, were given with an interval of 7 or 10 days. The injection medicine consisted of 25 mg of prednisolone acetate and (9-14) ml of 0.5% lidocaine. Patients were evaluated by an independent observer and received questionnaires before the initial injection and at 6,12 months after TFESI. Questionnaires included an eleven points visual analog scale (VAS) and a five points patient satisfaction scale. A successful outcome required a patient satisfaction scale score of 3 (very good) or 4(excellent) and a reduction on the VAS score of 2 or more points after TFESI. Pain relief was classified as 'excellent' when the pain was completely resolved or diminished by 5 points or more, as 'good' when a diminution of pain was 2 points or more, as 'fair' and 'poor' when a diminution of pain was 1 point or less, or even an increase in pain. Results: Twenty-nine patients received single injection, 22 patients received two, 15 patients received three and 13 patients received four times of injection, with a mean of 1.96 times per patient. The mean VAS scores were 6.5(ranged 3.5-9.5) before and 3.8(ranged 0-9.5) 6 months after the procedure. Pain relief was graded as excellent in 35 patients (44.3%), good in 26 patients(32.9%), fair in 10 patients(12.7%), and poor in 8

"Forgotten" Chapters in the History of Transcervical Sterilization: Carl Clauberg and Hans-Joachim Lindemann.

Science.gov (United States)

Hildebrandt, Sabine; Benedict, Susan; Miller, Erin; Gaffney, Michael; Grodin, Michael A

2017-07-01

Transcervical sterilization is a non-surgical method of permanent female sterilization that is widely used and critically discussed. A review of the historiography of the method reveals that instances of its coercive use are not included in the historical account. This study offers a reexamination of the work of Carl Clauberg and Hans-Joachim Lindemann, to more deeply contextualize within the framework of current usage the coercive use of transcervical sterilization during the Third Reich and in postwar Germany. This inquiry is based on postwar criminal trial records on Clauberg, and on archival documents detailing Lindemann's activities in 1979. A comparative analysis examines arguments by medical historian Karl-Heinz Roth, and identifies shared characteristics and differences between Clauberg and Lindemann, their methods and scientific connections. The results demonstrate that the technique of transcervical sterilization has an abusive potential that may be explained as a function of the person of the physician, of the scientific method itself, and of societal and political influences. The analysis supports the argument that insights from the cases of Clauberg and Lindemann are transferrable geographically and over time, and have the potential to inform current medical practice, such as transcervical sterilization with the Essure device, whose historiographic exploration remains a desideratum. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Transcervical, intrauterine ultrasound-guided radiofrequency ablation of uterine fibroids with the VizAblate® System: three- and six-month endpoint results from the FAST-EU study.

Science.gov (United States)

Bongers, Marlies; Brölmann, Hans; Gupta, Janesh; Garza-Leal, José Gerardo; Toub, David

This was a prospective, longitudinal, multicenter, single-arm controlled trial, using independent core laboratory validation of MRI results, to establish the effectiveness and confirm the safety of the VizAblate® System in the treatment of symptomatic uterine fibroids. The VizAblate System is a transcervical device that ablates fibroids with radiofrequency energy, guided by a built-in intrauterine ultrasound probe. Fifty consecutive women with symptomatic uterine fibroids received treatment with the VizAblate System. Patients had a minimum Menstrual Pictogram score of 120, no desire for fertility, and met additional inclusion and exclusion criteria. The VizAblate System was inserted transcervically and individual fibroids were ablated with radiofrequency energy. An integrated intrauterine ultrasound probe was used for fibroid imaging and targeting. Anesthesia was at the discretion of each investigator. The primary study endpoint was the percentage change in perfused fibroid volume, as assessed by contrast-enhanced MRI at 3 months. Secondary endpoints, reached at 6 months, included safety, percentage reductions in the Menstrual Pictogram (MP) score and the Symptom Severity Score (SSS) subscale of the Uterine Fibroid Symptom-Quality of Life questionnaire (UFS-QOL), along with the rate of surgical reintervention for abnormal uterine bleeding and the mean number of days to return to normal activity. Additional assessments included the Health-Related Quality of Life (HRQOL) subscale of the UFS-QOL, medical reintervention for abnormal uterine bleeding, and procedure times. Fifty patients were treated, representing 92 fibroids. Perfused fibroid volumes were reduced at 3 months by an average of 68.8 ± 27.8 % ( P  abnormal uterine bleeding associated with fibroids, with appropriate safety and a low reintervention rate.

Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results

Energy Technology Data Exchange (ETDEWEB)

Lee, Joon Woo; Myung, Jae Sung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seong Nam, Gyeongi-do (Korea); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Seong Nam, Gyeongi-do (Korea); Kim, Ki-Jeong; Kim, Hyun-Jib [Seoul National University Bundang Hospital, Department of Neurosurgery, Seong Nam, Gyeongi-do (Korea)

2010-07-15

To evaluate the short-term and long-term effects of fluoroscopically guided caudal epidural steroid injection (ESI) for the management of degenerative lumbar spinal stenosis (DLSS) and to analyze outcome predictors. All patients who underwent caudal ESI in 2006 for DLSS were included in the study. Response was based on chart documentation (aggravated, no change, slightly improved, much improved, no pain). In June 2009 telephone interviews were conducted, using formatted questions including the North American Spine Society (NASS) patient satisfaction scale. For short-term and long-term effects, age difference was evaluated by the Mann-Whitney U test, and gender, duration of symptoms, level of DLSS, spondylolisthesis, and previous operations were evaluated by Fisher's exact test. Two hundred and sixteen patients (male: female = 75:141; mean age 69.2 years; range 48{proportional_to}91 years) were included in the study. Improvements (slightly improved, much improved, no pain) were seen in 185 patients (85.6%) after an initial caudal ESI and in 189 patients (87.5%) after a series of caudal ESIs. Half of the patients (89/179, 49.8%) replied positively to the NASS patient satisfaction scale (1 or 2). There were no significant outcome predictors for either the short-term or the long-term responses. Fluoroscopically guided caudal ESI was effective for the management of DLSS (especially central canal stenosis) with excellent short-term and good long-term results, without significant outcome predictors. (orig.)

Intrapartum transcervical amnioinfusion for meconium-stained amniotic fluid.

Science.gov (United States)

Das, A K; Jana, N; Dasgupta, S; Samanta, B

2007-06-01

To assess the rates of cesarean deliveries and perinatal outcome following intrapartum transcervical amnioinfusion in women with meconium-stained amniotic fluid (MSAF) in a setting with no electronic fetal monitoring or specialized neonatal care. In this prospective comparative study with 150 women who were in labor and had MSAF, 50 of the women received a transcervical amnioinfusion and the remaining 100 women received standard care. The inclusion criteria were a pregnancy of at least 37 weeks' duration, a single live fetus in cephalic presentation, no major medical or obstetric complications, and no known fetal malformation. The amnioinfusion was performed with 1000 mL of normal saline solution through a red rubber catheter. Amnioinfusion was associated with a significant decrease in the incidence of low Apgar score (amnioinfusion than in the control group (24% vs. 48%; RR, 0.5; 95% CI, 0.29-0.85). There were no major complications related to amnioinfusion. Intrapartum amnioinfusion for MSAF is a simple, safe, effective, and inexpensive procedure feasible in settings where intrapartum monitoring is limited. It is associated with improved perinatal outcome and could lower cesarean delivery rates in low-resource countries.

Scale-space for empty catheter segmentation in PCI fluoroscopic images.

Science.gov (United States)

Bacchuwar, Ketan; Cousty, Jean; Vaillant, Régis; Najman, Laurent

2017-07-01

In this article, we present a method for empty guiding catheter segmentation in fluoroscopic X-ray images. The guiding catheter, being a commonly visible landmark, its segmentation is an important and a difficult brick for Percutaneous Coronary Intervention (PCI) procedure modeling. In number of clinical situations, the catheter is empty and appears as a low contrasted structure with two parallel and partially disconnected edges. To segment it, we work on the level-set scale-space of image, the min tree, to extract curve blobs. We then propose a novel structural scale-space, a hierarchy built on these curve blobs. The deep connected component, i.e. the cluster of curve blobs on this hierarchy, that maximizes the likelihood to be an empty catheter is retained as final segmentation. We evaluate the performance of the algorithm on a database of 1250 fluoroscopic images from 6 patients. As a result, we obtain very good qualitative and quantitative segmentation performance, with mean precision and recall of 80.48 and 63.04% respectively. We develop a novel structural scale-space to segment a structured object, the empty catheter, in challenging situations where the information content is very sparse in the images. Fully-automatic empty catheter segmentation in X-ray fluoroscopic images is an important and preliminary step in PCI procedure modeling, as it aids in tagging the arrival and removal location of other interventional tools.

Clinical application of percutaneous gastrostomy and gastrojejunostomy under fluoroscopic guidance

International Nuclear Information System (INIS)

Zhou Jianping; Wang Zhongmin; Liu Tao; Chen Kemin; Gong Ju; Zheng Yunfeng; Chen Zhijin; Shen Jieyun

2011-01-01

Objective: To evaluate the safety and effectiveness of percutaneous gastrostomy (PRG) and gastrojejunostomy (PRGJ) under fluoroscopic guidance, and to discuss its technical manipulation, the indications and contraindications as well as the complications. Methods: During the period from May 2002 to June 2010 in authors' hospital fluoroscopically-guided PRG or PRGJ was carried out in 40 patients. The clinical data were retrospectively analyzed. With Seldinger technique and under fluoroscopic guidance, a 14 F radiopaque gastrostomy or gastrojejunostomy feeding catheter was successfully placed. The indications, operation procedures, clinical success rate, procedure-related complications, and tube indwelling time, etc. were discussed and analyzed. Results: PRG was conducted in 30 patients. The reasons for performing PRG included neurologic disease (n=13), recurrent aspiration pneumonia (n=6), gastroesophageal reflux due to disfunction of gastrointestinal tract (n=3), subtotal gastrectomy (n=2), esophagomediastinal fistula (n=1) and esophageal carcinoma (n=5). PRGJ was carried out in 10 patients. The disorders included bulbar paralysis (n=3), malignant duodenal obstruction (n=4) and previous gastrostomy-related complications (n=3). Two anchors were used in all patients receiving PRG or PRGJ. Clinical success was achieved in all study patients. No procedure-related or severe complications occurred. Minor complications were observed in four patients (10%), which included local soft tissue infection (n=1), severe puncture site pain (n=1), gastrostomy tube dislodgement (n=1) and obstruction of gastrojejunostomy tube (n=1). During the follow-up period, no aggravation of gastroesophageal reflux or aspiration pneumonia was observed in all patients. The tube indwelling time was 115 to 585 days (mean of 150 days) after tube placement. Conclusion: Fluoroscopically-guided percutaneous gastrostomy or gastrojejunostomy is a safe, simple and minimally-invasive technique. This

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

International Nuclear Information System (INIS)

Martinez, L C; Vano, E; Gutierrez, F; Rodriguez, C; Gilarranz, R; Manzanas, M J

2007-01-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for 2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers

Fluoroscopically guided closed reduction and internal fixation of fractures of the lateral portion of the humeral condyle: prospective clinical study of the technique and results in ten dogs.

Science.gov (United States)

Cook, J L; Tomlinson, J L; Reed, A L

1999-01-01

To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. Prospective clinical case study. Ten dogs with 11 fractures. Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. Postoperative reduction was considered anatomic in 6 fractures with all other fractures having ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.

An assessment of methods for monitoring entrance surface dose in fluoroscopically guided interventional procedures

International Nuclear Information System (INIS)

Waite, J.C.; Fitzgerald, M.

2001-01-01

In the light of a growing awareness of the risks of inducing skin injuries as a consequence of fluoroscopically guided interventional procedures (FGIPs), this paper compares three methods of monitoring entrance surface dose (ESD). It also reports measurements of ESDs made during the period August 1998 to June 1999 on 137 patients undergoing cardiac, neurological and general FGIPs. Although the sample is small, the results reinforce the need for routine assessments to be made of ESDs in FGIPs. At present, the most reliable and accurate form of ESD measurement would seem to be arrays of TLDs. However, transducer based methods, although likely to be less accurate, have considerable advantages in relation to a continuous monitoring programme. It is also suggested that there may be the potential locally for threshold dose area product (DAP) values to be set for specific procedures. These could be used to provide early warning of the potential for skin injuries. (author)

Fluoroscopically guided tunneled trans-caudal epidural catheter technique for opioid-free neonatal epidural analgesia.

Science.gov (United States)

Franklin, Andrew D; Hughes, Elisabeth M

2016-06-01

Epidural analgesia confers significant perioperative advantages to neonates undergoing surgical procedures but may be very technically challenging to place using a standard interlaminar loss-of-resistance to saline technique given the shallow depth of the epidural space. Thoracic epidural catheters placed via the caudal route may reduce the risk of direct neural injury from needle placement, but often pose higher risks of infection and/or improper positioning if placed without radiographic guidance. We present a detailed method of placing a fluoroscopically guided, tunneled transcaudal epidural catheter, which may reduce both of these risks. The accuracy and precision of this technique often provides adequate analgesia to allow for opioid-free epidural infusions as well as significant reductions in systemic opioids through the perioperative period. Opioid-free analgesia using a regional anesthetic technique allows for earlier extubation and reduced perioperative sedation, which may have a less deleterious neurocognitive effect on the developing brain of the neonate.

Transbronchial lung biopsy without fluoroscopic guide in Tehran Imam Khomeini’s Hospital (1999

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"Firoozbakhsh S

2002-08-01

Full Text Available Background: Transbronchial lung biopsy (TBLB is an attractive alternative to open lung biopsy as an initial diagnostic procedure for patients with diffuse parenchymal disease or localized densities beyond direct endoscopic vision. TBLB can be carried out safely without fluoroscopy in patients with diffuse lung disease. Since in our bronchoscopic department fluoroscopy is not available, we planned to evaluate the blind (without fluoroscopic guide TBLB being performed in our department to determine the success rate in obtaining lung tissue, the sensitivity of the procedure and the risk of complications. Materials and Methods: Sixty-Four TBLB were done in our department during a 6 month period (March-September 1999. Results: Lung tissue wasn’t detected in two (3.1 percent samples. Pathological results were helpful in 46 (71.9 percent cases. No evidence of hemoptysis was found after the procedure. Three (4.68 percent cases of pneumothorax was detected. Only one of them required chest tube (1.51 percent. Conclusion: We concluded that blind TBLB was successful in our department with rates of complications comparable to other approved centers.

Registration of angiographic image on real-time fluoroscopic image for image-guided percutaneous coronary intervention.

Science.gov (United States)

Kim, Dongkue; Park, Sangsoo; Jeong, Myung Ho; Ryu, Jeha

2018-02-01

In percutaneous coronary intervention (PCI), cardiologists must study two different X-ray image sources: a fluoroscopic image and an angiogram. Manipulating a guidewire while alternately monitoring the two separate images on separate screens requires a deep understanding of the anatomy of coronary vessels and substantial training. We propose 2D/2D spatiotemporal image registration of the two images in a single image in order to provide cardiologists with enhanced visual guidance in PCI. The proposed 2D/2D spatiotemporal registration method uses a cross-correlation of two ECG series in each image to temporally synchronize two separate images and register an angiographic image onto the fluoroscopic image. A guidewire centerline is then extracted from the fluoroscopic image in real time, and the alignment of the centerline with vessel outlines of the chosen angiographic image is optimized using the iterative closest point algorithm for spatial registration. A proof-of-concept evaluation with a phantom coronary vessel model with engineering students showed an error reduction rate greater than 74% on wrong insertion to nontarget branches compared to the non-registration method and more than 47% reduction in the task completion time in performing guidewire manipulation for very difficult tasks. Evaluation with a small number of experienced doctors shows a potentially significant reduction in both task completion time and error rate for difficult tasks. The total registration time with real procedure X-ray (angiographic and fluoroscopic) images takes [Formula: see text] 60 ms, which is within the fluoroscopic image acquisition rate of 15 Hz. By providing cardiologists with better visual guidance in PCI, the proposed spatiotemporal image registration method is shown to be useful in advancing the guidewire to the coronary vessel branches, especially those difficult to insert into.

Transcervical Sterilization: A Comparison of Essure® Permanent Birth Control System and Adiana® Permanent Contraception System

Science.gov (United States)

Palmer, Sophia N; Greenberg, James A

2009-01-01

Transcervical sterilization has moved female sterilization from a minimally invasive laparoscopic technique, which requires entry into the abdominal cavity, to a less invasive hysteroscopic procedure. Along with the decreased potential for complications, its ease of performance with minimal anesthesia has facilitated a move from the operating room to the office. This review compares the available data on transcervical sterilization procedures to better understand the strengths and weakness of each system. PMID:19609402

Percutaneous ethanol injection under interventional radiographic computed tomography-fluoroscopic guidance for the treatment of small hepatocellular carcinomas

Energy Technology Data Exchange (ETDEWEB)

Furuse, Junji; Satake, Mitsuo; Iwasaki, Masahiko; Sekiguchi, Ryuzo; Moriyama, Noriyuki; Yoshino, Masahiro [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East

1998-04-01

Some small hepatocellular carcinoma (HCC) lesions show as tumor stains by dynamic CT, but cannot be detected by ultrasonography. Percutaneous ethanol injection (PEI) is effective for treating small HCC lesions, but lack of adequate visualization of some lesions can limit its use. In this study, interventional radiographic, CT-fluoroscopically-guided PEI was performed as a new method for treating small HCC lesions that were difficult to detect by ultrasonography. Interventional radiographic, CT-fluoroscopically-guided PEI was performed on 11 patients (12 lesions) with HCC lesions measuring 2 cm or less in diameter. A thin needle was introduced into each tumor under CT-fluoroscopic guidance, with injection of contrast medium into the dominant hepatic artery. While lesions were observed using CT-fluoroscopy with the arteriogram, absolute ethanol was injected into the tumors. The ethanol injection rate and volume were monitored by observation of loss of tumor staining during real-time CT angiography. Needle introduction was successful in all 12 lesions, and disappearance of tumor staining was immediately observed on CT images after ethanol injection. Complications noted after treatment were local abdominal pain in all 11 patients, a slight fever in 9 patients, pneumothorax, right pleural effusion, and ascites, each in 1 patient. No other serious complications were observed. Interventional radiographic, CT-fluoroscopically-guided PEI is effective in the treatment of small HCC lesions, which are difficult to show by ultrasonography and treat by conventional PEI. (author)

Transrectal Drainage of Deep Pelvic Abscesses Using a Combined Transrectal Sonographic and Fluoroscopic Guidance

International Nuclear Information System (INIS)

Jeong, Kyung Soon; Lee, Eun Jung; Ko, Ji Ho; Joh, Young Duk; Jung, Gyoo Sik

2005-01-01

To evaluate the feasibility and clinical efficacy of transrectal drainage of a deep pelvic abscess using combined transrectal sonographic and fluoroscopic guidance. From March 1995 and August 2004, 17 patients (9 men; 8 women; mean age, 39 years) suffering from pelvic pain, fever and leukocytosis were enrolled in this retrospective study. Ultrasound (US) or computed tomography (CT), which was obtained prior to the procedure, showed pelvic fluid collections that were deemed unapproachable by the percutaneous trans abdominal routes. Transrectal drainage of the pelvic abscess was performed under combined transrectal sonographic and fluoroscopic guidance. The causes of the deep pelvic abscess were postoperative complications (n=7), complications associated with radiation (n=3) and chemotherapy (n=1) as well as unknown causes (n=6). A 7.5-MHz end-firing transrectal US probe with a needle biopsy guide attachment was advanced into the rectum. Once the abscess was identified, a needle was advanced via the biopsy guide and the abscess was punctured. Under US guidance, either a 0.018'or 0.035' guide wire was passed through the needle in the abscess. Under fluoroscopic guidance, the tract was dilated to the appropriate diameter with sequential fascial dilators, and a catheter was placed over the guide wire within the abscess. Clinical success of drainage was determined by a combination closure of the cavity on the follow up images and diminished leukocytosis. The technical and clinical success rate, complications, and patient's discomfort were analyzed. Drainage was technically successful in all patients and there were no serious complications. Surgery was eventually performed in two cases due to fistular formation with the rectum and leakage of the anastomosis site. The procedure was well tolerated in all but one patient who complained of discomfort while the catheter was inserted . The catheter did not interfere with defecation and there was no incidence of catheter

Eye lens dosimetry for fluoroscopically guided clinical procedures: practical approaches to protection and dose monitoring

International Nuclear Information System (INIS)

Martin, Colin J.

2016-01-01

Doses to the eye lenses of clinicians undertaking fluoroscopically guided procedures can exceed the dose annual limit of 20 mSv, so optimisation of radiation protection is essential. Ceiling-suspended shields and disposable radiation absorbing pads can reduce eye dose by factors of 2-7. Lead glasses that shield against exposures from the side can lower doses by 2.5-4.5 times. Training in effective use of protective devices is an essential element in achieving good protection and acceptable eye doses. Effective methods for dose monitoring are required to identify protection issues. Dosemeters worn adjacent to the eye provide the better option for interventional clinicians, but an unprotected dosemeter worn at the neck will give an indication of eye dose that is adequate for most interventional staff. Potential requirements for protective devices and dose monitoring can be determined from risk assessments using generic values for dose linked to examination workload. (author)

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

Science.gov (United States)

Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

2007-08-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

Fluoroscopically-guided transnasal insertion of ileus tube intestinal decompression in patients with inoperable malignant bowel obstruction

International Nuclear Information System (INIS)

Fang Shiming; Li Haili; Lin Qing; Mao Aiwu; Wu Shaoqiu; Jiang Haosheng; Cao Yan; Wang Zhenlei

2011-01-01

Objective: To assess the technical feasibility and effectiveness of fluoroscopically-guided transnasal insertion of ileus tube for intestinal decompression in the treatment of inoperable malignant bowel obstruction. Methods: A total of 211 patients with inoperable malignant bowel obstruction were enrolled in this study. The median KPS scale was 40 (ranged from 20 to 60). Under fluoroscopic guidance, transnasal insertion of ileus tube by using conventional technique or guidewire-catheter exchange technique was performed in all patients. The technical success rate, the clinical effective rate, the curative rate and adverse reactions as well as complications were documented. The correlation among the obstructive sites, obstruction causes and therapeutic effectiveness was analyzed. The ileus tube used in this study was a four-cavity and double-balloon catheter with a diameter of 16 F/18 f, which is produced by Cliny Company. Results: Transnasal drainage tube was successfully inserted into the proximal jejunum in all 211 patients with malignant bowel obstruction, and the total technical success rate was 100%. The initial technical success rate of the traditional technique and the catheter-guidewire exchange method was 85.5% (65/76) and 100% (135/135) respectively, the difference between the two was significant (P<0.05). After 24 hours, the clinical remission rate in the patients with high-level intestinal obstruction, lower-level intestinal obstruction and colorectal obstruction was 95.8% (46/48), 92.9% (117/126) and 83.8% (31/37), respectively. A follow-up of 4-245 days (mean 138 days) was conducted, and the total clinical cure rate was 27.5% (58/211). The clinical cure rate in small intestine obstruction and colorectal obstruction caused by primary tumor or recurrence was 12.7% (20/157) and 59.5% (22/37), respectively (P<0.05). The adverse reactions and complications included uncomfortable pharynx feeling or pain (99.1%, 199/221), the tube obstruction (23.2%, 49

Comparing the Efficacy and Side Effects of Trans-Cervical Catheter and Vaginal Misoprostol on Cervical Ripening

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F. Mallah

2016-08-01

Full Text Available Background: The success of labor induction is extremely dependent on the state of the cervix. There are various methods available in modern obstetrics practice for ripening the cervix, such as intravaginal prostaglandins and mechanical devices like transcervical catheters. Although plenty of studies have already compared the two methods for the unripened cervices, more studies are warranted in nulliparous patients only. This study aimed to compare the efficacy of intravaginal misoprostol tablets with transcervical Foley catheter for cervical ripening in nulliparous patients. Methods & Materials: In this randomized clinical trial, 120 nulliparous candidates for labor induction were recruited from two teaching centers in Tabriz within a 17-month period of time. All the enrolled cases had a live singleton fetus with cephalic presentation at term (≥37 weeks, on-admission Bishop Score≤4, intact membranes and reactive non-stress test results. They were randomly assigned to two equal age-matched groups receiving either intravaginal misoprostol (25 microgram, n=59, or transcervical insertion of 16F Foley catheter (n=60. Results: One time successful induction (i.e. successful induction after a single insertion of misoprostol, or expulsion of transcervical Foley catheter within 12 h of insertion was achieved in all the patients without employment of other methods such as use of syntocinon. Misoprostol was more effective in terms of induction-to-cervical ripening interval (15.16±3.59 h vs. 18.30±1.59 h; p<0.001. Tachysystole, on the other hand, was significantly more frequent in the misoprostol receivers (25.4% vs. 0%; p<0.001. The two groups were comparable for the rate of cesarean section (misoprostol, 37.3%; Folly catheter, 30%; p=0.40. Comparing the two groups, there was no significant difference with regard to change in Bishop Score (misoprostol, 1.90±0.54 h-1; Folly catheter, 1.89±0.74 h-1; p=0.95 and miscellaneous pregnancy-related and fetal

Fluoroscopic digital radiography

International Nuclear Information System (INIS)

Hynes, D.M.; Rowlands, J.A.; Edmonds, E.W.; Porter, A.J.; Toth, B.D.

1987-01-01

The authors have been working with three different developmental systems, exploring the clinical benefits of digital recording of the fluoroscopic image. This educational exhibit describes the components of such systems and emphasizes the strengths and weaknesses of each. Specific technical reference is made to the image intensifier, TV camera, 1,024/sup 2/ image store, hard copy devices, and the mechanics of operation in the general fluoroscopic environment. All observations indicate that the problems of resolution, motion blur, noise, field size, and dose can be solved. The findings are supported by clinical examples

Cryo-balloon catheter localization in fluoroscopic images

Science.gov (United States)

Kurzendorfer, Tanja; Brost, Alexander; Jakob, Carolin; Mewes, Philip W.; Bourier, Felix; Koch, Martin; Kurzidim, Klaus; Hornegger, Joachim; Strobel, Norbert

2013-03-01

Minimally invasive catheter ablation has become the preferred treatment option for atrial fibrillation. Although the standard ablation procedure involves ablation points set by radio-frequency catheters, cryo-balloon catheters have even been reported to be more advantageous in certain cases. As electro-anatomical mapping systems do not support cryo-balloon ablation procedures, X-ray guidance is needed. However, current methods to provide support for cryo-balloon catheters in fluoroscopically guided ablation procedures rely heavily on manual user interaction. To improve this, we propose a first method for automatic cryo-balloon catheter localization in fluoroscopic images based on a blob detection algorithm. Our method is evaluated on 24 clinical images from 17 patients. The method successfully detected the cryoballoon in 22 out of 24 images, yielding a success rate of 91.6 %. The successful localization achieved an accuracy of 1.00 mm +/- 0.44 mm. Even though our methods currently fails in 8.4 % of the images available, it still offers a significant improvement over manual methods. Furthermore, detecting a landmark point along the cryo-balloon catheter can be a very important step for additional post-processing operations.

Role of intrapartum transcervical amnioinfusion in patients with meconium-stained amniotic fluid.

Science.gov (United States)

Bhatia, Pushpa; Reena, Kumari; Nangia, Sangita

2013-03-01

The study was undertaken to evaluate maternal, perinatal outcomes following transcervical intrapartum amnioinfusion in women with meconium-stained amniotic fluid. A prospective comparative study was conducted on 100 women with meconium-stained amniotic fluid in labor. Group A: study group (50 cases) received amnioinfusion. Group B: control group (50 cases) did not receive amnioinfusion. FHR monitoring was done using cardiotocography. Significant relief from variable decelerations was seen in 68.18 % cases in the amnioinfusion group as compared to 7.1 % cases in the control group. 78 % cases who were given amnioinfusion had vaginal delivery as compared to 18 % cases in the control group. Fourteen percent cases in the study group had cesarean delivery as compared to 68 % cases in the control group. Meconium aspiration syndrome was seen in six percent neonates in the study group as compared to 20 % in the control group. Two neonates died in the control group due to meconium aspiration syndrome. There was no maternal mortality or major maternal complication. Intrapartum transcervical amnioinfusion is valuable in patients with meconium-stained amniotic fluid.

Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections

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Huang, Ambrose J.; Torriani, Martin; Bredella, Miriam A.; Chang, Connie Y.; Simeone, Frank J.; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Balza, Rene [Centro Medico de Occidente, Department of Radiology, Maracaibo (Venezuela, Bolivarian Republic of)

2016-03-15

To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m{sup 2}) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m{sup 2} versus 13.5 ± 17.3 μGy-m{sup 2}, P = 0.006). Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient. (orig.)

Patient and staff doses and relationships between them in fluoroscopically guided procedures

International Nuclear Information System (INIS)

Avramova-Cholakova, S.; Christova-Popova, Y.; Sagorska, A.

2015-01-01

Full text: Medical exposure has the main contribution to man-made sources of exposures to the population in developed countries. Fluoroscopically guided procedures in interventional cardiology, gastroenterology, urology, orthopaedics and others may be related to high doses to both patients and staff. The main risk for both groups is the radiation carcinogenesis and it is increasing with dose. However deterministic effects are also possible: severe patient skin injuries occur sometimes. There are such cases in Bulgarian radiological practice. For the medical staff, involved in the procedures, radiation induced cataract is observed occasionally. Learning objective: In many cases there is direct correlation between patient and staff doses. Several simple rules must be observed in order to decrease exposure. Rules related to patient: Patient dose (dose-area product (DAP), fluoroscopy time, number of series,number of images) should be recorded for every patient; The patient should be positioned as far away as possible from the x-ray tube and as closer as possible to the image intensifier/digital image receptor; Fluoroscopy time should be minimized; Pulsed fluoroscopy with the lowest dose rate and the lowest frame rate providing acceptable image quality should be used; Different skin areas should be exposed in different projections; Oblique projections increase the dose - they should be avoided; Magnification also increases the dose several times and should be avoided; The acquisition mode should be avoided; it delivers dozens of times higher doses. Minimal number of frames and cine runs should be used. Use of “last image hold” is encouraged; The x-ray beam should be collimated to the area of interest. Rules related to staff: The staff receives scattered radiation from patient’s body. Every measure to decrease patient’s dose decreases staff dose as well; Every available protective device should be used (lead apron, thyroid collar, lead glasses, screens). They

Palliation of malignant gastric obstruction : fluoroscopic guided covered metallic stent placement

International Nuclear Information System (INIS)

Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Lee, Sang Yong; Choi, Ki Chul; Lee, Soo Tak; Han, Hyun Young

2000-01-01

To demonstrate the feasibility and clinical efficacy of self-expanding, covered metallic stent placement for the palliative treatment of malignant gastric obstruction. Under fluoroscopic guidance, the placement of self-expanding, covered stents was attempted in 23 patients (age range, 31-78 years) with inoperable or recurrent gastric malignancies. All 23 suffered dysphagia and/or vomiting after the ingestion of soft foods, or swallowing difficulty. Three different types of self-expanding, covered metallic stents were used and in all patients, these were placed perorally using over the guide wire technique. Success was defined both technically and clinically. Stent placement was technically successful in 19 patients (82.6%) but because the guidewire failed to successfully negotiate the sites at which there was obstruction, was unsuccessful in four (17.4%). Stent placement was well tolerated in all patients except one, in whom an acutely angled efferent loop from remnant stomach was present. In this case, stent placement required a strong metallic guidewire. After placement, 17 of the 19 patients (89.5%) were able to ingest solid and/or soft foods without dysphagia and showed a markedly decreased incidence of vomiting. Two others showed some improvement in the frequency of vomiting but were able to ingest only a liquid diet. In one patient, the stent migrated two days after the procedure. During the follow-up period of 2-7 months (mean, 74 days), there were no clinically significant complications. For the short-term palliative treatment of patients with gastric inlet or outlet obstruction, the placement of self-expanding metallic stents has proven relatively easy and safe, as well as reasonably effective. (author)

Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

Science.gov (United States)

ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

2018-01-01

A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

Evaluation of the UF/NCI hybrid computational phantoms for use in organ dosimetry of pediatric patients undergoing fluoroscopically guided cardiac procedures

Science.gov (United States)

Marshall, Emily L.; Borrego, David; Tran, Trung; Fudge, James C.; Bolch, Wesley E.

2018-03-01

Epidemiologic data demonstrate that pediatric patients face a higher relative risk of radiation induced cancers than their adult counterparts at equivalent exposures. Infants and children with congenital heart defects are a critical patient population exposed to ionizing radiation during life-saving procedures. These patients will likely incur numerous procedures throughout their lifespan, each time increasing their cumulative radiation absorbed dose. As continued improvements in long-term prognosis of congenital heart defect patients is achieved, a better understanding of organ radiation dose following treatment becomes increasingly vital. Dosimetry of these patients can be accomplished using Monte Carlo radiation transport simulations, coupled with modern anatomical patient models. The aim of this study was to evaluate the performance of the University of Florida/National Cancer Institute (UF/NCI) pediatric hybrid computational phantom library for organ dose assessment of patients that have undergone fluoroscopically guided cardiac catheterizations. In this study, two types of simulations were modeled. A dose assessment was performed on 29 patient-specific voxel phantoms (taken as representing the patient’s true anatomy), height/weight-matched hybrid library phantoms, and age-matched reference phantoms. Two exposure studies were conducted for each phantom type. First, a parametric study was constructed by the attending pediatric interventional cardiologist at the University of Florida to model the range of parameters seen clinically. Second, four clinical cardiac procedures were simulated based upon internal logfiles captured by a Toshiba Infinix-i Cardiac Bi-Plane fluoroscopic unit. Performance of the phantom library was quantified by computing both the percent difference in individual organ doses, as well as the organ dose root mean square values for overall phantom assessment between the matched phantoms (UF/NCI library or reference) and the patient

Patient radiation dose audits for fluoroscopically guided interventional procedures

International Nuclear Information System (INIS)

Balter, Stephen; Rosenstein, Marvin; Miller, Donald L.; Schueler, Beth; Spelic, David

2011-01-01

Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K a,r ) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K a,r exceeds the 75th percentile of the ADS and (2) when the percent of instances where K a,r exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and of the

Fluoroscopic-guided primary single-step percutaneous gastrostomy. Initial results using the Freka {sup registered} GastroTube; Primaere einzeitige durchleuchtungsgesteuerte perkutane Gastrostomie (PG). Erste Ergebnisse mit dem Freka {sup registered} GastroTube

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Hahne, J.D.; Schoennagel, B.P.; Arndt, C.; Bannas, P.; Koops, A.; Adam, G.; Habermann, C.R. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Herrmann, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Zentrum fuer Radiologie; Universitaetsklinikum Hamburg-Eppendorf (Germany). Abt. Paediatrische Radiologie

2011-07-15

Purpose: To determine the practicability and outcome of fluoroscopic-guided primary one-step treatment of percutaneous gastrostomy (PG) with the system Freka {sup registered} Gastro Tube (Fresenius Kabi, Germany). Materials and Methods: In 39 patients (mean age 62.7 {+-} 12.0 years), primary PG was performed based on clinical indication from August 2009 to April 2010. The intervention was performed by an experienced radiologist under aseptic conditions by direct puncture with Freka {sup registered} Gastro Tube under fluoroscopic guidance. The clinical data and outcome as well as any complications originated from the electronic archive of the University Medical Center Hamburg-Eppendorf. Results: The intervention was technically successful in all 39 patients. Within the mean follow-up time of 155.3 {+-} 73.6 days, 29 patients (74.4 %) did not experience complications. 10 patients (25.6 %) had to be revised. Complications manifested after a mean of 135.6 {+-} 61.2 days and mainly corresponded to accidental dislocation (50 %). One patient had to be surgically revised under suspicion of a malpositioned tube and suspected intestinal perforation. Clinically relevant wound infections were not detected. The total costs per patient were 553.17 Euro for our single-step treatment (OPS 5 - 431.x) vs. 963.69 Euro (OPS 5 - 431.x and OPS 8 - 123.0) for the recommended two-step treatment. Conclusion: Fluoroscopic-guided primary single-step treatment with Freka {sup registered} Gastro Tube system is feasible and not associated with an increased complication rate when compared to published literature applying a two-step treatment approach. Material costs as well as human and time resources could be significantly reduced using the single-step treatment. (orig.)

Echocardiographic and Fluoroscopic Fusion Imaging for Procedural Guidance: An Overview and Early Clinical Experience.

Science.gov (United States)

Thaden, Jeremy J; Sanon, Saurabh; Geske, Jeffrey B; Eleid, Mackram F; Nijhof, Niels; Malouf, Joseph F; Rihal, Charanjit S; Bruce, Charles J

2016-06-01

There has been significant growth in the volume and complexity of percutaneous structural heart procedures in the past decade. Increasing procedural complexity and accompanying reliance on multimodality imaging have fueled the development of fusion imaging to facilitate procedural guidance. The first clinically available system capable of echocardiographic and fluoroscopic fusion for real-time guidance of structural heart procedures was approved by the US Food and Drug Administration in 2012. Echocardiographic-fluoroscopic fusion imaging combines the precise catheter and device visualization of fluoroscopy with the soft tissue anatomy and color flow Doppler information afforded by echocardiography in a single image. This allows the interventionalist to perform precise catheter manipulations under fluoroscopy guidance while visualizing critical tissue anatomy provided by echocardiography. However, there are few data available addressing this technology's strengths and limitations in routine clinical practice. The authors provide a critical review of currently available echocardiographic-fluoroscopic fusion imaging for guidance of structural heart interventions to highlight its strengths, limitations, and potential clinical applications and to guide further research into value of this emerging technology. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

Exposition of the operator's eye lens and efficacy of radiation shielding in fluoroscopically guided interventions

International Nuclear Information System (INIS)

Galster, M.; Adamus, R.; Guhl, C.; Uder, M.

2013-01-01

Purpose: Efficacy of radiation protection tools for the eye lens dose of the radiologist in fluoroscopic interventions. Materials and Methods: A patient phantom was exposed using a fluoroscopic system. Dose measurements were made at the eye location of the radiologist using an ionization chamber. The setting followed typical fluoroscopic interventions. The reduction of scattered radiation by the equipment-mounted shielding (undercouch drapes and overcouch top) was evaluated. The ceiling-suspended lead acrylic glass screen was tested in scattered radiation generated by a slab phantom. The protective properties of different lead glass goggles and lead acrylic visors were evaluated by thermoluminescence measurements on a head phantom in the primary beam. Results: The exposition of the lens of about 110 to 550 μSv during radiologic interventions is only slightly reduced by the undercouch drapes. Applying the top in addition to the drapes reduces the lens dose by a factor of 2 for PA projections. In 25 LAO the dose is reduced by a factor between 1.2 and 5. The highest doses were measured for AP angulations furthermore the efficacy of the equipment-mounted shielding is minimal. The ceiling-suspended lead screen reduced scatter by a factor of about 30. The lead glass goggles and visors reduced the lens dose up to a factor of 8 to 10. Depending on the specific design, the tested models are less effective especially for radiation from lateral with cranial angulation of the beam. Occasionally the visors even caused an increase of dose. Conclusion: The exposition of the eye lens can be kept below the new occupational limit recommended by the ICRP if the radiation shielding equipment is used consistently. (orig.)

Fluoroscopic guidance of retrograde exchange of ureteral stents in women.

Science.gov (United States)

Chang, Ruey-Sheng; Liang, Huei-Lung; Huang, Jer-Shyung; Wang, Po-Chin; Chen, Matt Chiung-Yu; Lai, Ping-Hong; Pan, Huay-Ben

2008-06-01

The purpose of this study was to review our experience with fluoroscopically guided retrograde exchange of ureteral stents in women. During a 48-month period, 28 women (age range, 38-76 years) were referred to our department for retrograde exchange of a ureteral stent. The causes of urinary obstruction were tumor compression in 26 patients and benign fibrotic stricture in two patients. A large-diameter snare catheter (25-mm single loop or 18- to 35-mm triple loop) or a foreign body retrieval forceps (opening width, 11.3 mm) was used to grasp the bladder end of the stent under fluoroscopic guidance. The technique entailed replacement of a patent or occluded ureteral stent with a 0.035- or 0.018-inch guidewire with or without the aid of advancement of an angiographic sheath. A total of 54 ureteral stents were exchanged with a snare catheter in 42 cases or a forceps in 12 cases. One stent misplaced too far up the ureter was replaced successfully through antegrade percutaneous nephrostomy. Ten occluded stents, including one single-J stent, were managed with a 0.018-inch guidewire in three cases, advancement of an angiographic sheath over the occluded stent into the ureter in five cases, and recannulation of the ureteral orifice with a guidewire in two cases. No complications of massive hemorrhage, ureter perforation, or infection were encountered. With proper selection of a snare or forceps catheter, retrograde exchange of ureteral stents in women can be easily performed under fluoroscopic guidance with high technical success and a low complication rate.

[Exposition of the operator's eye lens and efficacy of radiation shielding in fluoroscopically guided interventions].

Science.gov (United States)

Galster, M; Guhl, C; Uder, M; Adamus, R

2013-05-01

Efficacy of radiation protection tools for the eye lens dose of the radiologist in fluoroscopic interventions. A patient phantom was exposed using a fluoroscopic system. Dose measurements were made at the eye location of the radiologist using an ionization chamber. The setting followed typical fluoroscopic interventions. The reduction of scattered radiation by the equipment-mounted shielding (undercouch drapes and overcouch top) was evaluated. The ceiling-suspended lead acrylic glass screen was tested in scattered radiation generated by a slab phantom. The protective properties of different lead glass goggles and lead acrylic visors were evaluated by thermoluminescence measurements on a head phantom in the primary beam. The exposition of the lens of about 110 to 550 μSv during radiologic interventions is only slightly reduced by the undercouch drapes. Applying the top in addition to the drapes reduces the lens dose by a factor of 2 for PA projections. In 25°LAO the dose is reduced by a factor between 1.2 and 5. The highest doses were measured for AP angulations furthermore the efficacy of the equipment-mounted shielding is minimal. The ceiling-suspended lead screen reduced scatter by a factor of about 30. The lead glass goggles and visors reduced the lens dose up to a factor of 8 to 10. Depending on the specific design, the tested models are less effective especially for radiation from lateral with cranial angulation of the beam. Occasionally the visors even caused an increase of dose. The exposition of the eye lens can be kept below the new occupational limit recommended by the ICRP if the radiation shielding equipment is used consistently. © Georg Thieme Verlag KG Stuttgart · New York.

21 CFR 892.1650 - Image-intensified fluoroscopic x-ray system.

Science.gov (United States)

2010-04-01

... fluoroscopic x-ray system. (a) Identification. An image-intensified fluoroscopic x-ray system is a device... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Image-intensified fluoroscopic x-ray system. 892... equipment, patient and equipment supports, component parts, and accessories. (b) Classification. Class II...

Comparing radiation exposure during percutaneous vertebroplasty using one- vs. two-fluoroscopic technique

Directory of Open Access Journals (Sweden)

Li Yen-Yao

2013-01-01

Full Text Available Abstract Background Percutaneous vertebroplasty (PV requires relatively lengthy fluoroscopic guidance, which might lead to substantial radiation exposure to patients or operators. The two-fluoroscopic technique (two-plane radiographs obtained using two fluoroscopes during PV can provide simultaneous two-planar projections with reducing operative time. However, the two-fluoroscopic technique may expose the operator or patient to increased radiation dose. The aim of this study was to quantify the amount of radiation exposure to the patient or operator that occurs during PV using one- vs. two-fluoroscopic technique. Methods Two radiation dosimeters were placed on the right flank of each patient and on the upper sternum of each operator during 26 single-level PV procedures by one senior surgeon. The use of two-fluoroscopic technique (13 patients and one-fluoroscopic technique (13 patients were allocated in a consecutive and alternative manner. The operative time and mean radiation dose to each patient and operator were monitored and compared between groups. Results Mean radiation dose to the patient was 1.97 ± 1.20 mSv (95% CI, 0.71 to 3.23 for the one-fluoroscopic technique group vs. 0.95 ± 0.34 mSv (95% CI, 0.85 to 1.23 for the two-fluoroscopic technique group (P =0.031. Mean radiation dose to the operator was 0.27 ± 0.12 mSv (95% CI, 0.17–0.56 for the one-fluoroscopic technique group vs. 0.25 ± 0.14 mSv (95% CI, 0.06–0.44 for the two-fluoroscopic technique group (P = 0.653. The operative time was significantly different between groups: 47.15 ± 13.48 min (range, 20–75 for the one-fluoroscopic technique group vs. 36.62 ± 8.42 min (range, 21–50 for the two-fluoroscopic technique group (P =0.019. Conclusion Compared to the one-fluoroscopic technique, the two-fluoroscopic technique used during PV provides not only shorter operative times but also reduces the radiation exposure to the patient. There was no

Fluoroscopically-Guided Posterior Approach for Shoulder Magnetic Resonance Arthrography: Comparison with Conventional Anterior Approach

International Nuclear Information System (INIS)

Yoo, Koun J.; Ha, Doo Hoe; Lee, Sang Min

2011-01-01

To prospectively evaluate the usefulness of the fluoroscopically-guided posterior approach compared with the anterior approach for shoulder magnetic resonance(MR) arthrography. Institutional review board approval and informed consent were obtained. Among 60 shoulder MR arthrographies performed on 59 patients with symptomatic shoulders, an intra-articular injection was performed (30 cases using the anterior approach and 30 using the posterior approach). Procedure-related pain was assessed by using a 5 score visual analogue scale (VAS). Depth of the puncture and standardized depth of puncture by body mass index (BMI) were recorded. The contrast leakage along the course of the puncture was evaluated by reviewing the MR. The statistical analyses included the Mann-Whitney U and Kruskal-Wallis test. There was no significant difference in VAS scores between the anterior and posterior groups (1.77 ± 1.10 vs. 1.80 ± 0.96). Depth of puncture and standardized depth of puncture by BMI were significantly shorter in the posterior group than those in the anterior group (4.4 ± 0.8 cm and 1.8 ± 0.3 cm vs. 6.6 ± 0.9 cm and 2.8 ± 0.4 cm, p < 0.001), respectively. The incidence of contrast leakage was more frequent in the posterior group (p = 0.003). The posterior approach will be useful in shoulder MR arthrography with a suspected anterior pathology, a postoperative follow-up study or obese patient.

ROLE OF TRANSCERVICAL AMNIOINFUSION IN LABOUR COMPLICATED WITH THICK MECONIUM STAINED LIQUOR

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Anuragamayi

2015-10-01

Full Text Available OBJECTIVE: This is to evaluate the effectiveness of amnio infusion in cases of thick and particulate meconium stained liquor to reduce the incidence of fetal distress and meconium aspiration syndrome in neonates and compare neonatal outcome with control group . METHODS: A prospective comparative case control study was conducted in the Department of Obstetrics and gynecology, Government General Hospital, Kakinada. A total of 100 cases of labour complicated with thick meconium stained liquor were studied of which in 50 cases Transcervical Amnioinfusion was given and remaining 50 cases without amnioinfusion were taken as controls. The statistical analysis of neonatal outcome was done by Chi square test analysis of variance and paired t test. Liquor to reduce the incidence of fetal distress and meconium aspiration syndrome in neonates and compare neonatal. RESULTS: Operative interventions for fetal distress were significantly less in infusion group (p7 were observed in more cases of infusion group with significant difference in control group. Use of resuscitative measures for neonates were relatively more in control group with higher incidence of meconium at and below vocal cords (p <0.01. In amnioinfusion group, admissions in NICU were less (p <0.01 CONCLUSION : Transcervical amnioinfusion during labour is a safe, simple, inexpensive and effective procedure in improving the obstetric and perinatal outcome in patients labouring with thick meconium stained liquor

Occupational exposures during abdominal fluoroscopically guided interventional procedures for different patient sizes - A Monte Carlo approach.

Science.gov (United States)

Santos, William S; Belinato, Walmir; Perini, Ana P; Caldas, Linda V E; Galeano, Diego C; Santos, Carla J; Neves, Lucio P

2018-01-01

In this study we evaluated the occupational exposures during an abdominal fluoroscopically guided interventional radiology procedure. We investigated the relation between the Body Mass Index (BMI), of the patient, and the conversion coefficient values (CC) for a set of dosimetric quantities, used to assess the exposure risks of medical radiation workers. The study was performed using a set of male and female virtual anthropomorphic phantoms, of different body weights and sizes. In addition to these phantoms, a female and a male phantom, named FASH3 and MASH3 (reference virtual anthropomorphic phantoms), were also used to represent the medical radiation workers. The CC values, obtained as a function of the dose area product, were calculated for 87 exposure scenarios. In each exposure scenario, three phantoms, implemented in the MCNPX 2.7.0 code, were simultaneously used. These phantoms were utilized to represent a patient and medical radiation workers. The results showed that increasing the BMI of the patient, adjusted for each patient protocol, the CC values for medical radiation workers decrease. It is important to note that these results were obtained with fixed exposure parameters. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study.

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Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-11

Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.

21 CFR 892.1660 - Non-image-intensified fluoroscopic x-ray system.

Science.gov (United States)

2010-04-01

... fluoroscopic x-ray system. (a) Identification. A non-image-intensified fluoroscopic x-ray system is a device... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Non-image-intensified fluoroscopic x-ray system... display equipment, patient and equipment supports, component parts, and accessories. (b) Classification...

The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method

International Nuclear Information System (INIS)

Bender, Greg N.; Mullins, Daniel J.; Makuch, Richard S.

1999-01-01

Purpose: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. Materials and methods: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. Results: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89% whereas the sensitivity of greater curvature biopsy is 62%. The difference is considered clinically significant at P≤0.05. Conclusions: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy

The need for using fluoroscopic guidance to obtain gastric biopsies when in search of Helicobacter pylori with a nonendoscopic method

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Bender, Greg N.; Mullins, Daniel J.; Makuch, Richard S

1999-12-01

Purpose: Nonendoscopic, fluoroscopic biopsy of the gastric mucosa, following barium examination of the stomach, has gained attention with its ease of performance and cost savings potential over endoscopy. Endoscopic research concerning the efficacy of biopsy sites has revealed an increased sensitivity of antral biopsies over greater curvature biopsies for the detection of Helicobacter pylori. Fluoroscopically guided biopsies of the gastric mucosal are studied to determine whether such a difference between site sensitivity held true. If not, blind biopsy through a nasogastric tube, which traditionally samples only the greater curvature, might prove an even less expensive alternative. Materials and methods: Seventy-two patients underwent nonendoscopic, fluoroscopically guided, mucosal biopsy of both the gastric antrum and the greater curvature of the stomach. Pathologic reports from both sites, using each patient as their own control, are compared to assess site sensitivity in the diagnosis of H. pylori gastritis. Results: The sensitivity for the detection of H. pylori gastritis by antral biopsy is 89% whereas the sensitivity of greater curvature biopsy is 62%. The difference is considered clinically significant at P{<=}0.05. Conclusions: This study confirms the need for antral biopsies when desiring a nonendoscopic approach to gastric mucosal sampling, in order to obtain a reasonable yield of data in dyspeptic patients with H. pylori gastritis. Blind techniques cannot reliably reach the antrum. Fluoroscopy can, and remains a less expensive alternative to endoscopy.

Technique of the transcervical-subxiphoid-videothoracoscopic maximal thymectomy

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Zielinski Marcin

2007-01-01

Full Text Available Background: The aim of this study is to present the new technique of transcervical-subxiphoid-videothoracoscopic "maximal"thymectomy introduced by the authors of this study for myasthenia gravis. Materials and Methods: Two hundred and sixteen patients with Osserman scores ranging from I-III were operated on from 1/9/2000 to 31/12/2006 for this study. The operation was performed through four incisions: a transverse 5-8 cm incision in the neck, a 4-6 cm subxiphoid incision and two 1 cm incisions for videothoracoscopic (VTS ports. The cervical part of the procedure was performed with an open technique while the intrathoracic part was performed using a video-assisted thoracoscopic surgical (VATS technique. The whole thymus with the surrounding fatty tissue containing possible ectopic foci of the thymic tissue was removed. Such an operation can be performed by one surgical team (the one team approach or by two teams working simultaneously (two team approach. The early and late results as well as the incidence and localization of ectopic thymic foci have been presented in this report. Results: There were 216 patients in this study of which 178 were women and 38 were men. The ages of the patients ranged from 11 to 69 years (mean 29.7 years. The duration of myasthenia was 2-180 months (mean 28.3 months. Osserman scores were in the range of I-III. Almost 27% of the patients were taking steroids or immunosuppressive drugs preoperatively. The mean operative time was 201.5 min (120-330 min for a one-team approach and it was 146 (95-210 min for a two-team approach (P < 0.05. While there was no postoperative mortality, the postoperative morbidity was 12%. The incidence of ectopic thymic foci was 68.4%. The rates of complete remission after one, two, three, four and five years of follow-up were 26.3, 36.5, 42.9, 46.8 and 50.2%, respectively. Conclusion: Transcervical-subxiphoid-VTS maximal thymectomy is a complete and highly effective treatment modality for

Transcervical intrapartum amnioinfusion for preterm premature rupture of the membranes.

Science.gov (United States)

Puertas, Alberto; Tirado, Pilar; Pérez, Isabel; López, María S; Montoya, Francisco; Cañizares, José M; Miranda, José A

2007-03-01

To investigate the effect of transcervical amnioinfusion on the management of labour and neonatal outcomes in preterm premature rupture of the membranes. This clinical trial included 86 patients with premature rupture of the membranes between weeks 27 and 35 of gestation. Patients were randomly assigned to receive amnioinfusion via a two-way catheter or to the control group. Clinical management was otherwise the same in both groups. Amnioinfusion decreased the frequency of variable decelerations in fetal heart rate (27.9% versus 53.5%, pamnioinfusion for preterm premature rupture of the membranes reduced the number of interventions needed because of nonreassuring fetal status, and improved neonatal gasometric values without increasing maternal or fetal morbidity.

Ultrasound-guided intraarticular injection for MR arthrography of the shoulder

International Nuclear Information System (INIS)

Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K.

2010-01-01

Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

Laparoscopic supracervical hysterectomy with transcervical morcellation: our experience.

Science.gov (United States)

Graziano, Angela; Lo Monte, Giuseppe; Hanni, Herbert; Brugger, Johann Georg; Engl, Bruno; Marci, Roberto

2015-02-01

To present our experience with laparoscopic supracervical hysterectomy with transcervical morcellation (LSH-TM). A retrospective observational study (Canadian Task Force Classification III). Gynecologic Department at Brunico Hospital, Brunico, Italy. Three hundred sixty-five patients affected by gynecologic benign diseases who underwent LSH-TM. A minimally invasive surgical technique for supracervical hysterectomy that involves extraction of the morcellated uterus through the cervical canal. We performed LSH-TM successfully in 365 patients; the mean (standard deviation) operating time was 72.24 (23.21) minutes. We registered no intraoperative complications. The main postoperative complications resulted in 2 cases of second-look laparoscopy because of internal bleeding, 5 cases of asymptomatic hematoma around the cervical stump, and 7 cases of pelvic pain. Our experience shows that LSH-TM is a safe and easy to perform technique and that it ensures minimal blood loss. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

International Nuclear Information System (INIS)

Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W.; Jhangri, G.S.

2006-01-01

Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (±15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation

Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

Energy Technology Data Exchange (ETDEWEB)

Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton (Canada); Jhangri, G.S. [Department of Public Health Sciences, University of Alberta Hospital, Edmonton (Canada)

2006-11-15

Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 ({+-}15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation.

Patient and staff doses in fluoroscopically guided invasive diagnostic and interventional urology procedures

International Nuclear Information System (INIS)

Ivanova, D.; Hristova-Popova, J.; Avramova-Cholakova, S.; Deyanova, Ts.; Dobrikov, R.

2015-01-01

Full text: The aim of this study is to evaluate patient and staff doses in fluoroscopically guided invasive diagnostic and interventional urology procedures. All the data were collected in the Emergency Hospital 'N. I. Pirogov'. While recording data for the patients, a real time dosimetry measurement of the medical staff was made. Air kerma-area product (KAP) was recorded for intravenous pyelogram (IVP), percutaneous nephrostomy (PN) and ureteral 'double-J' stenting. Patient data sex, age and weight were also taken. Staff doses were estimated with the system RaySafe i2. It contains four dosimeters, with a wireless connection to a real time display. The dosimeters were worn on the unprotected upper part of the body and measured the personal dose equivalent Hp(10). The mean KAP values for the procedures are: 3.21 Gy.cm 2 for IVP, 10.37 Gy.cm 2 for PN and 4.15 Gy.cm 2 for 'double-J' respectively. The highest staff dose for PN and 'double-J' is received by the urologist (160 μSv and 47.3 μSv, respectively), while for the IVP the radiographer has the highest exposure (20 μSv). Each member of the medical staff was on a different position in respect to the X-ray tube and the patient, which is the main reason for the differences in the staff doses. The variations in the mean patient and staff doses are mostly due to the interventions themselves, their complexity and the individual treatment of every patient. RaySafe i2 is very useful as guideline for making a choice of a better position and in the decreasing of radiation exposure to the staff

Quality assurance in diagnostic radiology - assessing the fluoroscopic image quality

International Nuclear Information System (INIS)

Tabakov, S.

1995-01-01

The X-ray fluoroscopic image has a considerably lower resolution than the radiographic one. This requires a careful quality control aiming at optimal use of the fluoroscopic equipment. The basic procedures for image quality assessment of Image Intensifier/TV image are described. Test objects from Leeds University (UK) are used as prototypes. The results from examining 50 various fluoroscopic devices are shown. Their limiting spatial resolution varies between 0.8 lp/mm (at maximum II field size) and 2.24 lp/mm (at minimum field size). The mean value of the limiting spatial resolution for a 23 cm Image Intensifier is about 1.24 lp/mm. The mean limits of variation of the contrast/detail diagram for various fluoroscopic equipment are graphically expressed. 14 refs., 1 fig. (author)

Transcervical double-balloon catheter as an alternative and salvage method for medical termination of pregnancy in midtrimester

Directory of Open Access Journals (Sweden)

Yi-An Tu

2017-02-01

Conclusion: There was no significant additional benefit of using a double-balloon catheter in midtrimester termination of pregnancy, although the technique was considered simple and generally well-tolerated. Placing a transcervical double-balloon catheter could be the primary method, or one of the alternative medical methods if the patient and/or obstetrician prefers no operation.

The role of transcervical thymectomy in patients with hyperparathyroidism.

Science.gov (United States)

Welch, Kellen; McHenry, Christopher R

2012-03-01

The most common location for supernumerary or ectopic parathyroid glands is the thymus. A review of patients who underwent parathyroidectomy for hyperparathyroidism from 1990 to 2010 was completed to determine indications for thymectomy, the yield of parathyroid tissue, and outcome of therapy. Seventy of 379 patients with hyperparathyroidism underwent parathyroidectomy and transcervical thymectomy. Intrathymic parathyroid tissue was present in 23 (33%) patients, including supernumerary glands in 8 patients (11%). Indications for thymectomy were renal hyperparathyroidism in 35 patients (50%) and primary hyperparathyroidism with a missing inferior gland in 20 patients (29%), an ectopic adenoma in 9 patients (13%), hyperplasia in 5 patients (7%), and carcinoma in 1 patient (1%). Cure rates were similar (96% and 98%; P = not significant) and only transient hypocalcemia was higher (51% vs 24%, P hyperparathyroidism. Copyright © 2012 Elsevier Inc. All rights reserved.

Transcervical Inoculation with Chlamydia trachomatis Induces Infertility in HLA-DR4 Transgenic and Wild-Type Mice.

Science.gov (United States)

Pal, Sukumar; Tifrea, Delia F; Zhong, Guangming; de la Maza, Luis M

2018-01-01

Chlamydia trachomatis is the leading cause of infection-induced infertility in women. Attempts to control this epidemic with screening programs and antibiotic therapy have failed. Currently, a vaccine to prevent C. trachomatis infections is not available. In order to develop an animal model for evaluating vaccine antigens that can be applied to humans, we used C. trachomatis serovar D (strain UW-3/Cx) to induce infertility in mice whose major histocompatibility complex class II antigen was replaced with the human leukocyte antigen DR4 (HLA-DR4). Transcervical inoculation of medroxyprogesterone-treated HLA-DR4 transgenic mice with 5 × 10 5 C. trachomatis D inclusion forming units (IFU) induced a significant reduction in fertility, with a mean number of embryos/mouse of 4.4 ± 1.3 compared to 7.8 ± 0.5 for the uninfected control mice ( P < 0.05). A similar fertility reduction was elicited in the wild-type (WT) C57BL/6 mice (4.3 ± 1.4 embryos/mouse) compared to the levels of the WT controls (9.1 ± 0.4 embryos/mouse) ( P < 0.05). Following infection, WT mice mounted more robust humoral and cellular immune responses than HLA-DR4 mice. As determined by vaginal shedding, HLA-DR4 mice were more susceptible to a transcervical C. trachomatis D infection than WT mice. To assess if HLA-DR4 transgenic and WT mice could be protected by vaccination, 10 4 IFU of C. trachomatis D was delivered intranasally, and mice were challenged transcervically 6 weeks later with 5 × 10 5 IFU of C. trachomatis D. As determined by severity and length of vaginal shedding, WT C57BL/6 and HLA-DR4 mice were significantly protected by vaccination. The advantages and limitations of the HLA-DR4 transgenic mouse model for evaluating human C. trachomatis vaccine antigens are discussed. Copyright © 2017 American Society for Microbiology.

Induction of cervical dilation for transcervical embryo transfer in ewes

Science.gov (United States)

2014-01-01

Background A major limitation in the application of assisted reproductive technologies in sheep arises from the inability to easily traverse the uterine cervix. The cervix of the non-pregnant ewe is a narrow and rigid structure, with 5–7 spiral folds and crypts that block its lumen. The first two folds closest to the vagina appear to be the greatest obstacle for the instrument insertion into the sheep cervix. Therefore, the dilation of the distal part of the cervix could provide the conformational change necessary to perform non-invasive transcervical procedures. The present study set out to assess the efficacy of Cervidil®, a patented dinoprostone (PgE2)-containing vaginal insert with a controlled-release mechanism, to safely induce sufficient cervical dilation for the purpose of transcervical embryo transfer (TCET) in cyclic ewes. Methods The transfer of frozen-thawed ovine embryos was attempted in 22 cross-bred Rideau Arcott x Polled Dorset ewes, with or without the pre-treatment with Cervidil® for 12 or 24 h prior to TCET. Results Cervical penetration rate was significantly improved after Cervidil® pre-treatment, with 55% (6/11) of treated versus 9% (1/11) of control animals successfully penetrated (χ2-test, p ewes that were penetrated, 67% (4/6) had been exposed to Cervidil(R) for 24 h and 33% (2/6) had had a 12-h exposure (p > 0.05). Variations in the age, weight, genotype, parity, lifetime lamb production (LLP) and post-partum interval (PPI) between penetrated and non-penetrated ewes were not significant (p > 0.05). The time taken to traverse the uterine cervix was negatively correlated (p ewes, but no fetuses were detected ultrasonographically 55 days post-TCET. Conclusions The present results indicate a significant benefit of using Cervidil® for inducing cervical dilation during the mid-luteal phase in ewes but the reason(s) for impaired fertility after the transfer of frozen-thawed ovine embryos remains to be elucidated. PMID:24467737

Radiologic fallopian tube catheterization for diagnosis and treatment of proximal tubal obstruction

International Nuclear Information System (INIS)

Thurmond, A.S.; Rosch, J.

1988-01-01

Seventy-five infertile women in whom proximal fallopian tube obstruction had been demonstrated by conventional hysterosalpingography were managed by means of fluoroscopic transcervical fallopian tube catheterization techniques. The procedure helped avoid surgery for diagnosis and/or treatment of proximal tubal obstruction in 71 women (95%). In 32 patients who had patent tube(s) following the procedure, 15 pregnancies have occurred, 14 intrauterine and one tubal (follow-up, 6 months). Fifteen patients had follow-up studies after recanalization, and 19 of 23 tubes remained patent (83%). Fluoroscopic fallopian tube catheterization improves diagnosis of fallopian tube disease and is a low-cost, nonsurgical treatment for infertility caused by proximal fallopian tube obstruction

Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

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Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

2017-03-15

Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety.

Science.gov (United States)

Pierce, David B; Shivaram, Giri; Koo, Kevin S H; Shaw, Dennis W W; Meyer, Kirby F; Monroe, Eric J

2018-06-01

Disadvantages of fluoroscopically guided lumbar puncture include delivery of ionizing radiation and limited resolution of incompletely ossified posterior elements. Ultrasound (US) allows visualization of critical soft tissues and the cerebrospinal fluid (CSF) space without ionizing radiation. To determine the technical success and safety of US-guided lumbar puncture in pediatric patients. A retrospective review identified all patients referred to interventional radiology for lumbar puncture between June 2010 and June 2017. Patients who underwent lumbar puncture with fluoroscopic guidance alone were excluded. For the remaining procedures, technical success and procedural complications were assessed. Two hundred and one image-guided lumbar punctures in 161 patients were included. Eighty patients (43%) had previously failed landmark-based attempts. One hundred ninety-six (97.5%) patients underwent lumbar puncture. Five procedures (2.5%) were not attempted after US assessment, either due to a paucity of CSF or unsafe window for needle placement. Technical success was achieved in 187 (95.4%) of lumbar punctures attempted with US guidance. One hundred seventy-seven (90.3%) were technically successful with US alone (age range: 2 days-15 years, weight range: 1.9-53.1 kg) and an additional 10 (5.1%) were successful with US-guided thecal access and subsequent fluoroscopic confirmation. Three (1.5%) cases were unsuccessful with US guidance but were subsequently successful with fluoroscopic guidance. Of the 80 previously failed landmark-based lumbar punctures, 77 (96.3%) were successful with US guidance alone. There were no reported complications. US guidance is safe and effective for lumbar punctures and has specific advantages over fluoroscopy in pediatric patients.

Analytical guide wire motion algorithm for simulation of endovascular interventions

NARCIS (Netherlands)

Konings, M. K.; van de Kraats, E. B.; Alderliesten, T.; Niessen, W. J.

2003-01-01

Performing minimally invasive vascular interventions requires proper training, as a guide wire needs to be manipulated, by the tail, under fluoroscopic guidance. To provide a training environment, the motion of the guide wire inside the human vasculature can be simulated by computer. Such a

A rapid method of evaluating fluoroscopic system performance

International Nuclear Information System (INIS)

Sprawls, P.

1989-01-01

This paper presents a study to develop a method for the rapid evaluation and documentation of fluoroscopic image quality. All objects contained within a conventional contrast-detail test phantom (Leeds TO-10) are displayed in an array format according to their contrast and size. A copy of the display is used as the data collection form and a permanent record of system performance. A fluoroscope is evaluated by viewing the test phantom and marking the visible objects on the display. A line drawn through the objects with minimum visibility in each size group forms a contrast-detail curve for the system. This is compared with a standard or reference line, which is in the display.Deviations in curve position are useful indicators of specific image quality problems, such as excessive noise or blurring. The use of a special object-visibility array format display makes it possible to collect data, analyze the results, and create a record of fluoroscopic performance in less than 2 minutes for each viewing mode

Laparoscopic Supracervical Hysterectomy With Transcervical Morcellation and Sacrocervicopexy: Initial Experience With a Novel Surgical Approach to Uterovaginal Prolapse

Science.gov (United States)

Rosenblatt, Peter L.; Apostolis, Costas A.; Hacker, Michele R.; DiSciullo, Anthony

2013-01-01

The objective of this retrospective study was to evaluate the feasibility, safety, and efficacy of a new laparoscopic technique for the treatment of uterovaginal prolapse using a transcervical access port to minimize the laparoscopic incision. From February 2008 through August 2010, symptomatic pelvic organ prolapse in 43 patients was evaluated and surgically treated using this novel procedure. Preoperative assessment included pelvic examination, the pelvic organ prolapse quantification scoring system (POP-Q), and complex urodynamic testing with prolapse reduction to evaluate for symptomatic or occult stress urinary incontinence. The surgical procedure consisted of laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy with anterior and posterior mesh extension. Concomitant procedures were performed as indicated. All procedures were completed laparoscopically using only 5-mm abdominal port sites, with no intraoperative complications. Patients were followed up postoperatively for pelvic examination and POP-Q at 6 weeks, 6 months, and 12 months. The median (interquartile range) preoperative POP-Q values for point Aa was 0 (−1.0 to 1.0), and for point C was −1.0 (−3.0 to 2.0). Postoperatively, median points Aa and C were significantly improved at 6 weeks, 6 months, and 12 months (all p < .001). One patient was found to have a mesh/suture exposure from the sacrocervicopexy, which was managed conservatively without surgery. We conclude that laparoscopic supracervical hysterectomy with transcervical morcellation and laparoscopic sacrocervicopexy is a safe and feasible surgical approach to treatment of uterovaginal prolapse, with excellent anatomic results at 6 weeks, 6 months, and 12 months. Potential advantages of the procedure include minimizing laparoscopic port site size, decreasing the rate of mesh exposure compared with other published data, and reducing the rate of postoperative cyclic bleeding in

Transcervical heller myotomy using flexible endoscopy.

Science.gov (United States)

Spaun, Georg O; Dunst, Christy M; Arnold, Brittany N; Martinec, Danny V; Cassera, Maria A; Swanström, Lee L

2010-12-01

Esophageal achalasia is most commonly treated by laparoscopic myotomy. Transesophageal approaches using flexible endoscopy have recently been described. We hypothesized that using techniques and flexible instruments from our NOTES experience through a small cervical incision would be a safer and less traumatic route for esophageal myotomy. The purpose of this study was to evaluate the feasibility, safety, and success rate of using flexible endoscopes to perform anterior or posterior Heller myotomy via a transcervical approach. This animal (porcine) and human cadaver study was conducted at the Legacy Research and Technology Center. Mediastinal operations on ten live, anesthetized pigs and two human cadavers were performed using standard flexible endoscopes through a small incision at the supra-sternal notch. The esophagus was dissected to the phreno-esophageal junction using balloon dilatation in the peri-esophageal space followed by either anterior or posterior distal esophageal myotomy. Success rate was recorded of esophageal dissection to the diaphragm and proximal stomach, anterior and posterior myotomy, perforation, and complication rates. Dissection of the esophagus to the diaphragm and performing esophageal myotomy was achieved in 100% of attempts. Posterior Heller myotomy was always extendable onto the gastric wall, while anterior gastric extension of the myotomy was found to be more difficult (4/4 and 2/8, respectively; P = 0.061). Heller myotomy through a small cervical incision using flexible endoscopes is feasible. A complete Heller myotomy was performed with a higher success rate posteriorly possibly due to less anatomic interference.

Fluoroscopic Imaging Systems. Chapter 8

Energy Technology Data Exchange (ETDEWEB)

Jones, A. K. [University of Texas MD Anderson Cancer Center, Houston (United States)

2014-09-15

Fluoroscopy refers to the use of an X ray beam and a suitable image receptor for viewing images of processes or instruments in the body in real time. Fluoroscopic imaging trades the high signal to noise ratio (SNR) of radiography for high temporal resolution, as factors that maintain patient dose at an acceptable level must be used.

Ultrasound Guided Percutaneous Nephrostomy: Experience at ...

African Journals Online (AJOL)

Background: Obstructive uropathy is a common problem in urologic practice; temporary relief of obstruction in the upper tract poses a significant challenge. Ultrasound‑guided percutaneous nephrostomy (PCN) is an option for upper tract drainage; compared to fluoroscopic guidance, it is readily available, affordable, and not ...

Objective masurement of image quality in fluoroscopic x-ray equipment FluoroQuality

CERN Document Server

Tapiovaara, M

2003-01-01

The report describes FluoroQuality, a computer program that is developed in STUK and used for measuring the image quality in medical fluoroscopic equipment. The method is based on the statistical decision theory (SDT) and the main measurement result is given in terms of the accumulation rate of the signal-to-noise ratio squared (SNR sup 2 sub r sub a sub t sub e). In addition to this quantity several other quantities are measured. These quantities include the SNR of single image frames, the spatio-temporal noise power spectrum and the temporal lag. The measurement method can be used, for example, for specifying the image quality in fluoroscopic images, for optimising the image quality and dose rate in fluoroscopy and for quality control of fluoroscopic equipment. The theory behind the measurement method is reviewed and the measurement of the various quantities is explained. An example of using the method for optimising a specified fluoroscopic procedure is given. The User's Manual of the program is included a...

Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best?

Science.gov (United States)

Randelli, Filippo; Brioschi, Marco; Randelli, Pietro; Ambrogi, Federico; Sdao, Silvana; Aliprandi, Alberto

2018-01-01

Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit. We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI. Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI. (1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€). We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.

Clinical application of transnasal feeding tube placement under fluoroscopic guidance

International Nuclear Information System (INIS)

Ge Kunyuan; Ni Caifang; Liu Yizhi; Zhu Xiaoli; Zou Jianwei; Jin Yonghai; Chen Long; Sun Ge; Sun Lingfang; Zhang Dong

2008-01-01

Objective: To evaluate the feasibility and effectiveness of duodenal feeding tube placement under fluoroscopic guidance and its clinical application. Methods: The transnasal duodenal nutriment tubes placement under fluoroscopic guidance were performed in 59 patients from June 3th, 2003 to August 17th, 2007. The successful placement of the feeding tube was defined as that of the tube tip was fixed at or distal to the duodenojejunal junction. Results: 57 out of 59 patients were successfully managed by feeding tube placement, with primary successful rate of 96.6% (57/59). The remaining two failures were due to overdistention of the stomach and were further managed after gastrointestinal decompression thoroughly. The mean fluoroscopy time of the procedure was 17.8 minutes with no severe immediate or delayed complications. Conclusion: The transnasal duodenal nutrient feeding tube placement under fluoroscopic guidance is a safe,economic, and effective management for enteral nutrition, providing extensive clinical utilization. (authors)

Fluoroscopically guided automated gun biopsy of chest lesions: diagnostic accuracy and complications

International Nuclear Information System (INIS)

Oh, Hee Sul; Han, Young Min; Choi, Ki Chul and others

1998-01-01

To determine the diagnostic accuracy and frequency of complications of fluoroscopyguided transthoracic needle biopsy, using an automated gun biopsy system. We retrospectively reviewed 86 patients who underwent automated gun biopsy between October 1995 and October 1996. An 18-gauge cutting needle was used in all cases. All biopsies were performed under fluoroscopic guidance by one interventional radiologist. Tissue sufficient for histologic diagnosis was obtained in 73 of 86 biopsies(84.9%). Fifty-six lesions were malignent and 30 were benign. Sensitivity and diagnostic accuracy for malignant lesions were 87.5% and 87.5%, respectively while cell type specificity in malignant diagnosis was 91.7%(11/12). Sensitivity and diagnostic accuracy for benign lesions were 80.0% and 73.3%, respectively. Postbioptic pneumothorax occurred in three of 86 biopsies(3.5%), one of which required placement of a chest tube. Automated gun biopsy is a simple, safe method for the diagnosis of focal chest lesions. An automated biopsy device offers high diagnostic accuracy in casis involving malignant and benign lesions of the chest, and is particularly useful for determining malignant cell type and specific diagnosis of benign lesions.=20

Ultrasound-guided intraarticular injection for MR arthrography of the shoulder; Ultraschallgesteuerte intraartikulaere Kontrastmittelapplikation fuer die MR-Arthrografie der Schulter

Energy Technology Data Exchange (ETDEWEB)

Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany)

2010-03-15

Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

CT-guided puncture for direct MR-arthrography of the shoulder: Description of possible techniques

Directory of Open Access Journals (Sweden)

Hauth E

2016-07-01

Full Text Available The following report describes the possible techniques of CT-guided puncture for direct magnetic resonance (MR arthrography of the shoulder. CT-guided puncture can be regarded as an alternative technique to fluoroscopic- or ultrasound-guided puncture for MR-arthrography of the shoulder with high efficiency, low dose and extremely low complication rate.

Effect of transcervical resection of adhesion combined with low-dose aspirin on uterine artery blood flow and Smad2/3 in endometrial tissue

Directory of Open Access Journals (Sweden)

Qian-Wen Chen

2016-11-01

Full Text Available Objective: To study the effect of transcervical resection of adhesion combined with lowdose aspirin on uterine artery blood flow and Smad2/3 in endometrial tissue. Methods: A total of 78 patients with severe intrauterine adhesions who received transcervical resection of adhesion in our hospital between June 2012 and October 2014 were prospectively studied and randomly divided into two groups, observation group received postoperative estrogenprogestogen combined with low-dose aspirin therapy, and control group received postoperative estrogen-progestogen therapy. Ultrasound examination was conducted before and after treatment to determine uterine artery and endometrial blood flow parameters, intrauterine adhesion tissue was collected to detect the expression levels of Smad2 and Smad3 as well as downstream molecules, and serum was collected to determine the levels of cytokines. Results: On the ovulation day after 3 cycles of treatment, uterine artery RI and PI of observation group were significantly lower than those of control group, and endometrial VI, FI and VFI were significantly higher than those of control group; uPA expression level in intrauterine adhesion tissue of observation group was significantly higher than that of control group, Smad2, Smad3, PAI-1, ADAM15 and ADAM17 expression levels were significantly lower than those of control group, and serum TGF-β, VEGF, CTGF, IGF-I and TNF-α levels were significantly lower than those of control group. Conclusions: Transcervical resection of adhesion combined with low-dose aspirin therapy can improve the postoperative uterine artery and endometrial blood flow state, inhibit extracellular matrix deposition mediated by Smad2/3 signaling pathway and prevent intrauterine re-adhesion in patients with intrauterine adhesions.

Reducing radiation exposure in an electrophysiology lab with introduction of newer fluoroscopic technology

Directory of Open Access Journals (Sweden)

Munish Sharma

2017-09-01

Full Text Available The use of fluoroscopic devices exposes patients and operators to harmful effects of ionizing radiation in an electrophysiology (EP lab. We sought to know if the newer fluoroscopic technology (Allura Clarity installed in a hybrid EP helps to reduce prescribed radiation dose. We performed radiation dose analysis of 90 patients who underwent various procedures in the EP lab at a community teaching hospital after the introduction of newer fluoroscopic technology in June of 2016.Watchman device insertion, radiofrequency ablation procedures, permanent pacemaker (PPM/implantable cardioverter defibrillator (ICD placement and battery changes were included in the study to compare radiation exposure during different procedures performed commonly in an EP lab. In all cases of watchman device placement, radiofrequency ablation procedures, PPM/ICD placement and battery changes, there was a statistically significant difference (<0.05 in radiation dose exposure. Significant reduction in radiation exposure during various procedures performed in an EP lab was achieved with aid of newer fluoroscopic technology and better image detection technology.

Fluoroscopic removal of metallic foreign bodies in the stomach with a magnetic orogastric tube

International Nuclear Information System (INIS)

Paulson, E.K.; Jaffe, R.B.

1989-01-01

Thirty-six cases of metallic foreign bodies in the stomach were referred for fluoroscopically guided removal by means of a 5-mm diameter magnet coupled to an orogastric tube. The foreign bodies included 29 disk batteries, two nails, two screws, a nut and bolt, an unopened jack knife, and a metallic whistle. The average patient age was 4 years (range, 11 months to 13 years). Removal was successful in 33 of the 36 cases (92%). The three failures were the result of inadvertent passage of the foreign body into the duodenum (two cases) and lack of magnetic attraction (one case). There were no complications. No patient required general anesthesia, hospital admission, or endoscopic surgical intervention

New Jersey's Thomas Edison and the fluoroscope.

Science.gov (United States)

Tselos, G D

1995-11-01

Thomas Edison played a major role in the development of early x-ray technology in 1896, notably increasing tube power and reliability and making the fluoroscope a practical instrument. Eventually, Edison would move x-ray technology from the laboratory to the marketplace.

Impact of myomas on the results of transcervical resection of the endometrium

DEFF Research Database (Denmark)

Christoffersen, Christian; Kahr, Henriette Strøm; Sørensen, Søren Stampe

2014-01-01

STUDY OBJECTIVE: To investigate long-term hysterectomy rates after transcervical resection of the endometrium (TCRE) performed by experienced surgeons in the presence and absence of intracavitary myomas. DESIGN: Multicenter case-control study (Canadian Task Force classification II-2). PATIENTS......: The study group comprised 456 women with myomas who met the inclusion criteria, and of these, 82 (17.98%) later underwent hysterectomy. The control group comprised 1438 women without myomas, and of these, 284 (19.75%) later underwent hysterectomy. METHODS: From 2001 to 2004, standardized results were...... AND MAIN RESULTS: After TCRE, women with type 2 myomas, compared with those with type 0 myomas, were found to have a significantly higher risk of undergoing hysterectomy (p = .04), and women, including controls, with myomas >3.6 cm in greatest diameter were found to have a significantly higher risk...

Design considerations for a new, high resolution Micro-Angiographic Fluoroscope based on a CMOS sensor (MAF-CMOS).

Science.gov (United States)

Loughran, Brendan; Swetadri Vasan, S N; Singh, Vivek; Ionita, Ciprian N; Jain, Amit; Bednarek, Daniel R; Titus, Albert; Rudin, Stephen

2013-03-06

The detectors that are used for endovascular image-guided interventions (EIGI), particularly for neurovascular interventions, do not provide clinicians with adequate visualization to ensure the best possible treatment outcomes. Developing an improved x-ray imaging detector requires the determination of estimated clinical x-ray entrance exposures to the detector. The range of exposures to the detector in clinical studies was found for the three modes of operation: fluoroscopic mode, high frame-rate digital angiographic mode (HD fluoroscopic mode), and DSA mode. Using these estimated detector exposure ranges and available CMOS detector technical specifications, design requirements were developed to pursue a quantum limited, high resolution, dynamic x-ray detector based on a CMOS sensor with 50 μm pixel size. For the proposed MAF-CMOS, the estimated charge collected within the full exposure range was found to be within the estimated full well capacity of the pixels. Expected instrumentation noise for the proposed detector was estimated to be 50-1,300 electrons. Adding a gain stage such as a light image intensifier would minimize the effect of the estimated instrumentation noise on total image noise but may not be necessary to ensure quantum limited detector operation at low exposure levels. A recursive temporal filter may decrease the effective total noise by 2 to 3 times, allowing for the improved signal to noise ratios at the lowest estimated exposures despite consequent loss in temporal resolution. This work can serve as a guide for further development of dynamic x-ray imaging prototypes or improvements for existing dynamic x-ray imaging systems.

Radiation exposure from shoe-fitting fluoroscopes

International Nuclear Information System (INIS)

Busch, Uwe

2015-01-01

It is 40 years ago that a very popular X-ray device disappeared in German shoe shops: the shoe-fitting fluoroscope or Pedoskop. Since the 1930s, these X-ray machines were an integral part of any good shoe business. Following the entry into force X-Ray Regulation (RoeV 1973) the use of these devices was prohibited in Germany.

Fluoroscopically Guided Sacroiliac Joint Injections: Comparison of the Effects of Intraarticular and Periarticular Injections on Immediate and Short-Term Pain Relief.

Science.gov (United States)

Nacey, Nicholas C; Patrie, James T; Fox, Michael G

2016-11-01

The purpose of this study was to determine whether intraarticular sacroiliac joint injections provide greater immediate and short-term pain relief than periarticular sacroiliac joint injections do. The records of all fluoroscopically guided sacroiliac joint injections performed over a 4-year period were identified. Patients who received an injection of 0.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone and who had preinjection, immediate, and 1-week postinjection pain scores (0-10 numeric scale) were included. Images from the procedures were retrospectively reviewed by two musculoskeletal radiologists to determine intraarticular or periarticular administration of the injection with discrepancies resolved by consensus. One hundred thirteen injections in 99 patients (65 women, 34 men; mean age, 59.4 years) met the inclusion criteria. There were 55 intraarticular and 58 periarticular injections. The mean preinjection, immediate, and 1-week postinjection pain scores for the intraarticular injections were 6.0, 1.6, and 4.1 and for the periarticular injections were 6.1, 2.0, and 4.2. The mean immediate and 1-week postinjection pain reduction were statistically significant in both groups (p sacroiliac joint injections provide statistically significant immediate and 1-week postinjection pain relief, no significant difference in the degree of pain relief achieved with intraarticular and periarticular injections was noted.

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children

Energy Technology Data Exchange (ETDEWEB)

Shellikeri, Sphoorti; Srinivasan, Abhay; Krishnamurthy, Ganesh; Vatsky, Seth; Zhu, Xiaowei; Keller, Marc S.; Cahill, Anne Marie [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Setser, Randolph M. [Siemens Medical Solutions USA, Inc., Hoffman Estates, IL (United States); Hwang, Tiffany J. [University of Southern California, Keck School of Medicine, Los Angeles, CA (United States); Girard, Erin [Siemens Medical Solutions USA, Inc., Princeton, NJ (United States)

2017-07-15

Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies. Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies. Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0

Fluoroscopic screen which is optically homogeneous

International Nuclear Information System (INIS)

1975-01-01

A high efficiency fluoroscopic screen for X-ray examination consists of an optically homogeneous crystal plate of fluorescent material such as activated cesium iodide, supported on a transparent protective plate, with the edges of the assembly beveled and optically coupled to a light absorbing compound. The product is dressed to the desired thickness and provided with an X-ray-transparent light-opaque cover. (Auth.)

Fluoroscopic guidance for placing a double lumen endotracheal tube in adults.

Science.gov (United States)

Calenda, Emile; Baste, Jean Marc; Hajjej, Ridha; Rezig, Najiba; Moriceau, Jerome; Diallo, Yaya; Sghaeir, Slim; Danielou, Eric; Peillon, Christophe

2014-09-01

The aim of this study was to assess the right placement of the double lumen endotracheal tube with fluoroscopic guidance, which is used in first intention prior to the fiberscope in our institution. This was a prospective observational study. The study was conducted in vascular and thoracic operating rooms. We enrolled 205 patients scheduled for thoracic surgery, with ASA physical statuses of I (n = 37), II (n = 84), III (n = 80), and IV (n = 4). Thoracic procedures were biopsy (n = 20), wedge (n = 34), culminectomy (n = 6), lobectomy (n = 82), pneumonectomy (n = 4), sympathectomy (n = 9), symphysis (n = 47), and thymectomy (n = 3). The intubation with a double lumen tube was performed with the help of a laryngoscope. Tracheal and bronchial balloons were inflated and auscultation was performed after right and left exclusions. One shot was performed to locate the position of the bronchial tube and the hook. Fluoroscopic guidance was used to relocate the tube in case of a wrong position. When the fluoroscopic guidance failed to position the tube, a fiberscope was used. Perioperative collapse of the lung was assessed by the surgeon during the surgery. Correct fluoroscopic image was obtained after the first attempt in 58.5% of patients therefore a misplaced position was encountered in 41.5%. The fluoroscopic guidance allowed an exact repositioning in 99.5% of cases, and the mean duration of the procedure was 8 minutes. A fiberscope was required to move the hook for one patient. We did not notice a moving of the double lumen endotracheal tube during the surgery. The surgeon satisfaction was 100%. The fluoroscopy evidenced the right position of the double lumen tube and allowed a right repositioning in 99.5% of patients with a very simple implementation. Copyright © 2014. Published by Elsevier B.V.

3D fluoroscopic image estimation using patient-specific 4DCBCT-based motion models

International Nuclear Information System (INIS)

Dhou, S; Hurwitz, M; Cai, W; Rottmann, J; Williams, C; Wagar, M; Berbeco, R; Lewis, J H; Mishra, P; Li, R; Ionascu, D

2015-01-01

3D fluoroscopic images represent volumetric patient anatomy during treatment with high spatial and temporal resolution. 3D fluoroscopic images estimated using motion models built using 4DCT images, taken days or weeks prior to treatment, do not reliably represent patient anatomy during treatment. In this study we developed and performed initial evaluation of techniques to develop patient-specific motion models from 4D cone-beam CT (4DCBCT) images, taken immediately before treatment, and used these models to estimate 3D fluoroscopic images based on 2D kV projections captured during treatment. We evaluate the accuracy of 3D fluoroscopic images by comparison to ground truth digital and physical phantom images. The performance of 4DCBCT-based and 4DCT-based motion models are compared in simulated clinical situations representing tumor baseline shift or initial patient positioning errors. The results of this study demonstrate the ability for 4DCBCT imaging to generate motion models that can account for changes that cannot be accounted for with 4DCT-based motion models. When simulating tumor baseline shift and patient positioning errors of up to 5 mm, the average tumor localization error and the 95th percentile error in six datasets were 1.20 and 2.2 mm, respectively, for 4DCBCT-based motion models. 4DCT-based motion models applied to the same six datasets resulted in average tumor localization error and the 95th percentile error of 4.18 and 5.4 mm, respectively. Analysis of voxel-wise intensity differences was also conducted for all experiments. In summary, this study demonstrates the feasibility of 4DCBCT-based 3D fluoroscopic image generation in digital and physical phantoms and shows the potential advantage of 4DCBCT-based 3D fluoroscopic image estimation when there are changes in anatomy between the time of 4DCT imaging and the time of treatment delivery. (paper)

Edge enhancement algorithm for low-dose X-ray fluoroscopic imaging.

Science.gov (United States)

Lee, Min Seok; Park, Chul Hee; Kang, Moon Gi

2017-12-01

Low-dose X-ray fluoroscopy has continually evolved to reduce radiation risk to patients during clinical diagnosis and surgery. However, the reduction in dose exposure causes quality degradation of the acquired images. In general, an X-ray device has a time-average pre-processor to remove the generated quantum noise. However, this pre-processor causes blurring and artifacts within the moving edge regions, and noise remains in the image. During high-pass filtering (HPF) to enhance edge detail, this noise in the image is amplified. In this study, a 2D edge enhancement algorithm comprising region adaptive HPF with the transient improvement (TI) method, as well as artifacts and noise reduction (ANR), was developed for degraded X-ray fluoroscopic images. The proposed method was applied in a static scene pre-processed by a low-dose X-ray fluoroscopy device. First, the sharpness of the X-ray image was improved using region adaptive HPF with the TI method, which facilitates sharpening of edge details without overshoot problems. Then, an ANR filter that uses an edge directional kernel was developed to remove the artifacts and noise that can occur during sharpening, while preserving edge details. The quantitative and qualitative results obtained by applying the developed method to low-dose X-ray fluoroscopic images and visually and numerically comparing the final images with images improved using conventional edge enhancement techniques indicate that the proposed method outperforms existing edge enhancement methods in terms of objective criteria and subjective visual perception of the actual X-ray fluoroscopic image. The developed edge enhancement algorithm performed well when applied to actual low-dose X-ray fluoroscopic images, not only by improving the sharpness, but also by removing artifacts and noise, including overshoot. Copyright © 2017 Elsevier B.V. All rights reserved.

Patient dose measurements in fluoroscopic examinations, aiming to the establishment of reference levels in Brazil

International Nuclear Information System (INIS)

Canevaro, L.; Drexler, G.

2001-01-01

This work was performed to investigate the actual exposure levels of the patients submitted to fluoroscopic procedures in diagnostic radiology. The data will be useful for a baseline in the establishment of local reference levels for fluoroscopic procedures, as recommended by the European Commission and IAEA. At present time there are no internationally accepted definitions for references levels for fluoroscopic complex procedures. Dose-area product (DAP) meters were employed in a pilot survey expressing the radiation exposures in terms of this quantity. This class of instrumentation has not yet been employed in Brazil. Parameters recorded were radiographic technique, fluoroscopy time, number of images, fluoroscopic and radiographic field sizes and DAPs. For fluoroscopy practice, a reference parameters set is recommended, instead of one diagnostic reference level. High patient exposures were found, calling for joined actions of health authorities, physicians, medical physicists, technicians and manufacturers. Monitoring of patient exposure, optimizing the radiation protection and establishing quantitative assessments of the exposition to the population in Brazil in this kind of procedure is important. (author)

Radiofrequency catheter ablation: Relationship between fluoroscopic time and skin doses according to diagnoses. Basis to establish a quality assurance programme

International Nuclear Information System (INIS)

Cotelo, E.; Pouso, J.; Reyes, W.

2001-01-01

Radiofrequency Cardiac Catheter Ablation is an Interventional Radiology procedure of great complexity because the cardiologist needs a simultaneous evaluation of fluoroscopic images and electrophysiologic information. Therefore, the procedure typically involves extended fluoroscopic time that may cause radiation-skin injures to patients. Skin doses depend on many factors: equipment design features and its proper use, cardiologist practice, fluoroscopic time, irradiated areas, application of radiation protection recommendations, etc. We evaluate fluoroscopic time in relation to pathology and we estimate skin doses on 233 procedures at the Electrophysiology Laboratory in Casa de Galicia, Montevideo, Uruguay. Significant differences among the medians of fluoroscopic time were found in those procedures depending on diagnoses and results. Higher fluoroscopic time was found in flutter and auricular tachycardia (median was 83 minutes, p=0.0001). In successful procedures (almost 90%), median skin doses was 2.0 Grays (p=0.0001). On the basis of records information, the standard operating procedure and the clinical protocol, expanding close cooperation between the cardiologists and the experts in Radiation Protection will secure the establishment of an Assurance Quality Program. (author)

Management of pediatric radiation dose using GE fluoroscopic equipment

International Nuclear Information System (INIS)

Belanger, Barry; Boudry, John

2006-01-01

In this article, we present GE Healthcare's design philosophy and implementation of X-ray imaging systems with dose management for pediatric patients, as embodied in its current radiography and fluoroscopy and interventional cardiovascular X-ray product offerings. First, we present a basic framework of image quality and dose in the context of a cost-benefit trade-off, with the development of the concept of imaging dose efficiency. A set of key metrics of image quality and dose efficiency is presented, including X-ray source efficiency, detector quantum efficiency (DQE), detector dynamic range, and temporal response, with an explanation of the clinical relevance of each. Second, we present design methods for automatically selecting optimal X-ray technique parameters (kVp, mA, pulse width, and spectral filtration) in real time for various clinical applications. These methods are based on an optimization scheme where patient skin dose is minimized for a target desired image contrast-to-noise ratio. Operator display of skin dose and Dose-Area Product (DAP) is covered, as well. Third, system controls and predefined protocols available to the operator are explained in the context of dose management and the need to meet varying clinical procedure imaging demands. For example, fluoroscopic dose rate is adjustable over a range of 20:1 to adapt to different procedure requirements. Fourth, we discuss the impact of image processing techniques upon dose minimization. In particular, two such techniques, dynamic range compression through adaptive multiband spectral filtering and fluoroscopic noise reduction, are explored in some detail. Fifth, we review a list of system dose-reduction features, including automatic spectral filtration, virtual collimation, variable-rate pulsed fluoroscopic, grid and no-grid techniques, and fluoroscopic loop replay with store. In addition, we describe a new feature that automatically minimizes the patient-to-detector distance, along with an

Diagnosis of cardiovascular diseases by digital fluoroscopic angiography

International Nuclear Information System (INIS)

Takahashi, Mutsumasa; Hirota, Yoshihisa; Tsuchigame, Naotoshi

1982-01-01

Digital fluoroscopic angiography (DFA) is a recently developed angiocardiographic technique, which consists of digitization and real-time subtraction of X-ray transmission data from an image intensifier and television fluoroscopic system. A prototype unit based on this principle was developed and installed at our hospital and initial clinical trial has been performed. Fifty-three examinations were performed on 49 patients with various cardiovascular conditions. DFA was useful in demonstration of intracardiac shunt, and valvular diseases secondary to congenital heart diseases. In ischemic heart diseases, DFA noninvasively demonstrated the heart wall motion, making it possible to evaluate dyskinesis, akinesis and ventricular aneurysm. DFA was also valuable in visualizing disproportionate enlargement of cardiac chambers, stasis, and frequently regurgitation of contrast media in valvular heart diseases. Abnormal mediastinal enlargement and aortic aneurysm were differentiated from other conditions to good advantage. DFA will be used more widely in the above conditions because of non-invasive and simple procedures. Future effort should be directed towards improvement of spatial resolution and development of new algorithm for hemodynamic evaluation. (author)

Transthoracic CT-guided biopsy with multiplanar reconstruction image improves diagnostic accuracy of solitary pulmonary nodules

International Nuclear Information System (INIS)

Ohno, Yoshiharu; Hatabu, Hiroto; Takenaka, Daisuke; Imai, Masatake; Ohbayashi, Chiho; Sugimura, Kazuro

2004-01-01

Objective: To evaluate the utility of multiplanar reconstruction (MPR) image for CT-guided biopsy and determine factors of influencing diagnostic accuracy and the pneumothorax rate. Materials and methods: 390 patients with 396 pulmonary nodules underwent transthoracic CT-guided aspiration biopsy (TNAB) and transthoracic CT-guided cutting needle core biopsy (TCNB) as follows: 250 solitary pulmonary nodules (SPNs) underwent conventional CT-guided biopsy (conventional method), 81 underwent CT-fluoroscopic biopsy (CT-fluoroscopic method) and 65 underwent conventional CT-guided biopsy in combination with MPR image (MPR method). Success rate, overall diagnostic accuracy, pneumothorax rate and total procedure time were compared in each method. Factors affecting diagnostic accuracy and pneumothorax rate of CT-guided biopsy were statistically evaluated. Results: Success rates (TNAB: 100.0%, TCNB: 100.0%) and overall diagnostic accuracies (TNAB: 96.9%, TCNB: 97.0%) of MPR were significantly higher than those using the conventional method (TNAB: 87.6 and 82.4%, TCNB: 86.3 and 81.3%) (P<0.05). Diagnostic accuracy were influenced by biopsy method, lesion size, and needle path length (P<0.05). Pneumothorax rate was influenced by pathological diagnostic method, lesion size, number of punctures and FEV1.0% (P<0.05). Conclusion: The use of MPR for CT-guided lung biopsy is useful for improving diagnostic accuracy with no significant increase in pneumothorax rate or total procedure time

Fluoroscopic dose reduction by acquisition frame rate reduction and image processing

International Nuclear Information System (INIS)

Fritz, S.L.; Mirvis, S.E.; Pals, S.O.

1986-01-01

A new design for fluoroscopic exposure reduction incorporates pulsed x-ray exposure, progressive scan video acquisition at frame rates below 30 Hz, interlaced video display at 30 Hz, and a video rate image processing. To evaluate this design, a variety of phantom systems have been developed to measure the impact of low frame rate pulsed digital fluoroscopy on the performance of several clinical tasks (e.g., catheter placement). The authors are currently using these phantoms with a digital fluoroscopy system using continuous x-ray, interlaced video acquisition and variable acquisition frame rate. The design of their target digital fluoroscopic system, sample image sequences, and the results of some preliminary phantom studies are reported

Experiences upgrading a fluoroscopic system to digital specifications

International Nuclear Information System (INIS)

Fox, T.; Fenzl, G.

1995-01-01

In 1993, an undertable fluoroscopic system was retrofitted with a Fluorospot HC digital system at the radiological clinic of the Knappschaftskrankenhaus in Puettlingen, Germany. The experiences and possibilities resulting from this digital upgrade are related by the authors, whose narrative is also accompanied by examples of clinical images. The costs involved are also discussed in this article. (orig.)

Adjustable radiation protection device of the fluoroscope DG 10

International Nuclear Information System (INIS)

Hoermann, D.

1980-01-01

In cooperation with the 'VEB Transformatoren- und Roentgenwerk Hermann Matern', Dresden, an adjustable radiation protection device has been developed. This supplementary equipment for fluoroscopes ensures a sufficient protection of the gonads against undesirable X radiation, can be handled easily and does not annoy patients, esp. children

SU-D-209-02: Percent Depth Dose Curves for Fluoroscopic X-Ray Beam Qualities Incorporating Copper Filtration

Energy Technology Data Exchange (ETDEWEB)

Wunderle, K [Cleveland Clinic Foundation, Cleveland, OH (United States); Wayne State University School of Medicine, Detroit, MI (United States); Godley, A; Shen, Z; Dong, F [Cleveland Clinic Foundation, Cleveland, OH (United States); Rakowski, J [Wayne State University School of Medicine, Detroit, MI (United States)

2016-06-15

Purpose: The purpose of this investigation was to quantify percent depth dose (PDD) curves for fluoroscopic x-ray beam qualities incorporating added copper filtration. Methods: A PTW (Freiburg, Germany) MP3 water tank was used with a Standard Imaging (Middleton, WI) Exradin Model 11 Spokas Chamber to measure PDD curves for 60, 80, 100 and 120 kVp x-ray beams with copper filtration ranging from 0.0–0.9 mm at 22cm and 42cm fields of view from 0 to 150 mm of water. A free-in-air monitor chamber was used to normalize the water tank data to fluctuations in output from the fluoroscope. The measurements were acquired on a Siemens (Erlangen, Germany) Artis ZeeGo fluoroscope. The fluoroscope was inverted from the typical orientation providing an x-ray beam originating from above the water tank. The water tank was positioned so that the water level was located at 60cm from the focal spot; which also represents the focal spot to interventional reference plane distance for that fluoroscope. Results: PDDs for 60, 80, 100, and 120 kVp with 0 mm of copper filtration compared well to previously published data by Fetterly et al. [Med Phys, 28, 205 (2001)] for those beam qualities given differences in fluoroscopes, geometric orientation, type of ionization chamber, and the water tank used for data collection. PDDs for 60, 80, 100, and 120 kVp with copper filtration were obtained and are presented, which have not been previously investigated and published. Conclusion: The equipment and processes used to acquire the reported data were sound and compared well with previously published data for PDDs without copper filtration. PDD data for the fluoroscopic x-ray beams incorporating copper filtration can be used as reference data for estimating organ or soft tissue dose at depth involving similar beam qualities or for comparison with mathematical models.

Peripheral Insertion of a Central Venous Access Device Under Fluoroscopic Guidance Using a Peripherally Accessed System (PAS) Port in the Forearm

International Nuclear Information System (INIS)

Hata, Yasuhiro; Morita, Sojiro; Morita, Yoshitaka; Awatani, Toshihide; Takasaki, Motohiro; Horimi, Tadashi; Ozawa, Zen

1998-01-01

Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis

MO-F-CAMPUS-I-01: A System for Automatically Calculating Organ and Effective Dose for Fluoroscopically-Guided Procedures

Energy Technology Data Exchange (ETDEWEB)

Xiong, Z; Vijayan, S; Rana, V; Rudin, S; Bednarek, D [Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (United States)

2015-06-15

Purpose: A system was developed that automatically calculates the organ and effective dose for individual fluoroscopically-guided procedures using a log of the clinical exposure parameters. Methods: We have previously developed a dose tracking system (DTS) to provide a real-time color-coded 3D- mapping of skin dose. This software produces a log file of all geometry and exposure parameters for every x-ray pulse during a procedure. The data in the log files is input into PCXMC, a Monte Carlo program that calculates organ and effective dose for projections and exposure parameters set by the user. We developed a MATLAB program to read data from the log files produced by the DTS and to automatically generate the definition files in the format used by PCXMC. The processing is done at the end of a procedure after all exposures are completed. Since there are thousands of exposure pulses with various parameters for fluoroscopy, DA and DSA and at various projections, the data for exposures with similar parameters is grouped prior to entry into PCXMC to reduce the number of Monte Carlo calculations that need to be performed. Results: The software developed automatically transfers data from the DTS log file to PCXMC and runs the program for each grouping of exposure pulses. When the dose from all exposure events are calculated, the doses for each organ and all effective doses are summed to obtain procedure totals. For a complicated interventional procedure, the calculations can be completed on a PC without manual intervention in less than 30 minutes depending on the level of data grouping. Conclusion: This system allows organ dose to be calculated for individual procedures for every patient without tedious calculations or data entry so that estimates of stochastic risk can be obtained in addition to the deterministic risk estimate provided by the DTS. Partial support from NIH grant R01EB002873 and Toshiba Medical Systems Corp.

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study

OpenAIRE

Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-01

Background Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. Methods The authors developed a new adjustable drill guide for cannulated screw guide wire insertion fo...

Common fluoroscopic studies in radiology : conduct and analysis method

International Nuclear Information System (INIS)

Valverde Sanchez, Allan

2011-01-01

A countless number of radiological procedures, that have involved the use of fluoroscopy and contrast media of different indole, have been carried out in all radiology services and medical images of Costa Rica for the diagnosis of diseases or conditions, in both adults and in children. Fluoroscopic studies, often called special or contrast studies, have had particular conditions for its realization. Some from the medical point of view: adequate training in the technical and cognitive development when evaluating the images to not miss important details. Other by the patient: adequate preparation to achieve the best images for optimal diagnosis. For example, adequate bowel preparation is essential for a barium enema, to cooperation by the patient to meet specific indications that the physician dictates when swallowing postures or just when you are prompted. Criteria have been met and unified for contrast studies in different hospitals and clinics. The indications, contra, method, technique of procedure, points to remember, number of images or projections minimum required in the interpretation of contrast studies, as well as a report template of standard and ideal study are presented in a simple, systematic and logical. The manual is intended for residents and attending physicians specialists in radiology and medical imaging including contrast studies more common. Spaces are promoted with current technology studies to set aside more complicated and less sophisticated as have been the fluoroscopic studies; however, in the national reality, access to computerized tomography and magnetic resonance imaging is not as easy. Radiological studies with fluoroscopy performed by trained staff led the treating physician to make sound decisions based on studies relatively simple and easy to do. The tests with the use of fluoroscopic have been named: the esophagogram, gastroduodenal series, gastro intestinal transit, the hysterosalpingography, the cystography and the

Measurements for testing of fluoroscopic screens, including the photofluorographic units

International Nuclear Information System (INIS)

Balfanz, R.

1986-01-01

Image quality control measurements for fluoroscopic screens and photofluorographs have shown that both types of equipment have a long operating life, so that constancy and technical performance tests are absolutely necessary. It is recommended to conclude in-service maintenance contracts with the manufacturers. (DG) [de

CT guided celiac plexus and splanchnic nerve neurolysis : the modified anterior approach

International Nuclear Information System (INIS)

Lee, Jeong Min; Lee, Mi Suk; Ym, Seong Hee; Lee, Jin Hee

1997-01-01

Since it was first described by Kappis, celiac plexus neurolysis (CPN) has been performed under fluoroscopic guidance by anesthetists or surgeons for the relief of intractable pain caused by upper abdominal malignancy. Recently, however, several groups have reported a computed tomography (CT)-guided technique that increased the safety of the blocking procedure and improved its results. The authors present a new technique CT-guided celiac plexus and splanchic nerve block, to be used simultaneously with a modified anterior approach. Using CT to guide needle tip placement, an anterior approach that permitted direct neurolysis of the celiac ganglia and splanchnic nerve was developed

Fluoroscopic tomography. [for body section synthesis

Science.gov (United States)

Baily, N. A.; Crepeau, R. L.; Lasser, E. C.

1974-01-01

A fluoroscopic tomography system capable of synthesizing body sections at a number of levels within the body has been developed. The synthesized body sections may lie either in a range of planes parallel to, tilted with respect to, skewed with respect to, or both tilted and skewed with respect to the plane of motion of the X-ray tube target. In addition, body sections can be presented which are contoured to the patient's anatomy. That is to say, they may even encompass such complex surfaces as a quadratic hyperplane. In addition, tomograms of organs in motion can be imaged.

General-purpose radiographic and fluoroscopic table

International Nuclear Information System (INIS)

Ishizaki, Noritaka

1982-01-01

A new series of diagnostic tables, Model DT-KEL, was developed for general-purpose radiographic and fluoroscopic systems. Through several investigations, the table was so constructed that the basic techniques be general radiography and GI examination, and other techniques be optionally added. The diagnostic tables involve the full series of the type for various purposes and are systematized with the surrounding equipment. A retractable mechanism of grids was adopted first for general use. The fine grids with a density of 57 lines per cm, which was adopted in KEL-2, reduced the X-ray doses by 16 percent. (author)

Minimally Invasive Spinal Surgery with Intraoperative Image-Guided Navigation

Directory of Open Access Journals (Sweden)

Terrence T. Kim

2016-01-01

Full Text Available We present our perioperative minimally invasive spine surgery technique using intraoperative computed tomography image-guided navigation for the treatment of various lumbar spine pathologies. We present an illustrative case of a patient undergoing minimally invasive percutaneous posterior spinal fusion assisted by the O-arm system with navigation. We discuss the literature and the advantages of the technique over fluoroscopic imaging methods: lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy.

Real-Time Verification of a High-Dose-Rate Iridium 192 Source Position Using a Modified C-Arm Fluoroscope

Energy Technology Data Exchange (ETDEWEB)

Nose, Takayuki, E-mail: nose-takayuki@nms.ac.jp [Department of Radiation Oncology, Nippon Medical School Tamanagayama Hospital, Tama (Japan); Chatani, Masashi [Department of Radiation Oncology, Osaka Rosai Hospital, Sakai (Japan); Otani, Yuki [Department of Radiology, Kaizuka City Hospital, Kaizuka (Japan); Teshima, Teruki [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Kumita, Shinichirou [Department of Radiology, Nippon Medical School Hospital, Tokyo (Japan)

2017-03-15

Purpose: High-dose-rate (HDR) brachytherapy misdeliveries can occur at any institution, and they can cause disastrous results. Even a patient's death has been reported. Misdeliveries could be avoided with real-time verification methods. In 1996, we developed a modified C-arm fluoroscopic verification of an HDR Iridium 192 source position prevent these misdeliveries. This method provided excellent image quality sufficient to detect errors, and it has been in clinical use at our institutions for 20 years. The purpose of the current study is to introduce the mechanisms and validity of our straightforward C-arm fluoroscopic verification method. Methods and Materials: Conventional X-ray fluoroscopic images are degraded by spurious signals and quantum noise from Iridium 192 photons, which make source verification impractical. To improve image quality, we quadrupled the C-arm fluoroscopic X-ray dose per pulse. The pulse rate was reduced by a factor of 4 to keep the average exposure compliant with Japanese medical regulations. The images were then displayed with quarter-frame rates. Results: Sufficient quality was obtained to enable observation of the source position relative to both the applicators and the anatomy. With this method, 2 errors were detected among 2031 treatment sessions for 370 patients within a 6-year period. Conclusions: With the use of a modified C-arm fluoroscopic verification method, treatment errors that were otherwise overlooked were detected in real time. This method should be given consideration for widespread use.

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

International Nuclear Information System (INIS)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark

1997-01-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis

Correction of malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance

Energy Technology Data Exchange (ETDEWEB)

Lee, Seung Ryong; Baek, Kyong Hee; Jung, Gyoo Sik; Huh, Jin Do; Joh, Young Duk; Rim, Hark [Kosin Medical College, Pusan (Korea, Republic of)

1997-11-01

To determine the efficacy of correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance. Between November 1994 and March 1997, we performed 15 manipulations in 12 patients in whom a dual-cuff, straight Tenckhoff peritoneal dialysis catheter had been implanted due to chronic renal failure. The causes of catheter malfunctioning were inadequate drainage of the dialysate(n=14) and painful dialysis(n=1). Under fluoroscopic guidance, adhesiolysis and repositioning of the malfunctioning catheter were performed with an Amplatz Super Stiff guidewire and the stiffener from a biliary drainage catheter. The results of procedures were categorized as either immediate or durable success, this latter being defined as adequate catheter function for at least one month after the procedure. Immediate success was achieved in 14 of 15 procedures (93%), and durable success in 7 of 15(47%). The mean duration of catheter function was 157 (range, 30 to 578) days. After manipulation, abdominal pain developed in eight patients and peritonitis in two, but with conservative treatment, these symptoms improved. The correction of a malfunctioning peritoneal dialysis catheter with guidewire and stiffener under fluoroscopic guidance is an effective means of restoring catheter function and may be an effective alternative to surgical reimplantation of the catheter, or hemodialysis.

Patient Dose Optimization in Fluoroscopically Guided Interventional Procedures. Final Report of a Coordinated Research Project

International Nuclear Information System (INIS)

2010-01-01

In recent years, many surgical procedures have increasingly been replaced by interventional procedures that guide catheters into the arteries under X ray fluoroscopic guidance to perform a variety of operations such as ballooning, embolization, implantation of stents etc. The radiation exposure to patients and staff in such procedures is much higher than in simple radiographic examinations like X ray of chest or abdomen such that radiation induced skin injuries to patients and eye lens opacities among workers have been reported in the 1990's and after. Interventional procedures have grown both in frequency and importance during the last decade. This Coordinated Research Project (CRP) and TECDOC were developed within the International Atomic Energy Agency's (IAEA) framework of statutory responsibility to provide for the worldwide application of the standards for the protection of people against exposure to ionizing radiation. The CRP took place between 2003 and 2005 in six countries, with a view of optimizing the radiation protection of patients undergoing interventional procedures. The Fundamental Safety Principles and the International Basic Safety Standards for Protection against Ionizing Radiation (BSS) issued by the IAEA and co-sponsored by the Food and Agriculture Organization of the United Nations (FAO), the International Labour Organization (ILO), the World Health Organization (WHO), the Pan American Health Organization (PAHO) and the Nuclear Energy Agency (NEA), among others, require the radiation protection of patients undergoing medical exposures through justification of the procedures involved and through optimization. In keeping with its responsibility on the application of standards, the IAEA programme on Radiological Protection of Patients encourages the reduction of patient doses. To facilitate this, it has issued specific advice on the application of the BSS in the field of radiology in Safety Reports Series No. 39 and the three volumes on Radiation

Image quality evaluation and patient dose assessment of medical fluoroscopic X-ray systems: A national study

International Nuclear Information System (INIS)

Economides, S.; Hourdakis, C. J.; Kalivas, N.; Kalathaki, M.; Simantirakis, G.; Tritakis, P.; Manousaridis, G.; Vogiatzi, S.; Kipouros, P.; Boziari, A.; Kamenopoulou, V.

2008-01-01

This study presents the results from a survey conducted by the Greek Atomic Energy Commission (GAEC), during the period 1998-2003, in 530 public and private owned fluoroscopic X-ray systems in Greece. Certain operational parameters for conventional and remote control systems were assessed, according to a quality control protocol developed by GAEC on the basis of the current literature. Public (91.5%) and private (81.5%) owned fluoroscopic units exhibit high-contrast resolution values over 1 lp mm -1 . Moreover, 88.5 and 87.1% of the fluoroscopic units installed in the public and private sector, respectively, present Maximum Patient Entrance Kerma Rate values lower than 100 mGy min -1 . Additionally, 68.3% of the units assessed were found to perform within the acceptance limits. Finally, the third quartile of the Entrance Surface Dose Rate distribution was estimated according to the Dose Reference Level definition and found equal to 35 mGy min -1 . (authors)

Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

Science.gov (United States)

Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

2010-01-01

Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

Trial manufacture of round mask for TV fluoroscopic unit

International Nuclear Information System (INIS)

Matsuoka, Shoji; Matsumoto, Yukio

1977-01-01

Demands for revision of existing medical law were described together with an introduction of TV fluoroscopic unit. Round mask, which does not always press out the bottom face of used x-ray beam from the effective primary fluorescent face of photomultiplier inspite of shifting of a spot in time of TV fluoroscopy, was manufactured for trial, and it was furnished with already established fluoroscopic stand. It is used in daily examination without any trouble. Round mask was divided into two parts, and opened upward and downward quickly by lod motor in time of photographing. Multiple iris was operated in order to fit to film size, and round mask was closed at the same time of the finishment of photographing and fluoroscopy was performed again. Item 3 of Para 2 of Art 30 of the existing medical low states that it is good not to press out, the distance between x-ray focus and fluorescent screen, and used x-ray beam from fluorescent screen. However, a regulation, which states that x-ray beam should not be pressed out from effective primary fluorescent face in x-ray fluoroscopy using photomultiplier, must be added. Improvement of the existing unit is expected, and decrease of unnecessary exposure even in small amount is proposed. (Tsunoda, M.)

Estimation of breast doses and breast cancer risk associated with repeated fluoroscopic chest examinations of women with tuberculosis

International Nuclear Information System (INIS)

Boice, J.D. Jr.; Rosenstein, M.; Trout, E.D.

1978-01-01

A methodology is presented to estimate cumulative breast dose and breast cancer risk for women exposed to repeated fluoroscopic chest examinations during air collapse therapy for pulmonary tuberculosis. Medical record abstraction, physician interview, patient contact, machine exposure measurements, and absorbed dose computations were combined to estimate average breast doses for 1047 Massachusetts women who were treated between 1930 and 1954. The methodology presented considers breast size and composition, patient orientation, x-ray field size and location, beam quality, type of examination, machine exposure rate, and exposure time during fluoroscopic examinations. The best estimate for the risk of radiation-induced cancer for the women living longer than 10 years after initial fluoroscopic exposure is 6.2 excess breast cancers per million woman-year-rad with 90% confidence limits of 2.8 and 10.7 cancers/10 6 WY-rad. When breast cancer risk is considered as a function of absorbed dose in the breast, instead of as a function of the number of fluoroscopic examinations, a linear dose--response relationship over the range of estimated doses is consistent with the data. However, because of the uncertainty due to small-sample variability and because of the wide range of assumptions regarding certain fluoroscopy conditions, other dose--response relationships are compatible with the data

Exposition of the operator's eye lens and efficacy of radiation shielding in fluoroscopically guided interventions; Exposition der Augenlinse des Untersuchers und Effizienz der Strahlenschutzmittel bei fluoroskopischen Interventionen

Energy Technology Data Exchange (ETDEWEB)

Galster, M.; Adamus, R. [Klinikum Nuernberg-Nord, Nuernberg (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Guhl, C. [Klinikum Nuernberg (Germany). Inst. fuer Medizinische Physik; Uder, M. [Erlangen Univ. (Germany). Radiologisches Inst.

2013-05-15

Purpose: Efficacy of radiation protection tools for the eye lens dose of the radiologist in fluoroscopic interventions. Materials and Methods: A patient phantom was exposed using a fluoroscopic system. Dose measurements were made at the eye location of the radiologist using an ionization chamber. The setting followed typical fluoroscopic interventions. The reduction of scattered radiation by the equipment-mounted shielding (undercouch drapes and overcouch top) was evaluated. The ceiling-suspended lead acrylic glass screen was tested in scattered radiation generated by a slab phantom. The protective properties of different lead glass goggles and lead acrylic visors were evaluated by thermoluminescence measurements on a head phantom in the primary beam. Results: The exposition of the lens of about 110 to 550 {mu}Sv during radiologic interventions is only slightly reduced by the undercouch drapes. Applying the top in addition to the drapes reduces the lens dose by a factor of 2 for PA projections. In 25 LAO the dose is reduced by a factor between 1.2 and 5. The highest doses were measured for AP angulations furthermore the efficacy of the equipment-mounted shielding is minimal. The ceiling-suspended lead screen reduced scatter by a factor of about 30. The lead glass goggles and visors reduced the lens dose up to a factor of 8 to 10. Depending on the specific design, the tested models are less effective especially for radiation from lateral with cranial angulation of the beam. Occasionally the visors even caused an increase of dose. Conclusion: The exposition of the eye lens can be kept below the new occupational limit recommended by the ICRP if the radiation shielding equipment is used consistently. (orig.)

Rapid development of thymic neuroendocrine carcinoma despite transcervical thymectomy in a patient with multiple endocrine neoplasia type 1

Directory of Open Access Journals (Sweden)

Dhalapathy Sadacharan

2013-01-01

Full Text Available Thymic neuroendocrine (NE tumors are a rare manifestation of multiple endocrine neoplasia syndrome type 1 (MEN-1. They are malignant and aggressive tumors and form a major cause of mortality in MEN-1. Transcervical thymectomy (TCT at the time of parathyroid surgery for primary hyperparathyroidism (PHPT in MEN-1 usually prevents thymic NE tumors. We report a 56-year-old nonsmoker male with sporadic MEN-1 who presented with thymic NE carcinoma developing rapidly within a span of 8 months after subtotal parathyroidectomy and TCT for PHPT. We present a brief review of literature on this rare NE malignancy, focusing on its occurrence despite TCT. This case highlights the fact that thymic NE carcinoma may develop even after TCT in MEN-1. Regular surveillance for these aggressive thymic NE tumors is mandatory even after TCT in MEN-1 setting.

Navigation for fluoroscopy-guided cryo-balloon ablation procedures of atrial fibrillation

Science.gov (United States)

Bourier, Felix; Brost, Alexander; Kleinoeder, Andreas; Kurzendorfer, Tanja; Koch, Martin; Kiraly, Attila; Schneider, Hans-Juergen; Hornegger, Joachim; Strobel, Norbert; Kurzidim, Klaus

2012-02-01

Atrial fibrillation (AFib), the most common arrhythmia, has been identified as a major cause of stroke. The current standard in interventional treatment of AFib is the pulmonary vein isolation (PVI). PVI is guided by fluoroscopy or non-fluoroscopic electro-anatomic mapping systems (EAMS). Either classic point-to-point radio-frequency (RF)- catheter ablation or so-called single-shot-devices like cryo-balloons are used to achieve electrically isolation of the pulmonary veins and the left atrium (LA). Fluoroscopy-based systems render overlay images from pre-operative 3-D data sets which are then merged with fluoroscopic imaging, thereby adding detailed 3-D information to conventional fluoroscopy. EAMS provide tracking and visualization of RF catheters by means of electro-magnetic tracking. Unfortunately, current navigation systems, fluoroscopy-based or EAMS, do not provide tools to localize and visualize single shot devices like cryo-balloon catheters in 3-D. We present a prototype software for fluoroscopy-guided ablation procedures that is capable of superimposing 3-D datasets as well as reconstructing cyro-balloon catheters in 3-D. The 3-D cyro-balloon reconstruction was evaluated on 9 clinical data sets, yielded a reprojected 2-D error of 1.72 mm +/- 1.02 mm.

Video dosimetry: evaluation of X-radiation dose by video fluoroscopic image

International Nuclear Information System (INIS)

Nova, Joao Luiz Leocadio da; Lopes, Ricardo Tadeu

1996-01-01

A new methodology to evaluate the entrance surface dose on patients under radiodiagnosis is presented. A phantom is used in video fluoroscopic procedures in on line video signal system. The images are obtained from a Siemens Polymat 50 and are digitalized. The results show that the entrance surface dose can be obtained in real time from video imaging

Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study.

Science.gov (United States)

van Duren, B H; Sugand, K; Wescott, R; Carrington, R; Hart, A

2018-05-01

Hip fractures contribute to a significant clinical burden globally with over 1.6 million cases per annum and up to 30% mortality rate within the first year. Insertion of a dynamic hip screw (DHS) is a frequently performed procedure to treat extracapsular neck of femur fractures. Poorly performed DHS fixation of extracapsular neck of femur fractures can result in poor mobilisation, chronic pain, and increased cut-out rate requiring revision surgery. A realistic, affordable, and portable fluoroscopic simulation system can improve performance metrics in trainees, including the tip-apex distance (the only clinically validated outcome), and improve outcomes. We developed a digital fluoroscopic imaging simulator using orthogonal cameras to track coloured markers attached to the guide-wire which created a virtual overlay on fluoroscopic images of the hip. To test the accuracy with which the augmented reality system could track a guide-wire, a standard workshop femur was used to calibrate the system with a positional marker fixed to indicate the apex; this allowed for comparison between guide-wire tip-apex distance (TAD) calculated by the system to be compared to that physically measured. Tests were undertaken to determine: (1) how well the apex could be targeted; (2) the accuracy of the calculated TAD. (3) The number of iterations through the algorithm giving the optimal accuracy-time relationship. The calculated TAD was found to have an average root mean square error of 4.2 mm. The accuracy of the algorithm was shown to increase with the number of iterations up to 20 beyond which the error asymptotically converged to an error of 2 mm. This work demonstrates a novel augmented reality simulation of guide-wire insertion in DHS surgery. To our knowledge this has not been previously achieved. In contrast to virtual reality, augmented reality is able to simulate fluoroscopy while allowing the trainee to interact with real instrumentation and performing the procedure on

Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.

NARCIS (Netherlands)

Rutten, M.J.; Collins, J.M.; Maresch, B.J.; Smeets, J.H.R.; Janssen, C.M.; Kiemeney, L.A.L.M.; Jager, G.J.

2009-01-01

To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and

SU-F-I-76: Fluoroscopic X-Ray Beam Profiles for Spectra Incorporating Copper Filtration

Energy Technology Data Exchange (ETDEWEB)

Wunderle, K [Cleveland Clinic Foundation, Cleveland, OH (United States); Wayne State University School of Medicine, Detroit, MI (United States); Godley, A; Shen, Z; Dong, F [Cleveland Clinic Foundation, Cleveland, OH (United States); Rakowski, J [Wayne State University School of Medicine, Detroit, MI (United States)

2016-06-15

Purpose: The purpose of this investigation is to characterize and quantify X-ray beam profiles for fluoroscopic x-ray beam spectra incorporating spectral (copper) filtration. Methods: A PTW (Freiburg, Germany) type 60016 silicon diode detector and PTW MP3 water tank were used to measure X-ray beam profiles for 60, 80, 100 and 120 kVp x-ray beams at five different copper filtration thicknesses ranging from 0–0.9 mm at 22 and 42 cm fields of view and depths of 1, 5, and 10 cm in both the anode-cathode axis (inplane) and cross-plane directions. All measurements were acquired on a Siemens (Erlangen, Germany) Artis ZeeGo fluoroscope inverted from the typical orientation providing an x-ray beam originating from above the water surface with the water level set at 60 cm from the focal spot. Results: X-ray beam profiles for beam spectra without copper filtration compared well to previously published data by Fetterly et al. [Med Phys, 28, 205 (2001)]. Our data collection benefited from the geometric orientation of the fluoroscope, providing a beam perpendicular to the tank water surface, rather than through a thin side wall as did the previously mentioned study. Profiles for beams with copper filtration were obtained which have not been previously investigated and published. Beam profiles in the anode-cathode axis near the surface and at lower x-ray energy exhibited substantial heel effect, which became less pronounced at greater depth. At higher energy with copper filtration in the beam, the dose falloff out-of-field became less pronounced, as would be anticipated given higher scatter photon energy. Conclusion: The x-ray beam profile data for the fluoroscopic x-ray beams incorporating copper filtration are intended for use as reference data for estimating doses to organs or soft tissue, including fetal dose, involving similar beam qualities or for comparison with mathematical models.

SU-F-I-75: Half-Value Layer Thicknesses and Homogeneity Coefficients for Fluoroscopic X-Ray Beam Spectra Incorporating Spectral Filtration

Energy Technology Data Exchange (ETDEWEB)

Wunderle, K [Cleveland Clinic Foundation, Cleveland, OH (United States); Wayne State University School of Medicine, Detroit, MI (United States); Godley, A; Shen, Z; Dong, F [Cleveland Clinic Foundation, Cleveland, OH (United States); Rakowski, J [Wayne State University School of Medicine, Detroit, MI (United States)

2016-06-15

Purpose: The purpose of this investigation is to quantify various first half-value-layers (HVLs), second HVLs and homogeneity coefficients (HCs) for a state-of-the-art fluoroscope utilizing spectral (copper) filtration. Methods: A Radcal (Monrovia, Ca) AccuPro dosimeter with a 10×6-6 calibrated ionization chamber was used to measure air kerma for radiographic x-ray exposures made on a Siemens (Erlangen, Germany) Artis ZeeGo fluoroscope operated in the service mode. The ionization chamber was centered in the x-ray beam at 72 cm from the focal spot with a source-to-image-distance of 120 cm. The collimators were introduced to limit the x-ray field to approximately 5 cm × 5 cm at the ionization chamber plane. Type-1100 aluminum filters, in 0.5 mm increments, were used to determine the HVL. Two HVL calculation methods were used, log-linear interpolation and Lambert-W interpolation as described by Mathieu [Med Phys, 38(8), 4546 (2011)]. Multiple measurements were made at 60, 80, 100, 120 kVp at spectral filtration thicknesses of 0, 0.1, 0.3, 0.6 and 0.9 mm. Results: First HVL, second HVL, and HCs are presented for the fluoroscopic x-ray beam spectra indicated above, with nearly identical results from the two interpolation methods. Accuracy of the set kVp was also determined and deviated less than 2%. First HVLs for fluoroscopic x-ray beam spectra without spectral filtration determined in our study were 7%–16% greater than previously published data by Fetterly et al. [Med Phys, 28, 205 (2001)]. However, the FDA minimum HVL requirements changed since that publication, requiring larger HVLs as of 2006. Additionally, x-ray tube and generator architecture have substantially changed over the last 15 years providing different beam spectra. Conclusion: X-ray beam quality characteristics for state-of-the-art fluoroscopes with spectral filtration have not been published. This study provides reference data which will be useful for defining beam qualities encountered on

US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

International Nuclear Information System (INIS)

Kim, Young Hwan; Cha, Soon Joo

2002-01-01

To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 ±3.8 min. in the right approach and 9.6 ±3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9±2.4 min. in the right approach and 3.8±2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD

US-guided percutaneous transhepatic biliary drainage: comparative study of right-sided and left-sided approach

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Hwan; Cha, Soon Joo [College of Medicine, Inje Univ., Kimhae (Korea, Republic of)

2002-02-01

To compare the feasibility and safety of US-guided right and left percutaneous transhepatic biliary drainage (PTBD). Between March 1998 and May 1999, 32 patients underwent 36 US-guided right or left PTBD in referred order, alternatively. The causes of biliary obstruction were bile duct stone (n=2), bile duct carcinoma (n=10), carcinoma of the pancreas (n=9), GB carcinoma (n=7), metastasis to the porta hepatis (n=3), and carcinoma of the ampulla of vater (n=1). Technical success, procedure time, fluoroscopic time, and complications were evaluated. PTBD was successful in 94% of both right and left approach. The average procedure time was 9.7 {+-}3.8 min. in the right approach and 9.6 {+-}3.1 min. in the left approach, respectively (p=0.794). The average fluoroscopic time were 3.9{+-}2.4 min. in the right approach and 3.8{+-}2.2 min. in the left approach (p=0.892). A major complication, bile peritonitis, occurred in one of 16 patient with right-sided approach. Minor complications occurred in six right (2 hemobilia, 3 tube malfunction, 1 cholangitis) and three left (1 hemobilia, 1 fever, 1cholangitis) PTBD. There were no significant difference in the complication rates between right and left PTBD (p=0.729). There were no significant differences in feasibility and safety in US-guided right and left PTBD.

28 CFR 552.13 - X-ray, major instrument, fluoroscope, or surgical intrusion.

Science.gov (United States)

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false X-ray, major instrument, fluoroscope, or... INSTITUTIONAL MANAGEMENT CUSTODY Searches of Housing Units, Inmates, and Inmate Work Areas § 552.13 X-ray, major... reasons only, with the inmate's consent. (b) The institution physician may authorize use of an X-ray for...

Ultrasound-guided radiofrequency neurotomy in cervical spine: sonoanatomic study of a new technique in cadavers

International Nuclear Information System (INIS)

Lee, S.-H.; Kang, C.H.; Lee, S.-H.; Derby, R.; Yang, S.N.; Lee, J.E.; Kim, J.H.; Kim, S.S.; Lee, J.-H.

2008-01-01

Aim: To develop an ultrasound-guided technique for radiofrequency (RF) cervical medial branch neurotomy and to validate the accuracy of this new method. Materials and methods: Five non-embalmed, fresh cadavers were used; three male and two female cadavers with a median age at death of 67.2 years (range 50-84 years). This study was conducted in two parts. First, two of the cadavers were used to define the sonographic target point for RF cervical medial branch neurotomy using high-resolution ultrasound (12 to 5 MHz). The needles were guided to five consecutive cervical medial branches in the cadavers under ultrasound guidance. Subsequently, the position of the ultrasound-guided needle was verified using C-arm fluoroscopy. Ultrasound-guided RF neurotomy was performed to the C5 medial branches in all five cadavers. In the three cadavers not used in the first part of the study, ultrasound-guided RF neurotomy without C-arm fluoroscopic confirmation was performed to the C3-C7 medial branches. The accuracy of neurotomy was assessed by pathological examination of the cervical medial branches obtained through cadaver dissection. Results: In all five cadavers, the sonographic target point was identified in all C3-C7 segments with the 12 to 5 MHz linear transducer. In all 20 needle placements for the first and second cadavers, C-arm fluoroscopy validated proper needle tip positions. In all five cadavers, successful neurotomy was pathologically confirmed in 30 of 34 cervical medial branches. Conclusions: Ultrasound-guided cervical medial branch neurotomy was successfully performed in 30 of 34 cervical medial branches in five cadavers. However, before eliminating fluoroscopic validation of final needle tip positioning, the technique should be validated in symptomatic patients

MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

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Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F. [Charite University Medicine Berlin (Germany). Dept. of Diagnostic and Interventional Radiology; Bretschneider, T. [Magdeburg Univ. (Germany). Dept. of Radiology and Nuclear Medicine; Hartwig, T.; Disch, A.C. [Charite University Medicine Berlin (Germany). Center for Musculoskeletal Surgery

2014-06-15

Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

MRI-guided and CT-guided cervical nerve root infiltration therapy. A cost comparison

International Nuclear Information System (INIS)

Maurer, M.H.; Froeling, V.; Roettgen, R.; Bucourt, M. de; Hamm, B.; Streitparth, F.; Bretschneider, T.; Hartwig, T.; Disch, A.C.

2014-01-01

Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain. Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated. Results: The mean intervention time was 24.9 min. (range: 12-36 min.) for MRI-guided infiltration and 19.7 min. (range: 5-54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76. Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance. (orig.)

An engineering development of fluoroscopic X-ray medical equipment based-on fluorescent screen

International Nuclear Information System (INIS)

Ferry Suyatno; I Putu Susila; Djoko Sukmono

2011-01-01

Fluoroscopic x-ray medical equipment uses fluorescent screen to capture structural image of organs. Unlike conventional x-ray equipment which uses film, in the fluoroscopic x-ray, the resulting image is visualized on the fluorescent screen and directly observed by physicians in the patients' rooms. In this study, we developed an image capture system that transforms the image on the fluorescent screen into digital data, which is then transferred to computer for visualization and further processing. By using this system, the observation of the resulting image can be done on a computer that is placed in the control room. The image can also be stored easily and at low cost compared to conventional film. The experiment shows that the system could be used to capture image of the object. However, its quality needs to be improved. In the future, the system will be modified and tested with different types of cameras to obtain better results. (author)

MR-guided lumbar sympathicolysis

Energy Technology Data Exchange (ETDEWEB)

Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H. [Department of Diagnostic Radiology, University of Tuebingen (Germany); Schneider, Wilke [Department of Vascular Surgery, University of Tuebingen (Germany)

2002-06-01

The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

MR-guided lumbar sympathicolysis

International Nuclear Information System (INIS)

Koenig, Claudius W.; Schott, Ulrich G.; Pereira, Philippe L.; Truebenbach, Jochen; Claussen, Claus D.; Duda, Stephan H.; Schneider, Wilke

2002-01-01

The aim of this study was to demonstrate the feasibility of MR-guided lumbar sympathicolysis (LSL) in a non-selected patient population. One hundred one MR-guided LSL procedures were performed in 89 patients according to Haaga's technique using a horizontally open clinical MR system (0.2 T) and non-ferromagnetic 20-G cannulas (neurolysis, n=93; blockade, n=8). Only gradient-recalled sequences in either single or multislice mode [fast imaging with steady-state precession (FISP) and fast low-angle shot] were applied for anatomical survey and needle guiding. Bupivacaine injection was monitored with MR fluoroscopically. Fluid distribution was subsequently documented in a CT scan in 65 patients. Ninety-one LSL procedures could be successfully completed. Ten patients were not treated using MR due to patient inconvenience, severe motion artifacts (n=4 each), excessive spondylophytes, and retroperitoneal hematoma (n=1 each). One case of ureteral necrosis occurred. Motion artifacts were rated less severe in single-slice FISP sequences and in obese patients. An average of 3.48 sequence measurements were required for definitive needle placement. Average table time was 32.3 min. An MR-guided LSL is feasible and can be performed with acceptable safety and time effort. It can be recommended for repeated sympathetic blockades in younger patients to avoid cumulative irradiation associated with CT guidance. (orig.)

Rationale and design of the NO-PARTY trial: near-zero fluoroscopic exposure during catheter ablation of supraventricular arrhythmias in young patients.

Science.gov (United States)

Casella, Michela; Dello Russo, Antonio; Pelargonio, Gemma; Bongiorni, Maria Grazia; Del Greco, Maurizio; Piacenti, Marcello; Andreassi, Maria Grazia; Santangeli, Pasquale; Bartoletti, Stefano; Moltrasio, Massimo; Fassini, Gaetano; Marini, Massimiliano; Di Cori, Andrea; Di Biase, Luigi; Fiorentini, Cesare; Zecchi, Paolo; Natale, Andrea; Picano, Eugenio; Tondo, Claudio

2012-10-01

Radiofrequency catheter ablation is the mainstay of therapy for supraventricular tachyarrhythmias. Conventional radiofrequency catheter ablation requires the use of fluoroscopy, thus exposing patients to ionising radiation. The feasibility and safety of non-fluoroscopic radiofrequency catheter ablation has been recently reported in a wide range of supraventricular tachyarrhythmias using the EnSite NavX™ mapping system. The NO-PARTY is a multi-centre, randomised controlled trial designed to test the hypothesis that catheter ablation of supraventricular tachyarrhythmias guided by the EnSite NavX™ mapping system results in a clinically significant reduction in exposure to ionising radiation compared with conventional catheter ablation. The study will randomise 210 patients undergoing catheter ablation of supraventricular tachyarrhythmias to either a conventional ablation technique or one guided by the EnSite NavX™ mapping system. The primary end-point is the reduction of the radiation dose to the patient. Secondary end-points include procedural success, reduction of the radiation dose to the operator, and a cost-effectiveness analysis. In a subgroup of patients, we will also evaluate the radiobiological effectiveness of dose reduction by assessing acute chromosomal DNA damage in peripheral blood lymphocytes. NO-PARTY will determine whether radiofrequency catheter ablation of supraventricular tachyarrhythmias guided by the EnSite NavX™ mapping system is a suitable and cost-effective approach to achieve a clinically significant reduction in ionising radiation exposure for both patient and operator.

Radiologic Analysis and Clinical Study of the Upper One-third Joint Technique for Fluoroscopically Guided Sacroiliac Joint Injection.

Science.gov (United States)

Park, Junghyun; Park, Hue Jung; Moon, Dong Eon; Sa, Gye Jeol; Kim, Young Hoon

2015-01-01

Sacroiliac intraarticular injection by the traditional technique can be challenging to perform when the joint is covered with osteophytes or is extremely narrow. To examine whether there is enough space for the needle to be advanced from the L5-S1 interspinous space to the upper one-third sacroiliac joint (SIJ) by magnetic resonance image (MRI) analysis as an alternative to fluoroscopically guided SIJ injection with the lower one-third joint technique, and to determine the feasibility of this novel technique in clinical practice. MRI analysis and observational study. An interventional pain management practice at a university hospital. We analyzed 200 axial T2-weighted MRIs between the L5 and S1 vertebrae of 100 consecutive patients. The following measurements were obtained on both sides: 1) the thickness of fat in the midline; 2) the distance between the midline (Point C) and the junction (Point A) of the skin and the imaginary line that connects the SIJ and the most medial cortex of the ilium; 3) the distance between the midline (Point C) and the junction (Point B) of the skin and the imaginary line that connects the SIJ and the L5 spinous process; 4) the distance between the SIJ and midline (Point C) on the skin, or between the SIJ and the midpoint (Point C') of the line from Point A to Point B; and 5) the angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin. The upper one-third joint technique was performed to establish the feasibility of the alternative technique in 20 patients who had unsuccessful sacroiliac intraarticular injections using the lower one-third joint technique. The mean distances from the midline to Point A and to Point B were 21.9 ± 13.7 mm and 27.8 ± 13.6 mm, respectively. The mean distance between the SIJ and Point C (or Point C') was 81.0 ± 13.3 mm. The angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin was 42.8 ± 5.1°. The success

Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique

Energy Technology Data Exchange (ETDEWEB)

Amoretti, Nicolas; Marcy, Pierre-Yves; Lesbats-Jacquot, Virginie; Fonquerne, Marie-Eve; Maratos, Yvonne [Centre Hospitalier Universitaire de Nice, Radiology Department, Nice (France); Hauger, Olivier [Hopital Pellegrin, Unite d' Imagerie Osteo-articulaire, CHU de Bordeaux (France); Hovorka, Istvan; Boileau, Pascal [Centre Hopitalier Universitaire de Nice, Orthopaedic Department, Nice (France)

2010-01-15

We report on a new minimally invasive technique for the retrieval of a surgical pin fragment after accidental migration into the soft tissue of the shoulder in two patients. The technique is performed under local anaesthesia and uses combined CT and fluoroscopic guidance. The materials used were simple, combining a bone biopsy needle and an endoscopy clamp. Pin displacement was confirmed under fluoroscopic guidance and the clamp was used to withdraw the pin to the cutaneous entry point under CT (step-by-step) guidance. The CT slices provide perfect visualisation of the vascular or nervous structures as well as perfect positioning of the extremity of the trocar relative to the material to be removed. This intervention avoids a second surgical intervention with a longer incision and avoided repeated general anaesthesia. (orig.)

Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer

DEFF Research Database (Denmark)

Rydhog, Jonas Scherman; de Blanck, Steen Riisgaard; Josipovic, Mirjana

2017-01-01

Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course...... of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean...... small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved....

Comparison of MR and fluoroscopic mucous fistulography in the pre-operative evaluation of infants with anorectal malformation: a pilot study

Energy Technology Data Exchange (ETDEWEB)

Alves, Jose C.G.; Lotz, Jan W.; Pitcher, Richard D. [Stellenbosch University, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital, Cape Town (South Africa); Sidler, Daniel [Stellenbosch University, Division of Pediatric Surgery, Department of Surgical Sciences, Tygerberg Academic Hospital, Cape Town (South Africa)

2013-08-15

Anorectal malformations are often associated with rectal pouch fistulas. Surgical correction requires accurate evaluation of the presence and position of such fistulas. Fluoroscopy is currently the chosen modality for the detection of fistulas. The role of MRI is unexplored. To compare the diagnostic accuracy of MR versus fluoroscopic fistulography in the pre-operative evaluation of infants with anorectal malformation. We conducted a pilot study of infants requiring defunctioning colostomy for initial management of anorectal malformation. Dynamic sagittal steady-state free-precession MRI of the pelvis was acquired during introduction of saline into the mucous fistulas. Findings were compared among MR fistulography, fluoroscopic fistulography and intraoperative inspection. Eight children were included. Median age at fistulography was 15 weeks, inter-quartile range 13-20 weeks; all were boys. There was full agreement among MR fistulography, fluoroscopic fistulography and surgical findings. The pilot data suggest that MR fistulography is promising in the pre-operative evaluation of children with anorectal malformation. (orig.)

Radiotherapy verification film for estimating cumulative entrance skin exposure for fluoroscopic examinations

International Nuclear Information System (INIS)

Geise, R.A.; Ansel, H.J.

1990-01-01

Measurement of skin entrance exposures during fluoroscopic procedures is complicated by the use of automatic exposure control devices and the presence of contrast media. Due to variability in positioning spot films from patient to patient, standard dosimeters, such as thermoluminescent, cannot be properly placed on the skin prior to examination. Prepackaged film of the type used for portal verification in radiation therapy held next to the patient's skin in a specially modified patient examination gown was found to be useful for determining the entrance skin exposure from both fluoroscopy and spot films during air contrast barium enema exams. The usable sensitivity range of this film has been found satisfactory for exposure measurements at exposures and kVps typically used for gastrointestinal fluoroscopic procedures. Errors in exposure estimates due to changes in film speed and contrast with kVp are less than 5% for the range of kVps used. Errors from variations in beam quality due to the adjacency of scattering material are approximately 5%. Entrance exposures determined with film agreed with those determined from TLD measurements to within 21%, with an average difference of 9%

Development of a method to calculate organ doses for the upper gastrointestinal fluoroscopic examination

International Nuclear Information System (INIS)

Suleiman, O.H.

1989-01-01

A method was developed to quantitatively measure the upper gastrointestinal fluoroscopic examination in order to calculate organ doses. The dynamic examination was approximated with a set of discrete x-ray fields. Once the examination was segmented into discrete x-ray fields appropriate organ dose tables were generated using an existing computer program for organ dose calculations. This, along with knowledge of the radiation exposures associated with each of the fields, enabled the calculation of organ doses for the entire dynamic examination. The protocol involves videotaping the examination while fluoroscopic technique factors, tube current and tube potential, are simultaneously recorded on the audio tracks of the videotape. Subsequent analysis allows the dynamic examination to be segmented into a series of discrete x-ray fields uniquely defined by field size, projection, and anatomical region. The anatomical regions associated with the upper gastrointestinal examination were observed to be the upper, middle, and lower esophagus, the gastroesophageal junction, the stomach, and the duodenum

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

International Nuclear Information System (INIS)

Kim, Young Hwan; Kim, Yong Joo; Shin, Tae Beom

2011-01-01

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Fluoroscopy-Guided Percutaneous Gallstone Removal Using a 12-Fr Sheath in High-Risk Surgical Patients with Acute Cholecystitis

Energy Technology Data Exchange (ETDEWEB)

Kim, Young Hwan [Keimyung University, College of Medicine, Daegu (Korea, Republic of); Kim, Yong Joo [Andong General Hospital, Andong (Korea, Republic of); Shin, Tae Beom [Gyeonsang National University, College of Medicine, Jinju (Korea, Republic of)

2011-04-15

To evaluate the technical feasibility and clinical efficacy of percutaneous transhepatic cholecystolithotomy under fluoroscopic guidance in high-risk surgical patients with acute cholecystitis. Sixty-three consecutive patients of high surgical risk with acute calculous cholecystitis underwent percutaneous transhepatic gallstone removal under conscious sedation. The stones were extracted through the 12-Fr sheath using a Wittich nitinol stone basket under fluoroscopic guidance on three days after performing a percutaneous cholecystostomy. Large or hard stones were fragmented using either the snare guide wire technique or the metallic cannula technique. Gallstones were successfully removed from 59 of the 63 patients (94%). Reasons for stone removal failure included the inability to grasp a large stone in two patients, and the loss of tract during the procedure in two patients with a contracted gallbladder. The mean hospitalization duration was 7.3 days for acute cholecystitis patients and 9.4 days for gallbladder empyema patients. Bile peritonitis requiring percutaneous drainage developed in two patients. No symptomatic recurrence occurred during follow-up (mean, 608.3 days). Fluoroscopy-guided percutaneous gallstone removal using a 12-Fr sheath is technically feasible and clinically effective in high-risk surgical patients with acute cholecystitis

Radiation brain dose to vascular surgeons during fluoroscopically guided interventions is not effectively reduced by wearing lead equivalent surgical caps.

Science.gov (United States)

Kirkwood, Melissa L; Arbique, Gary M; Guild, Jeffrey B; Zeng, Katie; Xi, Yin; Rectenwald, John; Anderson, Jon A; Timaran, Carlos

2018-03-12

Radiation to the interventionalist's brain during fluoroscopically guided interventions (FGIs) may increase the incidence of cerebral neoplasms. Lead equivalent surgical caps claim to reduce radiation brain doses by 50% to 95%. We sought to determine the efficacy of the RADPAD (Worldwide Innovations & Technologies, Lenexa, Kan) No Brainer surgical cap (0.06 mm lead equivalent at 90 kVp) in reducing radiation dose to the surgeon's and trainee's head during FGIs and to a phantom to determine relative brain dose reductions. Optically stimulated, luminescent nanoDot detectors (Landauer, Glenwood, Ill) inside and outside of the cap at the left temporal position were used to measure cap attenuation during FGIs. To check relative brain doses, nanoDot detectors were placed in 15 positions within an anthropomorphic head phantom (ATOM model 701; CIRS, Norfolk, Va). The phantom was positioned to represent a primary operator performing femoral access. Fluorography was performed on a plastic scatter phantom at 80 kVp for an exposure of 5 Gy reference air kerma with or without the hat. For each brain location, the percentage dose reduction with the hat was calculated. Means and standard errors were calculated using a pooled linear mixed model with repeated measurements. Anatomically similar locations were combined into five groups: upper brain, upper skull, midbrain, eyes, and left temporal position. This was a prospective, single-center study that included 29 endovascular aortic aneurysm procedures. The average procedure reference air kerma was 2.6 Gy. The hat attenuation at the temporal position for the attending physician and fellow was 60% ± 20% and 33% ± 36%, respectively. The equivalent phantom measurements demonstrated an attenuation of 71% ± 2.0% (P < .0001). In the interior phantom locations, attenuation was statistically significant for the skull (6% ± 1.4%) and upper brain (7.2% ± 1.0%; P < .0001) but not for the middle brain (1.4% ± 1.0%; P = .15

Entrapment of Guide Wire in an Inferior Vena Cava Filter: A Technique for Removal

International Nuclear Information System (INIS)

Abdel-Aal, Ahmed Kamel; Saddekni, Souheil; Hamed, Maysoon Farouk; Fitzpatrick, Farley

2013-01-01

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of vena cava filters (VCFs), this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. We describe a case in which a J-tipped guide wire introduced through a left subclavian access without fluoroscopic guidance during CVC placement was entrapped at the apex of an IVC filter. We describe a technique that we used successfully in removing the entrapped wire through the left subclavian access site. We also present simple useful recommendations to prevent this complication.

Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein.

Science.gov (United States)

Ansari, Md Abu Masud; Kumar, Naveen; Kumar, Shailesh; Kumari, Sarita

2016-10-01

Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.

High-speed rotary atherectomy under fluoroscopic and angioscopic guidance

International Nuclear Information System (INIS)

Deutsch, L.S.; Ahn, S.S.; Yeatman, L.A.; Marcus, D.R.; Auth, D.P.; Moore, W.S.

1988-01-01

This paper describes thirteen stenotic arteries treated by high-speed rotary abrasive burr atherectomy performed in the operating room under fluoroscopic-angioscopic control by a multidisciplinary team consisting of a vascular surgeon, an interventional radiologist, and an interventional cardiologist. Incrementally sized atherectomy burrs were used in each patient (1.75-4.0 mm in diameter). Rotary artherectomy was successful in 11 of 13 arteries ranging from 1 to 40 cm (median, 5 cm) with stenoses ranging from 50% to 99% (median, 90%), which improved to less than 30% in all 11 successfully atherectomized segments. Two early posttreatment failures (intimal dissection, burr shaft disruption), two posttreatment thromboses (unrelated to atherectomy), and two late failures (restenosis) occurred

Percutaneous interventional forceps removal of radiopaque foreign bodies in soft-tissue under fluoroscopic guidance

International Nuclear Information System (INIS)

Yang Xiujun; Xing Guangfu; Shi Changwen; Li Wei

2011-01-01

Objective: To evaluate the clinical value and limitations of percutaneous interventional forceps retrieval technique under fluoroscopic guidance in removing radiopaque foreign bodies in soft-tissue. Methods: A total of 4 105 consecutive soft-tissue injury patients with radiopaque foreign bodies, encountered in authors' hospital during the period from June 2005 to June 2010, were involved in this study. The diagnosis was confirmed by plain X-ray films in all patients. Additional CT scanning was performed in 1 591 patients, in some of them 3D reconstruction was adopted. With local anesthesia percutaneous interventional forceps retrieval of radiopaque foreign bodies (PIRFB) was carried out under C-arm video-fluoroscopic guidance. Results: Of all patients in this study, 61.34% (2 518/4 105) was treated by PIRFB (study group), and 38.66% (1 587/4 105) was not treated with PIRFB (control group). In study group,the complete and partial curative rate was 95.07% (2 394/2 518) and 4.81% (121/2 518) respectively, and the failure rate was 0.12% (3/2 518). Of 1 587 patients in control group, 25.02% (n=397) left hospital by patient's own reasons and 74.98% (n=1190) was discharged from hospital due to medical or technical reasons. In control group,the foreign objects were close to big vessels in 65.22% (1 035/1 587), large local hematoma was accompanied in 2.90% (46/1 587), associated traumatic pseudoaneurysm was seen in 1.32% (21/1 587) and the foreign objects were glass pieces and the like were found in 5.55% (88/1 587). No serious postoperative complications that required specific therapy, such as bleeding, infection and nerve damage, etc. occurred. CT, especially enhanced CT three-dimensional images, could precisely display the vasculatures nearby the foreign body, which helped make the correct judgment of the removal ability and the operation risk for foreign bodies with interventional procedure. Conclusion: Percutaneous interventional forceps retrieval technique under

Leaded eyeglasses substantially reduce radiation exposure of the surgeon's eyes during acquisition of typical fluoroscopic views of the hip and pelvis.

Science.gov (United States)

Burns, Sean; Thornton, Raymond; Dauer, Lawrence T; Quinn, Brian; Miodownik, Daniel; Hak, David J

2013-07-17

Despite recommendations to do so, few orthopaedists wear leaded glasses when performing operative fluoroscopy. Radiation exposure to the ocular lens causes cataracts, and regulatory limits for maximum annual occupational exposure to the eye continue to be revised downward. Using anthropomorphic patient and surgeon phantoms, radiation dose at the surgeon phantom's lens was measured with and without leaded glasses during fluoroscopic acquisition of sixteen common pelvic and hip views. The magnitude of lens dose reduction from leaded glasses was calculated by dividing the unprotected dose by the dose measured behind leaded glasses. On average, the use of leaded glasses reduced radiation to the surgeon phantom's eye by tenfold, a 90% reduction in dose. However, there was widespread variation in the amount of radiation that reached the phantom surgeon's eye among the various radiographic projections we studied. Without leaded glasses, the dose measured at the surgeon's lens varied more than 250-fold among these sixteen different views. In addition to protecting the surgeon's eye from the deleterious effects of radiation, the use of leaded glasses could permit an orthopaedist to perform fluoroscopic views on up to ten times more patients before reaching the annual dose limit of 20 mSv of radiation to the eye recommended by the International Commission on Radiological Protection. Personal safety and adherence to limits of occupational radiation exposure should compel orthopaedists to wear leaded glasses for fluoroscopic procedures if other protective barriers are not in use. Leaded glasses are a powerful tool for reducing the orthopaedic surgeon's lens exposure to radiation during acquisition of common intraoperative fluoroscopic views.

Fluoroscopically guided transforaminal epidural steroid injections at a quaternary-care teaching institution: effect of trainee involvement and patient body mass index on fluoroscopy time and patient dose

International Nuclear Information System (INIS)

Tiegs-Heiden, C.A.; Murthy, N.S.; Geske, J.R.; Diehn, F.E.; Schueler, B.A.; Wald, J.T.; Kaufmann, T.J.; Lehman, V.T.; Carr, C.M.; Amrami, K.K.; Morris, J.M.; Thielen, K.R.; Maus, T.P.

2016-01-01

Aim: To investigate whether there are differences in fluoroscopy time and patient dose for fluoroscopically guided lumbar transforaminal epidural steroid injections (TFESIs) performed by staff radiologists versus with trainees and to evaluate the effect of patient body mass index (BMI) on fluoroscopy time and patient dose, including their interactions with other variables. Materials and methods: Single-level lumbar TFESIs (n=1844) between 1 January 2011 and 31 December 2013 were reviewed. Fluoroscopy time, reference point air kerma (K_a_,_r), and kerma area product (KAP) were recorded. BMI and trainee involvement were examined as predictors of fluoroscopy time, K_a_,_r, and KAP in models adjusted for age and gender in multivariable linear models. Stratified models of BMI groups by trainee presence were performed. Results: Increased age was the only significant predictor of increased fluoroscopy time (p<0.0001). K_a_,_r and KAP were significantly higher in patients with a higher BMI (p<0.0001 and p=0.0009). When stratified by BMI, longer fluoroscopy time predicted increased K_a_,_r and KAP in all groups (p<0.0001). Trainee involvement was not a statistically significant predictor of fluoroscopy time or K_a_,_r in any BMI category. KAP was lower with trainees in the overweight group (p=0.0009) and higher in male patients for all BMI categories (p<0.02). Conclusion: Trainee involvement did not result in increased fluoroscopy time or patient dose. BMI did not affect fluoroscopy time; however, overweight and obese patients received significantly higher K_a_,_r and KAP. Male patients received a higher KAP in all BMI categories. Limiting fluoroscopy time and good collimation practices should be reinforced in these patients. - Highlights: • Trainee involvement did not contribute to increased fluoroscopy time or dose. • BMI did not affect fluoroscopy time. • Overweight and obese patients received significantly higher Ka,r and KAP.

Lung tumor tracking in fluoroscopic video based on optical flow

International Nuclear Information System (INIS)

Xu Qianyi; Hamilton, Russell J.; Schowengerdt, Robert A.; Alexander, Brian; Jiang, Steve B.

2008-01-01

Respiratory gating and tumor tracking for dynamic multileaf collimator delivery require accurate and real-time localization of the lung tumor position during treatment. Deriving tumor position from external surrogates such as abdominal surface motion may have large uncertainties due to the intra- and interfraction variations of the correlation between the external surrogates and internal tumor motion. Implanted fiducial markers can be used to track tumors fluoroscopically in real time with sufficient accuracy. However, it may not be a practical procedure when implanting fiducials bronchoscopically. In this work, a method is presented to track the lung tumor mass or relevant anatomic features projected in fluoroscopic images without implanted fiducial markers based on an optical flow algorithm. The algorithm generates the centroid position of the tracked target and ignores shape changes of the tumor mass shadow. The tracking starts with a segmented tumor projection in an initial image frame. Then, the optical flow between this and all incoming frames acquired during treatment delivery is computed as initial estimations of tumor centroid displacements. The tumor contour in the initial frame is transferred to the incoming frames based on the average of the motion vectors, and its positions in the incoming frames are determined by fine-tuning the contour positions using a template matching algorithm with a small search range. The tracking results were validated by comparing with clinician determined contours on each frame. The position difference in 95% of the frames was found to be less than 1.4 pixels (∼0.7 mm) in the best case and 2.8 pixels (∼1.4 mm) in the worst case for the five patients studied.

PET/CT-guided Interventions: Personnel Radiation Dose

Energy Technology Data Exchange (ETDEWEB)

Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States); Hsu, Meier [Memorial Sloan-Kettering Cancer Center, Department of Epidemiology and Biostatistics (United States); Quinn, Brian; Dauer, Lawrence T. [Memorial Sloan-Kettering Cancer Center, Department of Medical Physics (United States); Solomon, Stephen B. [Memorial Sloan-Kettering Cancer Center, Department of Radiology (United States)

2013-08-01

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.

Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy

International Nuclear Information System (INIS)

Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Awai, Kazuo; Matsumoto, Tomohiro; Hasebe, Terumitsu; Kakizawa, Hideaki; Toyoda, Naoyuki

2014-01-01

This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. (orig.)

Effectiveness of combined use of imprint cytological and histological examination in CT-guided tissue-core biopsy

Energy Technology Data Exchange (ETDEWEB)

Yamagami, Takuji; Yoshimatsu, Rika; Kajiwara, Kenji; Ishikawa, Masaki; Awai, Kazuo [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Matsumoto, Tomohiro; Hasebe, Terumitsu [Tokai University Hachioji Hospital, Tokai University School of Medicine, Department of Radiology, Hachioji, Tokyo (Japan); Kakizawa, Hideaki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Department of Diagnostic Radiology, Naka-Ku, Hiroshima (Japan); Toyoda, Naoyuki [Hiroshima University, Department of Diagnostic Radiology, Institute and Graduate School of Biomedical Sciences, Minami-Ku, Hiroshima (Japan); National Hospital Organisation Kure Medical Centre, Department of Diagnostic Radiology, Kure, Hiroshima (Japan)

2014-05-15

This study evaluated the efficacy of the combination of imprint cytology and histology in tissue-core percutaneous biopsy under real-time computed tomography (CT) fluoroscopic guidance. Between October 2009 and June 2013, 156 percutaneous needle biopsies were performed in our institution. Those obtained by tissue-core biopsy underwent both imprint cytological and histological examinations routinely after touch imprint cytology was performed on site to evaluate the samples' sufficiency for cytological and pathological examination. Final diagnosis was confirmed by independent surgical pathology, independent culture results or clinical follow-up. Rates of adequate specimens and precise diagnosis, by combined cytological and histological examination were 100 % (156/156) and 96.2 % (150/156), by cytology 94.4 % (152/156) and 83.3 % (130/156) and by histology 99.3 % (155/156) and 92.3 % (144/156). Precise diagnosis was achieved by combined examinations in 94.7 % (89/94) of thoracic lesions, 97.6 % (40/41) of musculoskeletal lesions, and 100 % (21/21) of abdominal, pelvic and retroperitoneal lesions. In all 104 lesions diagnosed as malignant by CT-guided biopsy and in 30 of 52 diagnosed as benign, specific cell types could be proved by combined examinations. Combined imprint cytology and histology performed after on-site touch imprint cytological evaluation improved the diagnostic ability of CT fluoroscopically guided biopsy. (orig.)

SU-G-IeP3-05: Effects of Image Receptor Technology and Dose Reduction Software On Radiation Dose Estimates for Fluoroscopically-Guided Interventional (FGI) Procedures

Energy Technology Data Exchange (ETDEWEB)

Merritt, Z; Dave, J; Eschelman, D; Gonsalves, C [Thomas Jefferson University, Philadelphia, PA (United States)

2016-06-15

Purpose: To investigate the effects of image receptor technology and dose reduction software on radiation dose estimates for most frequently performed fluoroscopically-guided interventional (FGI) procedures at a tertiary health care center. Methods: IRB approval was obtained for retrospective analysis of FGI procedures performed in the interventional radiology suites between January-2011 and December-2015. This included procedures performed using image-intensifier (II) based systems which were subsequently replaced, flat-panel-detector (FPD) based systems which were later upgraded with ClarityIQ dose reduction software (Philips Healthcare) and relatively new FPD system already equipped with ClarityIQ. Post procedure, technologists entered system-reported cumulative air kerma (CAK) and kerma-area product (KAP; only KAP for II based systems) in RIS; these values were analyzed. Data pre-processing included correcting typographical errors and cross-verifying CAK and KAP. The most frequent high and low dose FGI procedures were identified and corresponding CAK and KAP values were compared. Results: Out of 27,251 procedures within this time period, most frequent high and low dose procedures were chemo/immuno-embolization (n=1967) and abscess drainage (n=1821). Mean KAP for embolization and abscess drainage procedures were 260,657, 310,304 and 94,908 mGycm{sup 2}, and 14,497, 15,040 and 6307 mGycm{sup 2} using II-, FPD- and FPD with ClarityIQ- based systems, respectively. Statistically significant differences were observed in KAP values for embolization procedures with respect to different systems but for abscess drainage procedures significant differences were only noted between systems with FPD and FPD with ClarityIQ (p<0.05). Mean CAK reduced significantly from 823 to 308 mGy and from 43 to 21 mGy for embolization and abscess drainage procedures, respectively, in transitioning to FPD systems with ClarityIQ (p<0.05). Conclusion: While transitioning from II- to FPD- based

Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery.

Science.gov (United States)

Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2017-08-01

Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS's navigation system overcoming the earlier version's issues, aiming to move the RAFS system into a surgical environment. The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about [Formula: see text] (phantom) and [Formula: see text] (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error [Formula: see text], [Formula: see text]. Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.

Training Distal Locking Screw Insertion Skills to Novice Trainees: A Comparison Between Fluoroscopic- and Electromagnetic-Guided Techniques.

Science.gov (United States)

Leroux, Timothy; Khoshbin, Amir; Nousiainen, Markku T

2015-10-01

To compare the effect fluoroscopy or electromagnetic (EM) guidance has on the learning of locking screw insertion in tibial nails in surgical novices. A randomized, prospective, controlled trial was conducted involving 18 surgical trainees with no prior experience inserting locking screws in intramedullary nails. After a training session using fluoroscopy, participants underwent a pretest using fluoroscopic guidance. Participants were then randomized into either the fluoroscopy or EM group and were further trained using their respective technique. Post, retention, and transfer tests were conducted. Outcomes included task completion, drill attempts, screw changes, and radiation time. Intragroup comparisons revealed that the EM group used significantly less drill attempts during the post and retention tests compared with the pretest (P = 0.016 and P = 0.016, respectively). Intergroup comparisons revealed that the EM group was (1) more likely to complete the task during the retention test (P = 0.043) and (2) had significantly less radiation time during the post and retention tests (P = 0.002 and P = 0.003, respectively). Radiation time in the EM group during the transfer test increased to a level equal to what the fluoroscopy group used during the post and retention tests (P = 0.71 and P = 0.92, respectively). No other significant between-group differences occurred. EM guidance may be safely used to assist in the training of surgical novices in the skill of distal locking screw insertion. Not only does this technology significantly improve the ability to complete the task and decrease radiation use but also it does so without compromising skill acquisition. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Fluoroscopic extraction of esophageal foreign body

International Nuclear Information System (INIS)

Chon, Su Bin; Han, Young Min; Chung, Gyung Ho; Sohn, Myung Hee; Kim, Chong Soo; Choi, Ki Chul; Song, Young Ho; Choi, Yeon Wha

1993-01-01

The purpose of this study is to report our 5 year experience with fluoroscopic removal of blunt esophageal foreign body or impacted food in 15 consecutive patients who were referred by endoscopists because they couln't remove it endoscopically. The foreign body or impacted food was a piece of meat, a bean, a badug stone or a beef bone. Thirteen patients had underlying disease (11 of corrosive stricture, 2 of postopertive stricture) but 2 patient did not. We removed the object using one of the following 4 techniques: Basket extraction technique. Foley catheter technique, single balloon technique (dilatation of stenosis for passing the food into the stomach and for the treatment of the stricture as well), double balloon technique (removal of the foregin body by trapping it with two valvuloplasty balloons). Removal was successful in all patients. Esophageal performation occurred in one patient using the sibgle balloon technique, who treated nonoperatively by means of fasting, antibiotics and parenteral alimentation. No procedure related death occurred in these series. In conclusion, fliuroscopic removal of blunt esophageal foreign bodies of impacted food with various techniques is promising alternative to esophagoscopic removal

Ultrasonographic-guided, percutaneous antegarde pyelography: technique and clinical application in the dog and cat

International Nuclear Information System (INIS)

Rivers, B.J.; Walter, P.A.; Polzin, D.J.

1997-01-01

Fluoroscopically guided, percutaneous antegrade pyelography in canine patients has been described previously in the veterinary literature. This report describes the technique with ultrasonographic guidance and its clinical application in the diagnosis of four cases (two dogs, two cats) of obstructive uropathy. The technique provided successful diagnosis of ureteral obstruction in all four cases. No complications were observed in three cases. In one feline case, ureteral obstruction with a blood clot occurred following the procedure; however, it could not be ascertained whether this event represented a complication of the technique

SU-G-JeP1-11: Feasibility Study of Markerless Tracking Using Dual Energy Fluoroscopic Images for Real-Time Tumor-Tracking Radiotherapy System

Energy Technology Data Exchange (ETDEWEB)

Shiinoki, T; Shibuya, K [Yamaguchi University, Ube, Yamaguchi (Japan); Sawada, A [Kyoto college of medical science, Nantan, Kyoto (Japan); Uehara, T; Yuasa, Y; Koike, M; Kawamura, S [Yamaguchi University Hospital, Ube, Yamaguchi (Japan)

2016-06-15

Purpose: The new real-time tumor-tracking radiotherapy (RTRT) system was installed in our institution. This system consists of two x-ray tubes and color image intensifiers (I.I.s). The fiducial marker which was implanted near the tumor was tracked using color fluoroscopic images. However, the implantation of the fiducial marker is very invasive. Color fluoroscopic images enable to increase the recognition of the tumor. However, these images were not suitable to track the tumor without fiducial marker. The purpose of this study was to investigate the feasibility of markerless tracking using dual energy colored fluoroscopic images for real-time tumor-tracking radiotherapy system. Methods: The colored fluoroscopic images of static and moving phantom that had the simulated tumor (30 mm diameter sphere) were experimentally acquired using the RTRT system. The programmable respiratory motion phantom was driven using the sinusoidal pattern in cranio-caudal direction (Amplitude: 20 mm, Time: 4 s). The x-ray condition was set to 55 kV, 50 mA and 105 kV, 50 mA for low energy and high energy, respectively. Dual energy images were calculated based on the weighted logarithmic subtraction of high and low energy images of RGB images. The usefulness of dual energy imaging for real-time tracking with an automated template image matching algorithm was investigated. Results: Our proposed dual energy subtraction improve the contrast between tumor and background to suppress the bone structure. For static phantom, our results showed that high tracking accuracy using dual energy subtraction images. For moving phantom, our results showed that good tracking accuracy using dual energy subtraction images. However, tracking accuracy was dependent on tumor position, tumor size and x-ray conditions. Conclusion: We indicated that feasibility of markerless tracking using dual energy fluoroscopic images for real-time tumor-tracking radiotherapy system. Furthermore, it is needed to investigate the

Reduction of radiation exposure while maintaining high-quality fluoroscopic images during interventional cardiology using novel x-ray tube technology with extra beam filtering.

Science.gov (United States)

den Boer, A; de Feyter, P J; Hummel, W A; Keane, D; Roelandt, J R

1994-06-01

Radiographic technology plays an integral role in interventional cardiology. The number of interventions continues to increase, and the associated radiation exposure to patients and personnel is of major concern. This study was undertaken to determine whether a newly developed x-ray tube deploying grid-switched pulsed fluoroscopy and extra beam filtering can achieve a reduction in radiation exposure while maintaining fluoroscopic images of high quality. Three fluoroscopic techniques were compared: continuous fluoroscopy, pulsed fluoroscopy, and a newly developed high-output pulsed fluoroscopy with extra filtering. To ascertain differences in the quality of images and to determine differences in patient entrance and investigator radiation exposure, the radiated volume curve was measured to determine the required high voltage levels (kVpeak) for different object sizes for each fluoroscopic mode. The fluoroscopic data of 124 patient procedures were combined. The data were analyzed for radiographic projections, image intensifier field size, and x-ray tube kilovoltage levels (kVpeak). On the basis of this analysis, a reference procedure was constructed. The reference procedure was tested on a phantom or dummy patient by all three fluoroscopic modes. The phantom was so designed that the kilovoltage requirements for each projection were comparable to those needed for the average patient. Radiation exposure of the operator and patient was measured during each mode. The patient entrance dose was measured in air, and the operator dose was measured by 18 dosimeters on a dummy operator. Pulsed compared with continuous fluoroscopy could be performed with improved image quality at lower kilovoltages. The patient entrance dose was reduced by 21% and the operator dose by 54%. High-output pulsed fluoroscopy with extra beam filtering compared with continuous fluoroscopy improved the image quality, lowered the kilovoltage requirements, and reduced the patient entrance dose by 55% and

Fluoroscopic-guided radiofrequency ablation of the basivertebral nerve: application and analysis with multiple imaging modalities in an ovine model (Invited Paper)

Science.gov (United States)

Bergeron, Jeffrey A.; Eskey, Cliff J.; Attawia, Mohammed; Patel, Samit J.; Ryan, Thomas P.; Pellegrino, Richard; Sutton, Jeffrey; Crombie, John; Paul, B. T.; Hoopes, P. J.

2005-04-01

Pathologic involvement of the basivertebral nerve, an intraosseous vertebral nerve found in humans and most mammalian species, may play a role in some forms of back pain. This study was designed to assess the feasibility and effects of the percutaneous delivery of radiofrequency (RF) energy to thermally ablate the basivertebral nerve in the lumbar vertebrae of mature sheep. Using fluoroscopic guidance, a RF bipolar device was placed and a thermal dose delivered to lumbar vertebral bodies in sheep. Post-treatment assessment included multiple magnetic resonance imaging (MRI) techniques and computed tomography (CT). These data were analyzed and correlated to histopathology and morphometry findings to describe the cellular and boney structural changes resulting from the treatment. Imaging modalities MRI and CT can be implemented to non-invasively describe treatment region and volume, marrow cellular effects, and bone density alterations immediately following RF treatment and during convalescence. Such imaging can be utilized to assess treatment effects and refine the thermal dose to vertebral body volume ratio used in treatment planning. This information will be used to improve the therapeutic ratio and develop a treatment protocol for human applications.

Spontaneous rotation of the monorail-type guide extension support catheter during advancement of a curved guiding catheter: the potential hazard of twisting with the coronary guidewire.

Science.gov (United States)

Hashimoto, Sho; Takahashi, Akihiko; Yamada, Takeshi; Mizuguchi, Yukio; Taniguchi, Norimasa; Hata, Tetsuya; Nakajima, Shunsuke

2017-11-20

The extension support guiding catheter has been used to perform complex percutaneous coronary intervention to increase back-up support for the guiding catheter or to ensure deep intubation for device delivery. However, because of its monorail design, advancement of the stent into the distal extension tubing segment is sometimes problematic. Although this problem is considered due to simple collision of the stent, operators have observed tangling between a monorail extension catheter and coronary guidewire in some patients. To examine movement of the collar of the extension guide catheter during advancement of the guiding catheter, we set up an in vitro model in which the guiding catheter had two curves. Rotation of the extension guide catheter was examined by both fluoroscopic imaging and movement of the hub of the proximal end of the catheter. During advancement in the first curve, the collar moved toward the outer side of the curve of the guiding catheter as the operator pushed the shaft of the extension guiding catheter, which overrode the guidewire. After crossing the first curve, the collar moved again to the outer side of the second curve (the inner side of the first curve) of the mother catheter, and then, another clockwise rotation was observed in the proximal hub. Consequently, the collar and tubing portion of the extension guide catheter rotated 360° around the coronary guidewire, and the monorail extension catheter and guidewire became tangled. There is a potential risk of unintentional twisting with the guidewire during advancement into the curved guiding catheter because of its monorail design.

Selecting appropriate gastroenteric contrast media for diagnostic fluoroscopic imaging in infants and children: a practical approach.

Science.gov (United States)

Callahan, Michael J; Talmadge, Jennifer M; MacDougall, Robert D; Kleinman, Patricia L; Taylor, George A; Buonomo, Carlo

2017-04-01

In our experience, questions about the appropriate use of enteric contrast media for pediatric fluoroscopic studies are common. The purpose of this article is to provide a comprehensive review of enteric contrast media used for pediatric fluoroscopy, highlighting the routine use of these media at a large tertiary care pediatric teaching hospital.

SU-D-209-01: Can Fluoroscopic Air-Kerma Rates Be Reliably Measured with Solid-State Meters?

International Nuclear Information System (INIS)

Feng, C; Thai, L; Wagner, L; Ozus, B

2016-01-01

Purpose: Ionization chambers remain the standard for calibration of air-kerma rate measuring devices. Despite their strong energy-dependent response, solid state radiation detectors are increasingly used, primarily due to their efficiency in making standardized measurements. To test the reliability of these devices in measuring air-kerma rates, we compared ion chambers measurements with solid-state measurements for various mobile fluoroscopes operated at different beam qualities and air-kerma rates. Methods: Six mobile fluoroscopes (GE OEC models 9800 and 9900) were used to generate test beams. Using various field sizes and dose rate controls, copper attenuators and a lead attenuator were placed at the image receptor in varying combinations to generate a range of air-kerma rates. Air-kerma rates at 30 centimeters from the image receptors were measured using two 6-cm"3 ion chambers with electrometers (Radcal, models 1015 and 9015) and two with solid state detectors (Unfors Xi and Raysafe X2). No error messages occurred during measurements. However, about two months later, one solid-state device stopped working and was replaced by the manufacturer. Two out of six mobile fluoroscopic units were retested with the replacement unit. Results: Generally, solid state and ionization chambers agreed favorably well, with two exceptions. Before replacement of the detector, the Xi meter when set in the “RF High” mode deviated from ion chamber readings by factors of 2 and 10 with no message indicating error in measurement. When set in the “RF Low” mode, readings were within −4% to +3%. The replacement Xi detector displayed messages alerting the user when settings were not compatible with air-kerma rates. Conclusion: Air-kerma rates can be measured favorably well using solid-state devices, but users must be aware of the possibility that readings can be grossly in error with no discernible indication for the deviation.

SU-D-209-01: Can Fluoroscopic Air-Kerma Rates Be Reliably Measured with Solid-State Meters?

Energy Technology Data Exchange (ETDEWEB)

Feng, C; Thai, L; Wagner, L [The University of Texas Health Science Center at Houston, Houston, TX (United States); Ozus, B [CHI St Luke’s Health, Baylor St Luke’s Medical Center, Houston, TX (United States)

2016-06-15

Purpose: Ionization chambers remain the standard for calibration of air-kerma rate measuring devices. Despite their strong energy-dependent response, solid state radiation detectors are increasingly used, primarily due to their efficiency in making standardized measurements. To test the reliability of these devices in measuring air-kerma rates, we compared ion chambers measurements with solid-state measurements for various mobile fluoroscopes operated at different beam qualities and air-kerma rates. Methods: Six mobile fluoroscopes (GE OEC models 9800 and 9900) were used to generate test beams. Using various field sizes and dose rate controls, copper attenuators and a lead attenuator were placed at the image receptor in varying combinations to generate a range of air-kerma rates. Air-kerma rates at 30 centimeters from the image receptors were measured using two 6-cm{sup 3} ion chambers with electrometers (Radcal, models 1015 and 9015) and two with solid state detectors (Unfors Xi and Raysafe X2). No error messages occurred during measurements. However, about two months later, one solid-state device stopped working and was replaced by the manufacturer. Two out of six mobile fluoroscopic units were retested with the replacement unit. Results: Generally, solid state and ionization chambers agreed favorably well, with two exceptions. Before replacement of the detector, the Xi meter when set in the “RF High” mode deviated from ion chamber readings by factors of 2 and 10 with no message indicating error in measurement. When set in the “RF Low” mode, readings were within −4% to +3%. The replacement Xi detector displayed messages alerting the user when settings were not compatible with air-kerma rates. Conclusion: Air-kerma rates can be measured favorably well using solid-state devices, but users must be aware of the possibility that readings can be grossly in error with no discernible indication for the deviation.

Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty

Energy Technology Data Exchange (ETDEWEB)

Smith, Joshua R.; Marsh, Rebecca M.; Silosky, Michael S. [University of Colorado School of Medicine, Department of Radiology, Aurora, CO (United States)

2018-01-15

To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions - phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose. (orig.)

Is lead shielding of patients necessary during fluoroscopic procedures? A study based on kyphoplasty

International Nuclear Information System (INIS)

Smith, Joshua R.; Marsh, Rebecca M.; Silosky, Michael S.

2018-01-01

To determine the benefits, risks, and limitations associated with wrapping a patient with lead shielding during fluoroscopy-guided kyphoplasty procedures as a way to reduce operator radiation exposure. An anthropomorphic phantom was used to mimic a patient undergoing a kyphoplasty procedure under fluoroscopic guidance. Radiation measurements of the air kerma rate (AKR) were made at several locations and under various experimental conditions. First, AKR was measured at various angles along the horizontal plane of the phantom and at varying distances from the phantom, both with and without a lead apron wrapped around the lower portion of the phantom (referred to here as phantom shielding). Second, the effect of an operator's apron was simulated by suspending a lead apron between the phantom and the measurement device. AKR was measured for the four shielding conditions - phantom shielding only, operator apron only, both phantom shielding and operator apron, and no shielding. Third, AKR measurements were made at various heights and with varying C-arm angle. At all locations, the phantom shielding provided no substantial protection beyond that provided by an operator's own lead apron. Phantom shielding did not reduce AKR at a height comparable to that of an operator's head. Previous reports of using patient shielding to reduce operator exposure fail to consider the role of an operator's own lead apron in radiation protection. For an operator wearing appropriate personal lead apparel, patient shielding provides no substantial reduction in operator dose. (orig.)

Percutaneous Transhepatic Drainage of Inaccessible Abdominal Abscesses Following Abdominal Surgery Under Real-Time CT-Fluoroscopic Guidance

International Nuclear Information System (INIS)

Yamakado, Koichiro; Takaki, Haruyuki; Nakatsuka, Atsuhiro; Kashima, Masataka; Uraki, Junji; Yamanaka, Takashi; Takeda, Kan

2010-01-01

This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 ± 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 ± 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.

Ultrasound guided transrectal catheter drainage of pelvic collections.

Science.gov (United States)

Thakral, Anuj; Sundareyan, Ramaniwas; Kumar, Sheo; Arora, Divya

2015-01-01

The transrectal approach to draining deep-seated pelvic collections may be used to drain The transrectal approach to draining deep-seated pelvic collections may be used to drain intra-abdominal collections not reached by the transabdominal approach. We discuss 6 patients with such pelvic collections treated with transrectal drainage using catheter placement via Seldinger technique. Transrectal drainage helped achieve clinical and radiological resolution of pelvic collections in 6 and 5 of 6 cases, respectively. It simultaneously helped avoid injury to intervening bowel loops and neurovascular structures using real-time visualization of armamentarium used for drainage. Radiation exposure from fluoroscopic/CT guidance was avoided. Morbidity and costs incurred in surgical exploration were reduced using this much less invasive ultrasound guided transrectal catheter drainage of deep-seated pelvic collections.

PET/CT-guided Interventions: Personnel Radiation Dose

International Nuclear Information System (INIS)

Ryan, E. Ronan; Thornton, Raymond; Sofocleous, Constantinos T.; Erinjeri, Joseph P.; Hsu, Meier; Quinn, Brian; Dauer, Lawrence T.; Solomon, Stephen B.

2013-01-01

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0–0.13) mSv for the primary operator, 0.01 (range 0–0.05) mSv for the nurse anesthetist, and 0.02 (range 0–0.05) mSv for the radiology technologist. The median extremity dose equivalent for the operator was 0.05 (range 0–0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient

Lower radiation burden in state of the art fluoroscopic cystography compared to direct isotope cystography in children.

Science.gov (United States)

Haid, Bernhard; Becker, Tanja; Koen, Mark; Berger, Christoph; Langsteger, Werner; Gruy, Bernhard; Putz, Ernst; Haid, Stephanie; Oswald, Josef

2015-02-01

Both, fluoroscopic voiding cystourethrography (fVCUG) and direct isotope cystography (DIC) are diagnostic tools commonly used in pediatric urology. Both methods can detect vesicoureteral reflux (VUR) with a high sensitivity. Whilst the possibility to depict anatomical details and important structures as for instance the urethra in boys or the detailed calyceal anatomy are advantages of fVCUG, a lower radiation burden is thought to be the main advantage of DIC. In the last decade, however, a rapid technical evolution has occurred in fluoroscopy by implementing digital grid-controlled, variable rate, pulsed acquisition technique. As documented in literature this led to a substantial decrease in radiation burden conferred during fVCUGs. To question the common belief that direct isotope cystography confers less radiation burden compared to state of the art fluoroscopic voiding cystography. Radiation burden of direct isotope cystography in 92 children and in additional 7 children after an adaption of protocol was compared to radiation burden of fluoroscopic voiding cystourethrography in 51. The examinations were performed according to institutional protocols. For calculation of mean effective radiation dose [mSv] for either method published physical models correcting for age and sex were used. For DIC the model published by Stabin et al., 1998 was applied, for fVCUG two different physical models were used (Schultz et al., 1999, Lee et al., 2009). The radiation burden conferred by direct isotope cystography was significantly higher as for fluoroscopic voiding cystourethrography. The mean effective radiation dose for direct isotope cystography accounted to 0.23 mSv (± 0.34 m, median 0.085 mSv) compared to 0.015 mSv (± 0.013, median 0.008 mSv, model by Schultz et al.) - 0.024 mSv (± 0.018, median 0.018 mSv, model by Lee et al.) for fluoroscopic voiding cystourethrography. After a protocol adaption to correct for a longer examination time in DIC that was caused by

Role of sonography in the recognition, assessment, and treatment of cesarean scar ectopic pregnancies.

Science.gov (United States)

McKenna, David A; Poder, Liina; Goldman, Mindy; Goldstein, Ruth B

2008-05-01

Cesarean scar ectopic pregnancies (CSEPs) are rare but may have serious adverse consequences and are therefore important to promptly recognize on sonography. We aim to describe the typical sonographic appearances. Potential treatments are discussed, including sonographic guidance for transcervical injection of methotrexate (MTX) into the gestational sac. Two patients with CSEPs were treated with systemic and intra-amniotic administration of MTX under sonographic guidance. Both patients were followed clinically after medical treatment, resulting in low maternal morbidity and mortality. Considering the increasing rate of cesarean delivery and the increased risk of CSEPs, sonologists should be familiar with the sonographic appearances of a pregnancy implanted into the cesarean scar. We show how to correctly diagnose scar implantation and describe how to perform sonographically guided transcervical injection of MTX.

Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using a flexible bronchoscopic biopsy forcep

International Nuclear Information System (INIS)

Kim, Jai Keun; Chung, Tae Sub; Kim, Dong Ik; Suh, Jung Ho

1996-01-01

Otolaryngoscopic biopsy of nasopharyngeal carcinoma is a generalized method which may be associated with inadequate sampling of tissue and patient discomfort. So, we tried fluoroscopy-guided transnasal biopsy using bronchoscopic biopsy forcep and evaluated its safety and efficacy. Prospectively we performed fluoroscopy-guided transnasal biopsy in 11 patients who were radiographically suspected of nasopharyngeal carcinoma. The posterior wall of the nasopharynx was coated with barium sulfate under fluoroscopy. A flexible bronchoscopic biopsy forcep with a steerable guiding catheter which was used in removal of intrahepatic duct stones was inserted through the nare. After localization of the tip of the biopsy forcep at tumor site with fluoroscopy, a tissue specimen was obtained. We also tried CT guided biopsy in initial 2cases. Each patient had otolaryngoscopic biopsy to compare the biopsy result and patient discomfort. We could have sufficient amount of tissue for pathological evaluation in 10 of 11 patients by the first pass with the fluoroscopic technique. Contrarily, otolaryngoscopic biopsy was successful in 7 of 11 patients on single passage. Additionally, 2 patients had complaint in our method comparing with 9 patients in otolaryngoscopic biopsy. Fluoroscopy-guided transnasal biopsy of nasopharyngeal carcinoma using the bronchoscopic biopsy forcep is safe and accurate. It can be a appropriate method competing otolaryngoscopic biopsy

Under digital fluoroscopic guidance multiple-point injection with absolute alcohol and pinyangmycin for the treatment of superficial venous malformations

International Nuclear Information System (INIS)

Yang Ming; Xiao Gang; Peng Youlin

2010-01-01

Objective: to investigate the therapeutic efficacy of multiple-point injection with absolute alcohol and pinyangmycin under digital fluoroscopic guidance for superficial venous malformations. Methods: By using a disposal venous transfusion needle the superficial venous malformation was punctured and then contrast media lohexol was injected in to visualize the tumor body, which was followed by the injection of ethanol and pinyangmycin when the needle was confirmed in the correct position. The procedure was successfully performed in 31 patients. The clinical results were observed and analyzed. Results: After one treatment complete cure was achieved in 21 cases and marked effect was obtained in 8 cases, with a total effectiveness of 93.5%. Conclusion: Multiple-point injection with ethanol and pinyangmycin under digital fluoroscopic guidance is an effective and safe technique for the treatment of superficial venous malformations, especially for the lesions that are deeply located and ill-defined. (authors)

Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

International Nuclear Information System (INIS)

Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik; Chai, Jae Won; Ahn, Joong Mo

2015-01-01

To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases

Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

Energy Technology Data Exchange (ETDEWEB)

Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Chai, Jae Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Ahn, Joong Mo [Dept. of Radiology, University of Pittsburgh Medical Center, Pittsburgh (United States)

2015-09-15

To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

Stent placement under fluoroscopic monitoring and endoscopic direct vision for the treatment of malignant gastroduodenal obstruction: a report of 47 cases

International Nuclear Information System (INIS)

Zhang Baoyang; Li Weiping; Jiang Haosheng; Liu Shiyi; Hu Yi

2009-01-01

Objective: To discuss the operational technique and clinical effect of metallic stent placement in treating malignant gastroduodenal obstruction. Methods: Metallic stent placement under fluoroscopic monitoring and endoscopic direct vision was performed in 47 patients with malignant gastroduodenal obstruction. A total of 54 metallic stents was used. Results: The procedure was successfully completed in all 47 patients. During the follow-up period, all the patients could take liquid or ordinary diet and were markedly relived of vomiting. The living quality was much improved and no serious complications occurred. Conclusion: Under fluoroscopic monitoring and endoscopic direct vision, stent placement is a safe, effective, technically-simple and time-saving procedure for the treatment of malignant gastroduodenal obstruction with less sufferings to the patient. Therefore, it is definitely worth popularizing this technique in clinical practice. (authors)

Robust fluoroscopic tracking of fiducial markers: exploiting the spatial constraints

International Nuclear Information System (INIS)

Li Rui; Sharp, Gregory

2013-01-01

Two new fluoroscopic fiducial tracking methods that exploit the spatial relationship among the multiple implanted fiducial to achieve fast, accurate and robust tracking are proposed in this paper. The spatial relationship between multiple implanted markers are modeled as Gaussian distributions of their pairwise distances over time. The means and standard deviations of these distances are learned from training sequences, and pairwise distances that deviate from these learned distributions are assigned a low spatial matching score. The spatial constraints are incorporated in two different algorithms: a stochastic tracking method and a detection based method. In the stochastic method, hypotheses of the ‘true’ fiducial position are sampled from a pre-trained respiration motion model. Each hypothesis is assigned an importance value based on image matching score and spatial matching score. Learning the parameters of the motion model is needed in addition to learning the distribution parameters of the pairwise distances in the proposed stochastic tracking approach. In the detection based method, a set of possible marker locations are identified by using a template matching based fiducial detector. The best location is obtained by optimizing the image matching score and spatial matching score through non-serial dynamic programming. In this detection based approach, there is no need to learn the respiration motion model. The two proposed algorithms are compared with a recent work using a multiple hypothesis tracking (MHT) algorithm which is denoted by MHT, Tang et al (2007 Phys. Med. Biol. 52 4081–98). Phantom experiments were performed using fluoroscopic videos captured with known motion relative to an anthropomorphic phantom. The patient experiments were performed using a retrospective study of 16 fluoroscopic videos of liver cancer patients with implanted fiducials. For the motion phantom data sets, the detection based approach has the smallest tracking error (�

Characterization of a high-elbow, fluoroscopic electronic portal imaging device for portal dosimetry

International Nuclear Information System (INIS)

Boer, J.C.J. de; Visser, A.G.

2000-01-01

The application of a newly developed fluoroscopic (CCD-camera based) electronic portal imaging device (EPID) in portal dosimetry is investigated. A description of the EPID response to dose is presented in terms of stability, linearity and optical cross-talk inside the mechanical structure. The EPID has a relatively large distance (41 cm on-axis) between the fluorescent screen and the mirror (high-elbow), which results in cross-talk with properties quite different from that of the low-elbow fluoroscopic EPIDs that have been studied in the literature. In contrast with low-elbow systems, the maximum cross-talk is observed for points of the fluorescent screen that have the largest distance to the mirror, which is explained from the geometry of the system. An algorithm to convert the images of the EPID into portal dose images (PDIs) is presented. The correction applied for cross-talk is a position-dependent additive operation on the EPID image pixel values, with a magnitude that depends on a calculated effective field width. Deconvolution with a point spread function, as applied for low-elbow systems, is not required. For a 25 MV beam, EPID PDIs and ionization chamber measurements in the EPID detector plane were obtained behind an anthropomorphic phantom and a homogeneous absorber for various field shapes. The difference in absolute dose between the EPID and ionization chamber measurements, averaged over the four test fields presented in this paper, was 0.1±0.5% (1 SD) over the entire irradiation field, with no deviation larger than 2%. (author)

Accurate 3D kinematic measurement of temporomandibular joint using X-ray fluoroscopic images

Science.gov (United States)

Yamazaki, Takaharu; Matsumoto, Akiko; Sugamoto, Kazuomi; Matsumoto, Ken; Kakimoto, Naoya; Yura, Yoshiaki

2014-04-01

Accurate measurement and analysis of 3D kinematics of temporomandibular joint (TMJ) is very important for assisting clinical diagnosis and treatment of prosthodontics and orthodontics, and oral surgery. This study presents a new 3D kinematic measurement technique of the TMJ using X-ray fluoroscopic images, which can easily obtain the TMJ kinematic data in natural motion. In vivo kinematics of the TMJ (maxilla and mandibular bone) is determined using a feature-based 2D/3D registration, which uses beads silhouette on fluoroscopic images and 3D surface bone models with beads. The 3D surface models of maxilla and mandibular bone with beads were created from CT scans data of the subject using the mouthpiece with the seven strategically placed beads. In order to validate the accuracy of pose estimation for the maxilla and mandibular bone, computer simulation test was performed using five patterns of synthetic tantalum beads silhouette images. In the clinical applications, dynamic movement during jaw opening and closing was conducted, and the relative pose of the mandibular bone with respect to the maxilla bone was determined. The results of computer simulation test showed that the root mean square errors were sufficiently smaller than 1.0 mm and 1.0 degree. In the results of clinical application, during jaw opening from 0.0 to 36.8 degree of rotation, mandibular condyle exhibited 19.8 mm of anterior sliding relative to maxillary articular fossa, and these measurement values were clinically similar to the previous reports. Consequently, present technique was thought to be suitable for the 3D TMJ kinematic analysis.

Removal of a broken guide wire entrapped in a fractured femoral neck

Directory of Open Access Journals (Sweden)

ZHU Qing-hua

2013-08-01

Full Text Available 【Abstract】Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS. Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV frac-ture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotat-ing around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the bro-ken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixa-tion was easily finished. The patient had an uneventful re-covery without avascular necrosis of femoral head or non-union of the fracture at one year’s follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful. Key words: Femoral neck fractures; Bones wires; Complications

WE-G-207-06: 3D Fluoroscopic Image Generation From Patient-Specific 4DCBCT-Based Motion Models Derived From Physical Phantom and Clinical Patient Images

International Nuclear Information System (INIS)

Dhou, S; Cai, W; Hurwitz, M; Rottmann, J; Myronakis, M; Cifter, F; Berbeco, R; Lewis, J; Williams, C; Mishra, P; Ionascu, D

2015-01-01

Purpose: Respiratory-correlated cone-beam CT (4DCBCT) images acquired immediately prior to treatment have the potential to represent patient motion patterns and anatomy during treatment, including both intra- and inter-fractional changes. We develop a method to generate patient-specific motion models based on 4DCBCT images acquired with existing clinical equipment and used to generate time varying volumetric images (3D fluoroscopic images) representing motion during treatment delivery. Methods: Motion models are derived by deformably registering each 4DCBCT phase to a reference phase, and performing principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated by optimizing the resulting PCA coefficients iteratively through comparison of the cone-beam projections simulating kV treatment imaging and digitally reconstructed radiographs generated from the motion model. Patient and physical phantom datasets are used to evaluate the method in terms of tumor localization error compared to manually defined ground truth positions. Results: 4DCBCT-based motion models were derived and used to generate 3D fluoroscopic images at treatment time. For the patient datasets, the average tumor localization error and the 95th percentile were 1.57 and 3.13 respectively in subsets of four patient datasets. For the physical phantom datasets, the average tumor localization error and the 95th percentile were 1.14 and 2.78 respectively in two datasets. 4DCBCT motion models are shown to perform well in the context of generating 3D fluoroscopic images due to their ability to reproduce anatomical changes at treatment time. Conclusion: This study showed the feasibility of deriving 4DCBCT-based motion models and using them to generate 3D fluoroscopic images at treatment time in real clinical settings. 4DCBCT-based motion models were found to account for the 3D non-rigid motion of the patient anatomy during treatment and have the potential

Four-dimensional treatment planning and fluoroscopic real-time tumor tracking radiotherapy for moving tumor

International Nuclear Information System (INIS)

Shirato, Hiroki; Shimizu, Shinichi; Kitamura, Kei; Nishioka, Takeshi; Kagei, Kenji; Hashimoto, Seiko; Aoyama, Hidefumi; Kunieda, Tatsuya; Shinohara, Nobuo; Dosaka-Akita, Hirotoshi; Miyasaka, Kazuo

2000-01-01

Purpose: To achieve precise three-dimensional (3D) conformal radiotherapy for mobile tumors, a new radiotherapy system and its treatment planning system were developed and used for clinical practice. Methods and Materials: We developed a linear accelerator synchronized with a fluoroscopic real-time tumor tracking system by which 3D coordinates of a 2.0-mm gold marker in the tumor can be determined every 0.03 second. The 3D relationships between the marker and the tumor at different respiratory phases are evaluated using CT image at each respiratory phase, whereby the optimum phase can be selected to synchronize with irradiation (4D treatment planning). The linac is triggered to irradiate the tumor only when the marker is located within the region of the planned coordinates relative to the isocenter. Results: The coordinates of the marker were detected with an accuracy of ± 1 mm during radiotherapy in the phantom experiment. The time delay between recognition of the marker position and the start or stop of megavoltage X-ray irradiation was 0.03 second. Fourteen patients with various tumors were treated by conformal radiotherapy with a 'tight' planning target volume (PTV) margin. They were surviving without relapse or complications with a median follow-up of 6 months. Conclusion: Fluoroscopic real-time tumor tracking radiotherapy following 4D treatment planning was developed and shown to be feasible to improve the accuracy of the radiotherapy for mobile tumors

MR-guided direct arthrography of the glenohumeral joint

International Nuclear Information System (INIS)

Soh, E.; Bearcroft, P.W.P.; Graves, M.J.; Black, R.; Lomas, D.J.

2008-01-01

Aim: To evaluate the feasibility of magnetic resonance (MR)-guided direct arthrography of the glenohumeral joint with a 1.5 T MR system, performing the entire procedure in a single MR examination. Materials and methods: MR-guided direct arthrography was performed on 11 patients. MR imaging guidance and interactive MR fluoroscopy, with in-room control and display system, were used for needle placement and contrast medium injection. The outcome measures were success or failure of joint puncture, the time taken for introduction of contrast medium, and the diagnostic quality of the subsequent MR arthrography images. Results: Contrast medium was successfully instilled into the joint and diagnostic quality MR arthrography images were obtained in all cases. The median time from initial placement of the skin marker to introduction of the contrast medium was 17 min (range 11-29 min). There were no immediate post-procedure complications. Conclusion: Accurate needle placement is feasible in a single MR examination on a commercial 1.5 T closed-bore MR system, using an in-room control and display system together with interactive fluoroscopic imaging, and this was used to provide direct MR arthrography in this study

Pseudoaneurysm of the deep femoral artery caused by a guide wire following femur intertrochanteric fracture with a hip nail: A case report

Directory of Open Access Journals (Sweden)

Ji Wan Kim

2017-05-01

Full Text Available An 85-year-old woman developed severe swelling and pain in the proximal thigh after internal fixation of an intertrochanteric fracture of the femur with a hip nail. In order to identify the causes and determine the effective treatment, angiography was performed. The results of the angiography revealed a pseudoaneurysm of a branch of deep femoral artery. Endovascular embolization was used to treat the pseudoaneurysm. After reviewing all possible causes, we found a mistake in insertion of a guide wire for hip nail. Using intraoperative fluoroscopic images, we found the mal-positioned guide wire located posterior to trochanter on lateral view of hip. This case study reminds us that pseudoaneurysm can occur in a guide wire during hip nailing. Surgeons can avoid this complication with confirmation of lateral and anteroposterior view of hip.

Fluoroscopy-guided balloon dilation in patients with Eustachian tube dysfunction

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Kim, Kun Yung; Tsauo, Jiaywei; Song, Ho-Young [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Park, Hong Ju; Kang, Woo Seok [University of Ulsan College of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, Seoul (Korea, Republic of); Park, Jung-Hoon [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); University of Ulsan College of Medicine, Department of Biomedical Engineering Research Center, Asan Medical Center, Seoul (Korea, Republic of); Wang, Zhe [University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul (Korea, Republic of); Tianjin Medical University General Hospital, Department of Radiology (China)

2018-03-15

To prospectively evaluate the technical feasibility and safety of fluoroscopy-guided balloon dilation in patients with Eustachian tube (ET) dysfunction. Patients who could not do a Valsalva manoeuvre for more than 6 months and diagnosed with chronic otitis media or ET dysfunction were prospectively enrolled. A 0.035-in. guide wire and 6-mm long balloon catheter with a diameter of 2 mm were used to dilate the cartilaginous portion of the ET under fluoroscopic guidance. The balloon was inflated by manual injection twice for 1 min each time. Clinical outcomes were assessed by the patient's ability to perform a Valsalva manoeuvre, and symptoms were assessed using the 7-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7) score. Balloon dilation was attempted in a total of ten adult patients from October 2016 to March 2017. Technical success was achieved in all procedures (10/10). Ninety percent (9/10) of the balloons were fully dilated without waist deformity. There were no major complications. All patients were able to perform a Valsalva manoeuvre at the time of their last visit and/or improvement of at least one ETDQ-7 score. Fluoroscopy-guided balloon dilation seems to be technically feasible and safe in the treatment of ET dysfunction. (orig.)

The effect of barium temperature on esophageal and castric motility in dogs: a fluoroscopic study

International Nuclear Information System (INIS)

Eville, P.; Ackerman, N.

1984-01-01

The influence of barium temperature on canine esophageal transit time and gastric motility were studied fluoroscopically. Micropulverized barium sulfate (30% wt/vol) at 35°F, 70°F, and 100°F was given orally to each of five dogs with a minimum of two hours between each temperature. Esophageal transit times ranged from 4 to 9.67 seconds, and gastric contractions average four per minute. Barium temperature had no significant effect on either esophageal transit time or gastric motility

SU-E-J-01: 3D Fluoroscopic Image Estimation From Patient-Specific 4DCBCT-Based Motion Models

International Nuclear Information System (INIS)

Dhou, S; Hurwitz, M; Lewis, J; Mishra, P

2014-01-01

Purpose: 3D motion modeling derived from 4DCT images, taken days or weeks before treatment, cannot reliably represent patient anatomy on the day of treatment. We develop a method to generate motion models based on 4DCBCT acquired at the time of treatment, and apply the model to estimate 3D time-varying images (referred to as 3D fluoroscopic images). Methods: Motion models are derived through deformable registration between each 4DCBCT phase, and principal component analysis (PCA) on the resulting displacement vector fields. 3D fluoroscopic images are estimated based on cone-beam projections simulating kV treatment imaging. PCA coefficients are optimized iteratively through comparison of these cone-beam projections and projections estimated based on the motion model. Digital phantoms reproducing ten patient motion trajectories, and a physical phantom with regular and irregular motion derived from measured patient trajectories, are used to evaluate the method in terms of tumor localization, and the global voxel intensity difference compared to ground truth. Results: Experiments included: 1) assuming no anatomic or positioning changes between 4DCT and treatment time; and 2) simulating positioning and tumor baseline shifts at the time of treatment compared to 4DCT acquisition. 4DCBCT were reconstructed from the anatomy as seen at treatment time. In case 1) the tumor localization error and the intensity differences in ten patient were smaller using 4DCT-based motion model, possible due to superior image quality. In case 2) the tumor localization error and intensity differences were 2.85 and 0.15 respectively, using 4DCT-based motion models, and 1.17 and 0.10 using 4DCBCT-based models. 4DCBCT performed better due to its ability to reproduce daily anatomical changes. Conclusion: The study showed an advantage of 4DCBCT-based motion models in the context of 3D fluoroscopic images estimation. Positioning and tumor baseline shift uncertainties were mitigated by the 4DCBCT

Estimation of lung shunt fraction from simultaneous fluoroscopic and nuclear images

Science.gov (United States)

van der Velden, Sandra; Bastiaannet, Remco; Braat, Arthur J. A. T.; Lam, Marnix G. E. H.; Viergever, Max A.; de Jong, Hugo W. A. M.

2017-11-01

Radioembolisation with yttrium-90 (90Y) is increasingly used as a treatment of unresectable liver malignancies. For safety, a scout dose of technetium-99m macroaggregated albumin (99mTc-MAA) is used prior to the delivery of the therapeutic activity to mimic the deposition of 90Y. One-day procedures are currently limited by the lack of nuclear images in the intervention room. To cope with this limitation, an interventional simultaneous fluoroscopic and nuclear imaging device is currently being developed. The purpose of this simulation study was to evaluate the accuracy of estimating the lung shunt fraction (LSF) of the scout dose in the intervention room with this device and compare it against current clinical methods. Methods: A male and female XCAT phantom, both with two respiratory profiles, were used to simulate various LSFs resulting from a scout dose of 150 MBq 99mTc-MAA. Hybrid images were Monte Carlo simulated for breath-hold (5 s) and dynamic breathing (10 frames of 0.5 s) acquisitions. Nuclear images were corrected for attenuation with the fluoroscopic image and for organ overlap effects using a pre-treatment CT-scan. For comparison purposes, planar scintigraphy and mobile gamma camera images (both 300 s acquisition time) were simulated. Estimated LSFs were evaluated for all methods and compared to the phantom ground truth. Results: In the clinically relevant range of 10-20% LSF, hybrid imaging overestimated LSF with approximately 2 percentage points (pp) and 3 pp for the normal and irregular breathing phantoms, respectively. After organ overlap correction, LSF was estimated with a more constant error. Errors in planar scintigraphy and mobile gamma camera imaging were more dependent on LSF, body shape and breathing profile. Conclusion: LSF can be estimated with a constant minor error with a hybrid imaging device. Estimated LSF is highly dependent on true LSF, body shape and breathing pattern when estimated with current clinical methods. The hybrid

Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

Energy Technology Data Exchange (ETDEWEB)

Slattery, Michael M.; Goh, Gerard S.; Power, Sarah; Given, Mark F.; McGrath, Frank P.; Lee, Michael J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Department of Radiology (Ireland)

2015-06-15

PurposeTo prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques.Materials and MethodsHundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients’ age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests.ResultsSixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm{sup 2}. Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group.ConclusionUltrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

Reference Dose Rates for Fluoroscopy Guided Interventions

International Nuclear Information System (INIS)

Geleijns, J.; Broerse, J.J.; Hummel, W.A.; Schalij, M.J.; Schultze Kool, L.J.; Teeuwisse, W.; Zoetelief, J.

1998-01-01

The wide diversity of fluoroscopy guided interventions which have become available in recent years has improved patient care. They are being performed in increasing numbers, particularly at departments of cardiology and radiology. Some procedures are very complex and require extended fluoroscopy times, i.e. longer than 30 min, and radiation exposure of patient and medical staff is in some cases rather high. The occurrence of radiation-induced skin injuries on patients has shown that radiation protection for fluoroscopy guided interventions should not only be focused on stochastic effects, i.e. tumour induction and hereditary risks, but also on potential deterministic effects. Reference dose levels are introduced by the Council of the European Communities as an instrument to achieve optimisation of radiation protection in radiology. Reference levels in conventional diagnostic radiology are usually expressed as entrance skin dose or dose-area product. It is not possible to define a standard procedure for complex interventions due to the large inter-patient variations with regard to the complexity of specific interventional procedures. Consequently, it is not realistic to establish a reference skin dose or dose-area product for complex fluoroscopy guided interventions. As an alternative, reference values for fluoroscopy guided interventions can be expressed as the entrance dose rates on a homogeneous phantom and on the image intensifier. A protocol has been developed and applied during a nationwide survey of fluoroscopic dose rate during catheter ablations. From this survey reference entrance dose rates of respectively 30 mGy.min -1 on a polymethylmethacrylate (PMMA) phantom with a thickness of 21 cm, and of 0.8 μGy.s -1 on the image intensifier have been derived. (author)

Identification of arteries and veins in cerebral angiography fluoroscopic images

Science.gov (United States)

Andra Tache, Irina

2017-11-01

In the present study a new method for pixels tagging into arteries and veins classes from temporal cerebral angiography is presented. This need comes from the neurosurgeon who is evaluating the fluoroscopic angiography and the magnetic resonance images from the brain in order to locate the fistula of the patients who suffer from arterio-venous malformation. The method includes the elimination of the background pixels from a previous segmentation and the generation of the time intensity curves for each remaining pixel. The later undergo signal processing in order to extract the characteristic parameters needed for applying the k-means clustering algorithm. Some of the parameters are: the phase and the maximum amplitude extracted from the Fourier transform, the standard deviation and the mean value. The tagged classes are represented into images which then are re-classified by an expert into artery and vein pixels.

Closed reduction and fluoroscopic assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats

OpenAIRE

Boekhout-Ta, Christina L; Kim, Stanley E; Corss, Alan R; Pozzi, Antonio; Evans, Richard

2017-01-01

OBJECTIVE: To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 37) and cats (n = 4). MATERIALS AND METHODS: Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classi...

Fluoroscopic gating without implanted fiducial markers for lung cancer radiotherapy based on support vector machines

International Nuclear Information System (INIS)

Cui Ying; Dy, Jennifer G; Alexander, Brian; Jiang, Steve B

2008-01-01

Various problems with the current state-of-the-art techniques for gated radiotherapy have prevented this new treatment modality from being widely implemented in clinical routine. These problems are caused mainly by applying various external respiratory surrogates. There might be large uncertainties in deriving the tumor position from external respiratory surrogates. While tracking implanted fiducial markers has sufficient accuracy, this procedure may not be widely accepted due to the risk of pneumothorax. Previously, we have developed a technique to generate gating signals from fluoroscopic images without implanted fiducial markers using template matching methods (Berbeco et al 2005 Phys. Med. Biol. 50 4481-90, Cui et al 2007b Phys. Med. Biol. 52 741-55). In this note, our main contribution is to provide a totally different new view of the gating problem by recasting it as a classification problem. Then, we solve this classification problem by a well-studied powerful classification method called a support vector machine (SVM). Note that the goal of an automated gating tool is to decide when to turn the beam ON or OFF. We treat ON and OFF as the two classes in our classification problem. We create our labeled training data during the patient setup session by utilizing the reference gating signal, manually determined by a radiation oncologist. We then pre-process these labeled training images and build our SVM prediction model. During treatment delivery, fluoroscopic images are continuously acquired, pre-processed and sent as an input to the SVM. Finally, our SVM model will output the predicted labels as gating signals. We test the proposed technique on five sequences of fluoroscopic images from five lung cancer patients against the reference gating signal as ground truth. We compare the performance of the SVM to our previous template matching method (Cui et al 2007b Phys. Med. Biol. 52 741-55). We find that the SVM is slightly more accurate on average (1-3%) than

Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge

Science.gov (United States)

Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

2015-01-01

Background: Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. Objectives: In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. Patients and Methods: For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results: Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Conclusion: Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient

Fluoroscopic Analysis of Tibial Translation in Anterior Cruciate Ligament Injured Knees With and Without Bracing During Forward Lunge.

Science.gov (United States)

Jalali, Maryam; Farahmand, Farzam; Mousavi, Seyed Mohammad Ebrahim; Golestanha, Seyed Ali; Rezaeian, Tahmineh; Shirvani Broujeni, Shahram; Rahgozar, Mehdi; Esfandiarpour, Fateme

2015-07-01

Despite several studies with different methods, the effect of functional knee braces on knee joint kinematics is not clear. Direct visualization of joint components through medical imaging modalities may provide the clinicians with more useful information. In this study, for the first time in the literature, video fluoroscopy was used to investigate the effect of knee bracing on the sagittal plane kinematics of anterior cruciate ligament (ACL) injured patients. For twelve male unilateral ACL deficient subjects, the anterior tibial translation was measured during lunge exercise in non-braced and braced conditions. Fluoroscopic images were acquired from the subjects using a digital fluoroscopy system with a rate of 10 fps. The image of each frame was scaled using a calibration coin and analyzed in AutoCAD environment. The angle between the two lines, tangent to the posterior cortexes of the femoral and tibial shafts was measured as the flexion angle. For the fluoroscopic images associated with 0°, 15°, 30°, 45° and 60° knee flexion angles, the relative anterior-posterior configuration of the tibiofemoral joint was assessed by measuring the position of landmarks on the tibia and femur. Results indicated that the overall anterior translations of the tibia during the eccentric (down) and concentric (up) phases of lunge exercise were 10.4 ± 1.7 mm and 9.0 ± 2.2 mm for non-braced, and 10.1 ± 3.4 mm and 7.4 ± 2.5 mm, for braced conditions, respectively. The difference of the tibial anterior-posterior translation behaviors of the braced and non-braced knees was not statistically significant. Fluoroscopic imaging provides an effective tool to measure the dynamic behavior of the knee joint in the sagittal plane and within the limitations of this study, the pure mechanical stabilizing effect of functional knee bracing is not sufficient to control the anterior tibial translation of the ACL deficient patients during lunge exercise.

Imaging-guided percutaneous needle biopsy for infectious spondylitis: Factors affecting culture positivity

Energy Technology Data Exchange (ETDEWEB)

Sung, Si Yoon; Kwon, Jong Won [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

2015-11-15

To evaluate the variable factors affecting the results of percutaneous needle biopsies for infectious spondylitis. In all, 249 patients who underwent both MRI and percutaneous needle biopsies due to a suspicion of infectious spondylitis were evaluated with respect to the following factors: the usage of antibiotics before the procedure, the location of the biopsy, the guiding equipment used, the experience level of the operators, and the number of biopsies performed. The positivity of culture in cases of treated with antibiotics (16.3%) before the biopsy was lower than in the untreated cases (30.5%) (p = 0.004). Biopsies performed at the abscess (43.5%) and with fluoroscopic guidance (27.8%) showed higher culture positivity as well. The experience level of the operators and the number of biopsies had no effect on culture positivity. The usage of antibiotics before the biopsy, the biopsy's location, and the guiding equipment used affect the culture positivity, while the experience levels of the operators and the number of biopsies do not have an effect.

Imaging-guided percutaneous needle biopsy for infectious spondylitis: Factors affecting culture positivity

International Nuclear Information System (INIS)

Sung, Si Yoon; Kwon, Jong Won

2015-01-01

To evaluate the variable factors affecting the results of percutaneous needle biopsies for infectious spondylitis. In all, 249 patients who underwent both MRI and percutaneous needle biopsies due to a suspicion of infectious spondylitis were evaluated with respect to the following factors: the usage of antibiotics before the procedure, the location of the biopsy, the guiding equipment used, the experience level of the operators, and the number of biopsies performed. The positivity of culture in cases of treated with antibiotics (16.3%) before the biopsy was lower than in the untreated cases (30.5%) (p = 0.004). Biopsies performed at the abscess (43.5%) and with fluoroscopic guidance (27.8%) showed higher culture positivity as well. The experience level of the operators and the number of biopsies had no effect on culture positivity. The usage of antibiotics before the biopsy, the biopsy's location, and the guiding equipment used affect the culture positivity, while the experience levels of the operators and the number of biopsies do not have an effect

Diagnostic value of the fluoroscopic triggering 3D LAVA technique for primary liver cancer.

Science.gov (United States)

Shen, Xiao-Yong; Chai, Chun-Hua; Xiao, Wen-Bo; Wang, Qi-Dong

2010-04-01

Primary liver cancer (PLC) is one of the common malignant tumors. Liver acquisition with acceleration volume acquisition (LAVA), which allows simultaneous dynamic enhancement of the hepatic parenchyma and vasculature imaging, is of great help in the diagnosis of PLC. This study aimed to evaluate application of the fluoroscopic triggering 3D LAVA technique in the imaging of PLC and liver vasculature. The clinical data and imaging findings of 38 adults with PLC (22 men and 16 women; average age 52 years), pathologically confirmed by surgical resection or biopsy, were collected and analyzed. All magnetic resonance images were obtained with a 1.5-T system (General Electrics Medical Systems) with an eight-element body array coil and application of the fluoroscopic triggering 3D LAVA technique. Overall image quality was assessed on a 5-point scale by two experienced radiologists. All the nodules and blood vessel were recorded and compared. The diagnostic accuracy and feasibility of LAVA were evaluated. Thirty-eight patients gave high quality images of 72 nodules in the liver for diagnosis. The accuracy of LAVA was 97.2% (70/72), and the coincidence rate between the extent of tumor judged by dynamic enhancement and pathological examination was 87.5% (63/72). Displayed by the maximum intensity projection reconstruction, nearly all cases gave satisfactory images of branches III and IV of the hepatic artery. Furthermore, small early-stage enhancing hepatic lesions and the parallel portal vein were also well displayed. Sequence of LAVA provides good multi-phase dynamic enhancement scanning of hepatic lesions. Combined with conventional scanning technology, LAVA effectively and safely displays focal hepatic lesions and the relationship between tumor and normal tissues, especially blood vessels.

EUS-guided recanalization of complete gastrointestinal strictures

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Miguel Martínez-Guillén

Full Text Available Background and aim: Complete gastrointestinal strictures are a technically demanding problem. In this setting, an anterograde technique is associated with a high risk of complications and a combined anterograde-retrograde technique requires a prior ostomy. Our aim was to assess the outcome of a first case series for the management of complete gastrointestinal strictures using endoscopic ultrasound (EUS-guided puncture as a novel endoscopic approach. Patients and methods: This retrospective case-series describes four cases that were referred for treatment of complete benign gastrointestinal strictures, three upper and one lower. Recanalization was attempted with EUS-guided puncture using a 22G or 19G needle and contrast filling was visualized by fluoroscopy. Afterwards, a cystotome and/or a dilator balloon were used under endoscopic and fluoroscopic guidance. A fully covered metal stent was placed in two cases, keeping the strictures open in order to prevent another stricture. Feasibility, adverse events, efficacy and the number of dilations required after recanalization were evaluated. Results: Technical and clinical success was achieved in three of the four cases (75%. A first dilation was performed using a dilator balloon in all successful cases and fully covered metal stents were used in two cases. These patients underwent a consecutive number of balloon dilatations (range 1-4 and all three were able to eat a soft diet. No adverse events were related to the EUS-guided approach. In the failed case with a long stricture (> 3 cm, an endoscopic rendezvous technique was attempted which caused a pneumothorax requiring a chest tube placement. Conclusion: EUS-guided recanalization, as a first approach in the treatment of complete digestive stricture, is a feasible and promising procedure that can help to avoid major surgery.

Carotid artery and lower cranial nerve exposure with increasing surgical complexity to the parapharyngeal space.

Science.gov (United States)

Lemos-Rodriguez, Ana M; Sreenath, Satyan B; Rawal, Rounak B; Overton, Lewis J; Farzal, Zainab; Zanation, Adam M

2017-03-01

To investigate the extent of carotid artery exposure attained, including the identification of the external carotid branches and lower cranial nerves in five sequential external approaches to the parapharyngeal space, and to provide an anatomical algorithm. Anatomical study. Six latex-injected adult cadaver heads were dissected in five consecutive approaches: transcervical approach with submandibular gland removal, posterior extension of the transcervical approach, transcervical approach with parotidectomy, parotidectomy with lateral mandibulotomy, and parotidectomy with mandibulectomy. The degree of carotid artery exposure attained, external carotid branches, and lower cranial nerves visualized was documented. The transcervical approach exposed 1.5 cm (Standard Deviation (SD) 0.5) of internal carotid artery (ICA) and 1.25 cm (SD 0.25) of external carotid artery (ECA). The superior thyroid and facial arteries and cranial nerve XII and XI were identified. The posterior extension exposed 2.9 cm (SD 0.7) of ICA and 2.7 cm (SD 1.0) of ECA. Occipital and ascending pharyngeal arteries were visualized. The transparotid approach exposed 4.0 cm (SD 1.1) of ICA and 3.98 cm (SD 1.8) of ECA. Lateral mandibulotomy exposed the internal maxillary artery, cranial nerve X, the sympathetic trunk, and 4.6 cm (SD 2.4) of ICA. Mandibulectomy allowed for complete ECA exposure, cranial nerve IX, lingual nerve, and 6.9 cm (SD 1.3) of ICA. Approaches for the parapharyngeal space must be based on anatomic and biological patient factors. This study provides a guide for the skull base surgeon for an extended approach based on the desired anatomic exposure. N/A. Laryngoscope, 127:585-591, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Dacryocystoplasty

International Nuclear Information System (INIS)

Munk, P.L.; Lin, D.T.; Morris, D.C.

1990-01-01

Epiphora, or chronic tearing from the eye, is a common problem in ophthalmologic practice and frequently requires surgery for adequate treatment. This paper reports on the development of an interventional radiologic procedure for treatment of this disorder. This technique involves the introduction of a small-bore, soft-tipped guide wire through the superior canaliculis, which is then guided under fluoroscopic control through the nasolacrimal drainage apparatus to be retrieved from the nasal aperature. A small-bore angioplasty catheter is then used for dilation under fluoroscopic control

Assessing the usefulness of prostaglandin E2 (Cervidil) for transcervical artificial insemination in ewes.

Science.gov (United States)

Bartlewski, Pawel M; Candappa, Ivanka B R

2015-12-01

The underlying theme of this study involved the evaluation of the dilatory effects of prostaglandin E2 on the ovine cervix and thus the assessment of its potential applicability to transcervical artificial insemination (TCAI) in ewes. A novel method of prostaglandin E2 administration (controlled slow-release vaginal inserts) was examined, and the practical implications of this approach including cervical penetrability and posttreatment pregnancy rates were evaluated. The Guelph method of TCAI was performed during the seasonal anestrus (n = 40) and the breeding season (n = 40) on multiparous Rideau Arcott × Polled Dorset ewes, with or without the pretreatment with Cervidil (for a duration of 12 hours or 24 hours before TCAI). Cervical penetration rates averaged 82.5% (66 of 80), and they varied neither (P > 0.05) between the two seasons nor between Cervidil-treated ewes and their respective controls. Cervidil priming significantly reduced the total time required for TCAI during the breeding season in comparison with controls (54 vs. 98 seconds), especially after the 24-hour exposure (38 vs. 108 seconds). The time taken to traverse the uterine cervix was negatively correlated (P ewes. Four out of 36 (11%) successfully penetrated ewes in the breeding season (three ewes allocated to the 12-hour control group and one ewe that had received Cervidil for 12 hours) became pregnant and carried the lambs to term. Vaginal mucus impedance at TCAI was significantly and positively correlated with the total time required to complete the procedure in cyclic ewes, and the negative correlation between vaginal mucus impedance and total time values at the time of controlled intravaginal drug release device removal approached to significance in anestrous ewes. The present results indicate a moderate benefit of using Cervidil for inducing cervical dilation before TCAI in ewes, mainly in the breeding season. The specific reason(s) for impaired fertility after the TCAI using

Radiation dose associated with CT-guided drain placement for pediatric patients

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Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G. [University of North Carolina at Chapel Hill, Department of Radiology, UNC Health Care, Chapel Hill, NC (United States); Taylor, J.B. [University of North Carolina at Chapel Hill, Environment, Health and Safety, Chapel Hill, NC (United States)

2017-05-15

To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

Radiation dose associated with CT-guided drain placement for pediatric patients

International Nuclear Information System (INIS)

Schwartz, Cody J.; Isaacson, Ari J.; Fordham, Lynn Ansley; Ivanovic, Marija; Dixon, Robert G.; Taylor, J.B.

2017-01-01

To date, there are limited radiation dose data on CT-guided procedures in pediatric patients. Our goal was to quantify the radiation dose associated with pediatric CT-guided drain placement and follow-up drain evaluations in order to estimate effective dose. We searched the electronic medical record and picture archiving and communication system (PACS) to identify all pediatric (<18 years old) CT-guided drain placements performed between January 2008 and December 2013 at our institution. We compiled patient data and radiation dose information from CT-guided drain placements as well as pre-procedural diagnostic CTs and post-procedural follow-up fluoroscopic abscess catheter injections (sinograms). Then we converted dose-length product, fluoroscopy time and number of acquisitions to effective doses using Monte Carlo simulations and age-appropriate conversion factors based on annual quality-control testing. Fifty-two drainages were identified with mean patient age of 11.0 years (5 weeks to 17 years). Most children had diagnoses of appendicitis (n=23) or inflammatory bowel disease (n=11). Forty-seven patients had diagnostic CTs, with a mean effective dose of 7.3 mSv (range 1.1-25.5 mSv). Drains remained in place for an average of 16.9 days (range 0-75 days), with an average of 0.9 (0-5) sinograms per patient in follow-up. The mean effective dose for all drainages and follow-up exams was 5.3 mSv (0.7-17.1) and 62% (32/52) of the children had effective doses less than 5 mSv. The majority of pediatric patients who have undergone CT-guided drain placements at our institution have received total radiation doses on par with diagnostic ranges. This information could be useful when describing the dose of radiation to parents and providers when CT-guided drain placement is necessary. (orig.)

Risk of whole body radiation exposure and protective measures in fluoroscopically guided interventional techniques: a prospective evaluation

Directory of Open Access Journals (Sweden)

Rivera Jose

2003-08-01

Full Text Available Abstract Background Fluoroscopic guidance is frequently utilized in interventional pain management. The major purpose of fluoroscopy is correct needle placement to ensure target specificity and accurate delivery of the injectate. Radiation exposure may be associated with risks to physician, patient and personnel. While there have been many studies evaluating the risk of radiation exposure and techniques to reduce this risk in the upper part of the body, the literature is scant in evaluating the risk of radiation exposure in the lower part of the body. Methods Radiation exposure risk to the physician was evaluated in 1156 patients undergoing interventional procedures under fluoroscopy by 3 physicians. Monitoring of scattered radiation exposure in the upper and lower body, inside and outside the lead apron was carried out. Results The average exposure per procedure was 12.0 ± 9.8 seconds, 9.0 ± 0.37 seconds, and 7.5 ± 1.27 seconds in Groups I, II, and III respectively. Scatter radiation exposure ranged from a low of 3.7 ± 0.29 seconds for caudal/interlaminar epidurals to 61.0 ± 9.0 seconds for discography. Inside the apron, over the thyroid collar on the neck, the scatter radiation exposure was 68 mREM in Group I consisting of 201 patients who had a total of 330 procedures with an average of 0.2060 mREM per procedure and 25 mREM in Group II consisting of 446 patients who had a total of 662 procedures with average of 0.0378 mREM per procedure. The scatter radiation exposure was 0 mREM in Group III consisting of 509 patients who had a total 827 procedures. Increased levels of exposures were observed in Groups I and II compared to Group III, and Group I compared to Group II. Groin exposure showed 0 mREM exposure in Groups I and II and 15 mREM in Group III. Scatter radiation exposure for groin outside the apron in Group I was 1260 mREM and per procedure was 3.8182 mREM. In Group II the scatter radiation exposure was 400 mREM and with 0.6042 m

A digital fluoroscopic imaging system for verification during external beam radiotherapy

International Nuclear Information System (INIS)

Takai, Michikatsu

1990-01-01

A digital fluoroscopic (DF) imaging system has been constructed to obtain portal images for verification during external beam radiotherapy. The imaging device consists of a fluorescent screen viewed by a highly sensitive video camera through a mirror. The video signal is digitized and processed by an image processor which is linked on-line with a host microcomputer. The image quality of the DF system was compared with that of film for portal images of the Burger phantom and the Alderson anthropomorphic phantom using 10 MV X-rays. Contrast resolution of the DF image integrated for 8.5 sec. was superior to the film resolution, while spatial resolution was slightly inferior. The DF image of the Alderson phantom processed by the adaptive histogram equalization was better in showing anatomical landmarks than the film portal image. The DF image integrated for 1 sec. which is used for movie mode can show patient movement during treatment. (author)

Radiation injury of the skin following diagnostic and interventional fluoroscopic procedures

International Nuclear Information System (INIS)

Koenig, T.R.; Wagner, L.K.; Mettler, F.A.

2001-01-01

Many radiation injuries to the skin, resulting from diagnostic and interventional fluoroscopic procedures, have been reported in recent years. In some cases skin damage was severe and debilitating. We analyzed 72 reports of skin injuries for progression and location of injury, type and number of procedures, and contributing patient and operator factors. Most cases (46) were related to coronary angiography and percutaneous transluminal coronary angioplasty (PTCA). A smaller number was documented after cardiac radiofrequency catheter ablation (12), transjugular intrahepatic portosystemic shunt (TIPS) placement (7), neuroradiological interventions (3) and other procedures (4). Important factors leading to skin injuries were long exposure times over the same skin area, use of high dose rates, irradiation through thick tissue masses, hypersensitivity to radiation, and positioning of arms or breasts into the radiation entrance beam. Physicians were frequently unaware of the high radiation doses involved and did not recognize the injuries as radiation induced. Based on these findings, recommendations to reduce dose and improve patient care are provided. (author)

Clinical comparison between 100 mm photofluorography and digital (1024/sup 2/) fluoroscopic image acquisition

International Nuclear Information System (INIS)

Hynes, D.M.; Edmonds, E.W.; Rowlands, J.A.; Porter, A.J.; Toth, B.D.

1986-01-01

The authors describe current work in progress in which a clinical image can be recorded on both 100-mm film and a 1,024/sup 2/ image store with the same exposure. The 100-mm film is exposed in the usual manner. However, the same radiation exposure is utilized by the optics of the beam splitter to transfer the output image of the intensifier into a 1,024/sup 2/ image store and thence to hard copy by multiformat camera or laser printer. Comparative phantom and clinical images will be presented, along with observations on dose rates needed for diagnostic digital imaging. Use of this system may allow fluoroscopic dose rates to be reduced

Guide to shielding calculations for the design of fluoroscopic laboratory at 503 workshop AVN base Rawalpindi

International Nuclear Information System (INIS)

Din, J.U.; Ahmad, M.; Ashraf, M.M.; Khan, A.R.; Khan, A.A.

1986-11-01

Non-destructive testing plays an important role in assessing the quality of materials. Various methods are used for this purpose. Radiography by X-rays and gamma-rays is one of the NDT methods used. There are number of mathematical formulae used to estimate the required shielding for an X-ray tube operating at maximum rated voltage or a gamma radiation source having fixed energies. This report covers the shielding requirements for a 150 KV constant potential X-ray unit operating at maximum rated voltage. In addition, the report is a guide for the design of shielded enclosure required for X-rays machines in general. (orig./A.B.)

C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters

International Nuclear Information System (INIS)

Tam, Alda; Mohamed, Ashraf; Pfister, Marcus; Rohm, Esther; Wallace, Michael J.

2009-01-01

C-arm cone beam computed tomography is an advanced 3D imaging technology that is currently available on state-of-the-art flat-panel-based angiography systems. The overlay of cross-sectional imaging information can now be integrated with real-time fluoroscopy. This overlay technology was used to guide the placement of three percutaneous translumbar inferior vena cava catheters.

Characterization of MOSFET Dosimeter Angular Response Using a Spherical Phantom for Fluoroscopic Dosimetry.

Science.gov (United States)

Wang, Chu; Hill, Kevin; Yoshizumi, Terry

2016-01-01

Metal-Oxide Semiconductor Field-Effect Transistor (MOSFET) dosimeters, placed in anthropomorphic phantoms, are a standard method for organ dosimetry in medical x-ray imaging applications. However, many x-ray applications, particularly fluoroscopy procedures, use variable projection angles. During dosimetry, the MOSFET detector active area may not always be perpendicular to the x-ray beam. The goal of this study was to characterize the dosimeter's angular response in the fluoroscopic irradiation involved in pediatric cardiac catheterization procedures, during which a considerable amount of fluoroscopic x-ray irradiation is often applied from various projection angles. A biological x-ray irradiator was used to simulate the beam quality of a biplane fluoroscopy imaging system. A custom-designed acrylic spherical scatter phantom was fabricated to measure dosimeter response (in mV) in two rotational axes, axial (ψ) and normal-to-axial (θ), in 30° increments, as well as four common oblique angles used in cardiac catheterization: a) 90° Left Anterior Oblique (LAO); b) 70° LAO/ 20° Cranial; c) 20° LAO/ 15° Cranial; and d) 30° Right Anterior Oblique (RAO). All results were normalized to the angle where the dosimeter epoxy is perpendicular to the beam or the Posterior-Anterior projection angle in the clinical setup. The relative response in the axial rotation was isotropic (within ± 10% deviation); that in the normal-to-axial rotation was isotropic in all angles except the ψ = 270° angle, where the relative response was 83 ± 9%. No significant deviation in detector response was observed in the four common oblique angles, with their relative responses being: a) 102 ± 3%; b) 90 ± 3%; c) 92 ± 3%; and d) 95 ± 3%, respectively. These angular correction factors will be used in future dosimetry studies for fluoroscopy. The spherical phantom may be useful for other applications, as it allows the measurement of dosimeter response in virtually all angles in the 3

Experimental MR-guided cryotherapy of the brain with almost real-time imaging by radial k-space scanning

International Nuclear Information System (INIS)

Tacke, J.; Schorn, R.; Glowinski, A.; Grosskortenhaus, S.; Adam, G.; Guenther, R.W.; Rasche, V.

1999-01-01

Purpose: To test radial k-space scanning by MR fluoroscopy to guide and control MR-guided interstitial cryotherapy of the healthy pig brain. Methods: After MR tomographic planning of the approach, an MR-compatible experimental cryotherapy probe of 2.7 mm diameter was introduced through a 5 mm burr hole into the right frontal brain of five healthy pigs. The freeze-thaw cycles were imaged using a T 1 -weighted gradient echo sequence with radial k-space scanning in coronal, sagittal, and axial directions. Results: The high temporal resolution of the chosen sequence permits a continuous representation of the freezing process with good image quality and high contrast between ice and unfrozen brain parenchyma. Because of the interactive conception of the sequence the layer plane could be chosen as desired during the measurement. Ice formation was sharply demarcated, spherically configurated, and was free of signals. Its maximum diameter was 13 mm. Conclusions: With use of the novel, interactively controllable gradient echo sequence with radial k-space scanning, guidance of the intervention under fluoroscopic conditions with the advantages of MRT is possible. MR-guided cryotherapy allows a minimally-invasive, precisely dosable focal tissue ablation. (orig.) [de

Fluoroscopic guided benign oesophageal stricture dilatation in ...

African Journals Online (AJOL)

Gilliard bougienage (SGB) with balloon dilatation and the combination of both methods for the treatment of BOSs in children at Universitas Hospital, Bloemfontein, South Africa. Methods. A retrospective review of the patient notes on all children 12 ...

Skin dose mapping for fluoroscopically guided interventions.

Science.gov (United States)

Johnson, Perry B; Borrego, David; Balter, Stephen; Johnson, Kevin; Siragusa, Daniel; Bolch, Wesley E

2011-10-01

To introduce a new skin dose mapping software system for interventional fluoroscopy dose assessment and to analyze the benefits and limitations of patient-phantom matching. In this study, a new software system was developed for visualizing patient skin dose during interventional fluoroscopy procedures. The system works by translating the reference point air kerma to the location of the patient's skin, which is represented by a computational model. In order to orient the model with the x-ray source, geometric parameters found within the radiation dose structured report (RDSR) are used along with a limited number of in-clinic measurements. The output of the system is a visual indication of skin dose mapped onto an anthropomorphic model at a resolution of 5 mm. In order to determine if patient-dependent and patient-sculpted models increase accuracy, peak skin dose was calculated for each of 26 patient-specific models and compared with doses calculated using an elliptical stylized model, a reference hybrid model, a matched patient-dependent model and one patient-sculpted model. Results were analyzed in terms of a percent difference using the doses calculated using the patient-specific model as the true standard. Anthropometric matching, including the use of both patient-dependent and patient-sculpted phantoms, was shown most beneficial for left lateral and anterior-posterior projections. In these cases, the percent difference using a reference model was between 8 and 20%, using a patient-dependent model between 7 and 15%, and using a patient-sculpted model between 3 and 7%. Under the table tube configurations produced errors less than 5% in most situations due to the flattening affects of the table and pad, and the fact that table height is the main determination of source-to-skin distance for these configurations. In addition to these results, several skin dose maps were produced and a prototype display system was placed on the in-clinic monitor of an interventional fluoroscopy system. The skin dose mapping program developed in this work represents a new tool that, as the RDSR becomes available through automated export or real-time streaming, can provide the interventional physician information needed to modify behavior when clinically appropriate. The program is nonproprietary and transferable, and also functions independent to the software systems already installed on the control room workstation. The next step will be clinical implementation where the workflow will be optimized along with further analysis of real-time capabilities.

Ultrasound-Guided Transoral Videolaryngoscopic Surgery for Retropharyngeal Lymph Node Metastasis of Papillary Thyroid Cancer

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Kazunori Fujiwara

2017-07-01

Full Text Available Background: Endoscopic-assisted transoral surgery, including transoral robotic surgery for metastatic retropharyngeal lymph node (RPN from well-differentiated thyroid cancer, has been reported to reduce the complications resulting from transcervical and transmandibular approaches. However, the narrow working space and difficulty identifying RPN are problematic. To solve these issues, several studies have used intraoperative ultrasound in endoscopic-assisted transoral surgery. However, the type of ultrasonography suitable for this purpose remains unclear. Case Presentation: A 60-year-old female with thyroid papillary carcinoma (T4aN1bM0 initially underwent total thyroidectomy and paratracheal and selective neck dissections (D2a, with resectional management of recurrent laryngeal nerve, trachea, and esophagus. Three years later, she was diagnosed with left retropharyngeal and upper mediastinal lymph node metastases of papillary thyroid cancer. Transoral videolaryngoscopic surgery was performed with a combination of ultrasonography with a flexible laparoscopic transducer manipulated with forceps for identifying RPN intraoperatively. Due to the transducer’s small size and thin, flexible cable, the transducer interrupted the procedure in spite of the narrowness of oral cavity. RPN was resected completely without adverse events. Conclusion: We performed intraoperative ultrasound-guided endoscopic transoral surgery for metastatic RPN from papillary thyroid cancer and achieved complete resection as well as preservation of swallowing function.

Supplementation of bone marrow aspirate-derived platelet-rich plasma for treating radiation-induced ulcer after cardiac fluoroscopic procedures: A preliminary report

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Soh Nishimoto

2012-01-01

Full Text Available Background: The frequency of encountering radiodermatitis caused by X-ray fluoroscopic procedures for ischaemic heart disease is increasing. In severe cases, devastating ulcers with pain, for which conservative therapy is ineffective, emerge. Radiation-induced ulcers are notorious for being difficult to treat. Simple skin grafting often fails because of the poor state of the wound bed. A vascularized flap is a very good option. However, the non-adherence of the well-vascularized flap with the irradiated wound bed is frequently experienced. Aim: To ameliorate the irradiated wound bed, bone marrow-derived platelet-rich plasma (bm-PRP was delivered during the surgery. Materials and Methods: Four patients with severe cutaneous radiation injury accompanied by unbearable pain after multiple fluoroscopic procedures for ischaemic heart disease were treated. Wide excision of the lesion and coverage with a skin flap supplemented with bm-PRP injection was performed. Results: All patients obtained wound closure and were relieved from pain. No complication concerning the bone marrow aspiration and delivery of bm-PRP was observed. Conclusions: Supplementation of bm-PRP can be an option without major complications, time, and cost to improve the surgical outcome for irradiated wounds.

Balloon catheter dilatation of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-07-15

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures.

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon

1990-01-01

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures

Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

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Shah, Sweta [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Desouches, Stephane L. [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); St. Luke' s Hospital, Department of Radiology, Kansas City, MO (United States); Lowe, Lisa H.; Kasraie, Nima; Reading, Brenton [University of Missouri-Kansas City SOM, Department of Radiology, Kansas City, MO (United States); Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

2014-07-24

Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

Implementation of a competency check-off in diagnostic fluoroscopy for radiology trainees: impact on reducing radiation for three common fluoroscopic exams in children

International Nuclear Information System (INIS)

Shah, Sweta; Desouches, Stephane L.; Lowe, Lisa H.; Kasraie, Nima; Reading, Brenton

2015-01-01

Fluoroscopy is an important tool for diagnosis in the pediatric population, but it carries the risk of radiation exposure. Because radiology resident education and experience in the use of fluoroscopy equipment in children vary, we implemented an intervention to standardize fluoroscopy training. The purpose of this study is to determine the impact of implementing a fluoroscopy competency check-off for radiology resident trainees aimed at decreasing radiation exposure in three common pediatric fluoroscopic studies. A fluoroscopy competency check-off form was developed for radiology resident trainees performing pediatric procedures. Techniques used to limit radiation exposure for common pediatric radiologic studies were reviewed as part of the check-off process. Pediatric radiologists supervised each trainee until they demonstrated competence to independently perform three specified procedures. Radiation dose was recorded for the three procedures, upper GI (UGI), voiding cystourethrogram (VCUG) and oropharyngeal (OPM) exams, over 6 months preceding and 6 months following implementation of the competency check-off. The mean cumulative dose for each procedure was compared before and after implementation of competency check-off using a Kruskal-Wallis test. During the 12-month study period doses from 909 fluoroscopic procedures were recorded. In the 6 months preceding competency check-off implementation, procedures were performed by 24 radiology resident trainees including 171 UGI, 176 VCUG and 171 OPM exams. In the 6 months following competency check-off, 23 trainees performed 114 UGI, 145 VCUG and 132 OPM exams. After competency check-off implementation, a statistically significant reduction in average radiation dose was found for all three studies (P < 0.001). Median cumulative doses (mGy) were decreased by 33%, 36% and 13% for UGIs, VCUGs and OPMs, respectively. Implementation of a competency check-off for radiology resident trainees can reduce average radiation

The accuracy and safety of fluoroscopically guided percutaneous pedicle screws in the lumbosacral junction and the lumbar spine: a review of 880 screws.

Science.gov (United States)

Chiu, C K; Kwan, M K; Chan, C Y W; Schaefer, C; Hansen-Algenstaedt, N

2015-08-01

We undertook a retrospective study investigating the accuracy and safety of percutaneous pedicle screws placed under fluoroscopic guidance in the lumbosacral junction and lumbar spine. The CT scans of patients were chosen from two centres: European patients from University Medical Center Hamburg-Eppendorf, Germany, and Asian patients from the University of Malaya, Malaysia. Screw perforations were classified into grades 0, 1, 2 and 3. A total of 880 percutaneous pedicle screws from 203 patients were analysed: 614 screws from 144 European patients and 266 screws from 59 Asian patients. The mean age of the patients was 58.8 years (16 to 91) and there were 103 men and 100 women. The total rate of perforation was 9.9% (87 screws) with 7.4% grade 1, 2.0% grade 2 and 0.5% grade 3 perforations. The rate of perforation in Europeans was 10.4% and in Asians was 8.6%, with no significant difference between the two (p = 0.42). The rate of perforation was the highest in S1 (19.4%) followed by L5 (14.9%). The accuracy and safety of percutaneous pedicle screw placement are comparable to those cited in the literature for the open method of pedicle screw placement. Greater caution must be taken during the insertion of L5 and S1 percutaneous pedicle screws owing to their more angulated pedicles, the anatomical variations in their vertebral bodies and the morphology of the spinal canal at this location. ©2015 The British Editorial Society of Bone & Joint Surgery.

Deep architecture neural network-based real-time image processing for image-guided radiotherapy.

Science.gov (United States)

Mori, Shinichiro

2017-08-01

To develop real-time image processing for image-guided radiotherapy, we evaluated several neural network models for use with different imaging modalities, including X-ray fluoroscopic image denoising. Setup images of prostate cancer patients were acquired with two oblique X-ray fluoroscopic units. Two types of residual network were designed: a convolutional autoencoder (rCAE) and a convolutional neural network (rCNN). We changed the convolutional kernel size and number of convolutional layers for both networks, and the number of pooling and upsampling layers for rCAE. The ground-truth image was applied to the contrast-limited adaptive histogram equalization (CLAHE) method of image processing. Network models were trained to keep the quality of the output image close to that of the ground-truth image from the input image without image processing. For image denoising evaluation, noisy input images were used for the training. More than 6 convolutional layers with convolutional kernels >5×5 improved image quality. However, this did not allow real-time imaging. After applying a pair of pooling and upsampling layers to both networks, rCAEs with >3 convolutions each and rCNNs with >12 convolutions with a pair of pooling and upsampling layers achieved real-time processing at 30 frames per second (fps) with acceptable image quality. Use of our suggested network achieved real-time image processing for contrast enhancement and image denoising by the use of a conventional modern personal computer. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Image-Guided percutaneous biopsies with a biopsy gun

Energy Technology Data Exchange (ETDEWEB)

Lee, Kyung Hwan; Lim, Hyo Keun; Kim, Eun Ah; Yun, Ku Sub; Bae, Sang Hoo; Shin, Hyung Sik [Hallym University College of Medicine, Seoul (Korea, Republic of)

1994-07-15

We report the results of image-guided percutaneous biopsies with a biopsy gun and evaluate the clinical usefulness. One hundred and five biopsies under ultrasonographic or fluoroscopic guidance were performed. Various anatomic sites were targeted(liver; 50, chest; 22, kidney; 12, pancreas; 8, intraperitoeum; 7, retroperitoneum; ). Obtained tissue was diagnostic in 98 of the 105 biopsies(93%). In each instance, representative core tissue specimens were obtained. Evaluation of the core tissue by pathologist revealed consistent, uniform specimens that contained significant crush artifact in no case. Five biopsies yielded inadequate tissue which were too small for histopathologic interpretation or were composed of necrotic debris. Two biopsies yielded adequate tissues, but tissues were not of the target. The diagnoses were malignancy in 77 biopsies and benign disease in 21 biopsies. No complications other than mild, localized discomfort were encountered except a transient hemoptysis and pneumothorax which was observed in two patients. Cutting biopsy with a biopsy gun provided sufficient amount of target tissue for an accurate diagnosis of malignant and benign disease. It was a safe and useful procedure for percutaneous biopsy.

Fluoroscopic removal of retrievable self-expandable metal stents in patients with malignant oesophageal strictures: Experience with a non-endoscopic removal system.

Science.gov (United States)

Kim, Pyeong Hwa; Song, Ho-Young; Park, Jung-Hoon; Zhou, Wei-Zhong; Na, Han Kyu; Cho, Young Chul; Jun, Eun Jung; Kim, Jun Ki; Kim, Guk Bae

2017-03-01

To evaluate clinical outcomes of fluoroscopic removal of retrievable self-expandable metal stents (SEMSs) for malignant oesophageal strictures, to compare clinical outcomes of three different removal techniques, and to identify predictive factors of successful removal by the standard technique (primary technical success). A total of 137 stents were removed from 128 patients with malignant oesophageal strictures. Primary overall technical success and removal-related complications were evaluated. Logistic regression models were constructed to identify predictive factors of primary technical success. Primary technical success rate was 78.8 % (108/137). Complications occurred in six (4.4 %) cases. Stent location in the upper oesophagus (P=0.004), stricture length over 8 cm (P=0.030), and proximal granulation tissue (Pstent location in the upper oesophagus, and stricture length over 8 cm were negative predictive factors for primary technical success by standard extraction and may require a modified removal technique. • Fluoroscopic retrievable SEMS removal is safe and effective. • Standard removal technique by traction is effective in the majority of patients. • Three negative predictive factors of primary technical success were identified. • Caution should be exercised during the removal in those situations. • Eversion technique is effective in cases of proximal granulation tissue.

Appropriate Use Criteria for Fluoroscopically Guided Diagnostic and Therapeutic Sacroiliac Interventions: Results from the Spine Intervention Society Convened Multispecialty Collaborative.

Science.gov (United States)

MacVicar, John; Kreiner, D Scott; Duszynski, Belinda; Kennedy, David J

2017-11-01

To provide an overview of a multisociety effort to formulate appropriate use criteria for image-guided injections and radiofrequency procedures in the diagnosis and treatment of sacroiliac joint and posterior sacroiliac complex pain. The Spine Intervention Society convened a multisociety effort to guide physicians and define for payers the appropriate use of image-guided injections and radiofrequency procedures. An evidence panel was established to write systematic reviews, define key terms and assumptions, and develop clinical scenarios to be addressed. The rating panel considered the evidence presented in the systematic reviews, carefully reviewed the definitions and assumptions, and rated the clinical scenarios. Final median ratings, in combination with the level of agreement, determined the final ratings for the appropriate use of sacroiliac injections and radiofrequency neurotomy. More than 10,000 scenarios were addressed in the appropriate use criteria and are housed within five modules in the portal, available on the Spine Intervention Society website: Module 1: Clinical Indications and Imaging; Module 2: Anticoagulants; Module 3: Timing of Injections; Module 4: Number of Injections; and Module 5: Lateral Branch Radiofrequency Neurotomy. Within several of these modules, several issues of interest are identified and discussed. Physicians and payers can access the appropriate use criteria portal on the Spine Intervention Society's website and select specific clinical indications for a particular patient in order to learn more about the appropriateness of the intervention(s) under consideration. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Clinical Feasibility and Usefulness of CT Fluoroscopy-Guided Percutaneous Transhepatic Biliary Drainage in Emergency Patients with Acute Obstructive Cholangitis

Energy Technology Data Exchange (ETDEWEB)

Kim, Ji Hyung [Sam Anyang Hospital, Anyang (Korea, Republic of)

2009-04-15

To evaluate the feasibility of CT fluoroscopy (CTF)-guided percutaneous transhepatic biliary drainage (PTBD) in emergency patients with acute obstructive cholangitis. The study included 28 patients admitted to the emergency center due to obstructive jaundice and found to require urgent biliary drainage, as well as judged to have a suitable peripheral bile duct for a CTF-guided puncture (at least 4 mm in width). Prior to the CTF-guided puncture, a CT scan was performed to evaluate bile duct dilatation and the underlying causes of biliary obstruction. If the patient was judged to be a suitable candidate, a CTF-guided PTBD was performed in the same CT unit without additional fluoroscopic guidance. Technical feasibility of the procedure was investigated with the evaluation of overall success rate and causes of failure. A hepatic puncture was attempted at the left lobe in 23 patients and right lobe in five patients. The procedure was successful in 24 of 28 patients (86%) Successful biliary puncture was achieved on the first attempt in 16 patients, the second attempt in five patients, and the third attempt in three patients. The causes of failure included guide wire twisting in one patient, biliary puncture failure in two patients, and poor visualization of the guide wire in one patient. There were no significant procedure-related complication. The CTF-guided PTBD is technically feasible and highly successful in patients judged to have a suitable indication. Moreover, although the procedure is unfamiliar and inconvenient to interventionalists, it has economical advantages in that it saves time and manpower. We believe this method can be used in the emergency patients requiring urgent biliary drainage as an alternative for the fluoroscopy-guided PTBD.

Transcervical Embryo recovery by transcervical technique in ...

African Journals Online (AJOL)

Vicente Freitas

every four hours for as long as they exhibited standing oestrus. ... both techniques was inspected under a stereomicroscope (Nikon, Japan) at a magnification of 40-70x to ... to that cited by other researchers working on superovulation of goats.

A cost effective and high fidelity fluoroscopy simulator using the Image-Guided Surgery Toolkit (IGSTK)

Science.gov (United States)

Gong, Ren Hui; Jenkins, Brad; Sze, Raymond W.; Yaniv, Ziv

2014-03-01

The skills required for obtaining informative x-ray fluoroscopy images are currently acquired while trainees provide clinical care. As a consequence, trainees and patients are exposed to higher doses of radiation. Use of simulation has the potential to reduce this radiation exposure by enabling trainees to improve their skills in a safe environment prior to treating patients. We describe a low cost, high fidelity, fluoroscopy simulation system. Our system enables operators to practice their skills using the clinical device and simulated x-rays of a virtual patient. The patient is represented using a set of temporal Computed Tomography (CT) images, corresponding to the underlying dynamic processes. Simulated x-ray images, digitally reconstructed radiographs (DRRs), are generated from the CTs using ray-casting with customizable machine specific imaging parameters. To establish the spatial relationship between the CT and the fluoroscopy device, the CT is virtually attached to a patient phantom and a web camera is used to track the phantom's pose. The camera is mounted on the fluoroscope's intensifier and the relationship between it and the x-ray source is obtained via calibration. To control image acquisition the operator moves the fluoroscope as in normal operation mode. Control of zoom, collimation and image save is done using a keypad mounted alongside the device's control panel. Implementation is based on the Image-Guided Surgery Toolkit (IGSTK), and the use of the graphics processing unit (GPU) for accelerated image generation. Our system was evaluated by 11 clinicians and was found to be sufficiently realistic for training purposes.

The child fluoroscopic examination in the I.I.-DR. Reduction of radiation exposure dose

International Nuclear Information System (INIS)

Endo, Takayuki

2001-01-01

This examination for I.I.-DR conditions was done for the purpose of reducing radiation exposure dose in child gastrointestinal fluoroscopy. Fluoroscopic apparatus used was Toshiba MAX-1000A with imaging recorder DDX-1000A. Dose was measured with a thimble ionization chamber Radcal Corporation Model 9015. Examinations for conditions were performed with the standard dose determined, the digital value 300, giving the plateau contrast ratio of acryl plate/barium sulfate. Reduction to about 10% dose (57 μGy/min for pulse fluoroscopy and 6.8 μGy/film for filming) relative to the usual method (764 μGy/min and 36.0 μGy/film, respectively) was found attained with additional filter of Al 0.5 mm + Cu 0.2 mm and IRIS diameter 100 with acryl thickness of 10 cm. Actual images of 6 months old baby were presented. (K.H.)

Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

Energy Technology Data Exchange (ETDEWEB)

Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung [Kyungpook National University Hospital, Daegu (Korea, Republic of)

2006-08-15

The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

Ultrasound-guided percutaneous cholecysto-cholangiography for the exclusion of biliary atresia in infants

International Nuclear Information System (INIS)

Shin, Kyung Min; Ryeom, Hun Kyu; Choe, Byung Ho; Kim, Kap Cheol; Kim, Jong Yeol; Lee, Jong Min; Kim, Hye Jeong; Lee, Hee Jung

2006-01-01

The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice. Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings. The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient. Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder

Effectiveness of fluoroscopy-guided intra-articular steroid injection for hip osteoarthritis

International Nuclear Information System (INIS)

Subedi, N.; Chew, N.S.; Chandramohan, M.; Scally, A.J.; Groves, C.

2015-01-01

Aim: To demonstrate the benefits of fluoroscopy-guided intra-articular steroid injection in the hip with varying degrees of disease severity, and to investigate the financial aspects of the procedure and impact on waiting time. Materials and methods: A prospective study was undertaken of patients who underwent fluoroscopic intra-articular steroid injection over the 9-month study period. Comparative analysis of the Oxford hip pain score pre- and 6–8 weeks post-intra-articular injection was performed. Hip radiographs of all patients were categorised as normal, mild, moderate, or severe disease (four categories) based on the modified Kellgren–Lawrence severity scale, and improvement on the Oxford hip pain score on each of these four severity categories were assessed. Results: Within the study cohort of 100 patients, the mean increase in post-procedure hip score of 7.32 points confirms statistically significant benefits of the therapy (p<0.001, 95% confidence interval: 5.55–9.09). There was no significant difference in pre-injection hip score or change in score between the four severity categories (p=0.51). Significant improvement in hip score (p<0.05) was demonstrated in each of the four severity categories 6–8 weeks post-injection. No associated complications were observed. Conclusion: The present study confirms that fluoroscopy-guided intra-articular steroid injection is a highly effective therapeutic measure for hip osteoarthritis across all grades of disease severity with significant cost savings and the potential to reduce waiting times. - Highlights: • Comparable clinical effectiveness of fluoroscopy guided and theatre based therapeutic intra-articular hip injections. • Significant cost savings on fluoroscopy guided hip injection performed in a radiology department. • A potential reduction in patients' waiting time for the procedure.

LabVIEW Graphical User Interface for a New High Sensitivity, High Resolution Micro-Angio-Fluoroscopic and ROI-CBCT System.

Science.gov (United States)

Keleshis, C; Ionita, Cn; Yadava, G; Patel, V; Bednarek, Dr; Hoffmann, Kr; Verevkin, A; Rudin, S

2008-01-01

A graphical user interface based on LabVIEW software was developed to enable clinical evaluation of a new High-Sensitivity Micro-Angio-Fluoroscopic (HSMAF) system for real-time acquisition, display and rapid frame transfer of high-resolution region-of-interest images. The HSMAF detector consists of a CsI(Tl) phosphor, a light image intensifier (LII), and a fiber-optic taper coupled to a progressive scan, frame-transfer, charged-coupled device (CCD) camera which provides real-time 12 bit, 1k × 1k images capable of greater than 10 lp/mm resolution. Images can be captured in continuous or triggered mode, and the camera can be programmed by a computer using Camera Link serial communication. A graphical user interface was developed to control the camera modes such as gain and pixel binning as well as to acquire, store, display, and process the images. The program, written in LabVIEW, has the following capabilities: camera initialization, synchronized image acquisition with the x-ray pulses, roadmap and digital subtraction angiography acquisition (DSA), flat field correction, brightness and contrast control, last frame hold in fluoroscopy, looped playback of the acquired images in angiography, recursive temporal filtering and LII gain control. Frame rates can be up to 30 fps in full-resolution mode. The user friendly implementation of the interface along with the high framerate acquisition and display for this unique high-resolution detector should provide angiographers and interventionalists with a new capability for visualizing details of small vessels and endovascular devices such as stents and hence enable more accurate diagnoses and image guided interventions. (Support: NIH Grants R01NS43924, R01EB002873).

Discrepancy between fluoroscopic arthrography and magnetic resonance arthrography in patients with arthroscopically confirmed supraspinatus tendon tears: The additional benefit of cine fluoroscopic arthrography images

International Nuclear Information System (INIS)

Hahn, Seok; Lee, Young Han; Suh, Jin Suck

2016-01-01

To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself

Discrepancy between fluoroscopic arthrography and magnetic resonance arthrography in patients with arthroscopically confirmed supraspinatus tendon tears: The additional benefit of cine fluoroscopic arthrography images

Energy Technology Data Exchange (ETDEWEB)

Hahn, Seok; Lee, Young Han; Suh, Jin Suck [Dept. Radiology, Research Institute of Radiological Science, Medical Convergence Research Institute, and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul (Korea, Republic of)

2016-12-15

To determine the additional diagnostic benefits of fluoroscopic arthrography (FA) in patients with full-thickness supraspinatus tendon (SST) tears by comparing FA images with magnetic resonance arthrography (MRA) images. This study included FA and MRA images of 53 patients who were confirmed to have full-thickness SST tears by arthroscopy. In the FA analysis, the presence of contrast leakage into the subacromial-subdeltoid bursa was recorded. In the MRA analysis, contrast leakage, retraction of a torn tendon, width and length of the tear, and supraspinatus atrophy were evaluated. Patients were divided into the concordant group or the discordant group based on the presence of contrast leakage to compare the characteristics of SST tears. We used Fisher's exact test and two-sample t-test for the comparison. Of the 53 patients, 34 were included in the concordant group and 19 were included in the discordant group. In the concordant group, the grades of retraction were higher than those in the discordant group; the width and length of the tears were larger. Muscle atrophy was more severe in the concordant group. A full-thickness SST tear did not always exhibit contrast leakage on FA, particularly small SST tears or tears with low-grade retraction. FA can provide diagnostic information regarding the severity of full-thickness SST tears by itself.

TU-D-209-03: Alignment of the Patient Graphic Model Using Fluoroscopic Images for Skin Dose Mapping

Energy Technology Data Exchange (ETDEWEB)

Oines, A; Oines, A; Kilian-Meneghin, J; Karthikeyan, B; Rudin, S; Bednarek, D [University at Buffalo (SUNY) School of Med., Buffalo, NY (United States)

2016-06-15

Purpose: The Dose Tracking System (DTS) was developed to provide realtime feedback of skin dose and dose rate during interventional fluoroscopic procedures. A color map on a 3D graphic of the patient represents the cumulative dose distribution on the skin. Automated image correlation algorithms are described which use the fluoroscopic procedure images to align and scale the patient graphic for more accurate dose mapping. Methods: Currently, the DTS employs manual patient graphic selection and alignment. To improve the accuracy of dose mapping and automate the software, various methods are explored to extract information about the beam location and patient morphology from the procedure images. To match patient anatomy with a reference projection image, preprocessing is first used, including edge enhancement, edge detection, and contour detection. Template matching algorithms from OpenCV are then employed to find the location of the beam. Once a match is found, the reference graphic is scaled and rotated to fit the patient, using image registration correlation functions in Matlab. The algorithm runs correlation functions for all points and maps all correlation confidences to a surface map. The highest point of correlation is used for alignment and scaling. The transformation data is saved for later model scaling. Results: Anatomic recognition is used to find matching features between model and image and image registration correlation provides for alignment and scaling at any rotation angle with less than onesecond runtime, and at noise levels in excess of 150% of those found in normal procedures. Conclusion: The algorithm provides the necessary scaling and alignment tools to improve the accuracy of dose distribution mapping on the patient graphic with the DTS. Partial support from NIH Grant R01-EB002873 and Toshiba Medical Systems Corp.

TU-D-209-03: Alignment of the Patient Graphic Model Using Fluoroscopic Images for Skin Dose Mapping

International Nuclear Information System (INIS)

Oines, A; Oines, A; Kilian-Meneghin, J; Karthikeyan, B; Rudin, S; Bednarek, D

2016-01-01

Purpose: The Dose Tracking System (DTS) was developed to provide realtime feedback of skin dose and dose rate during interventional fluoroscopic procedures. A color map on a 3D graphic of the patient represents the cumulative dose distribution on the skin. Automated image correlation algorithms are described which use the fluoroscopic procedure images to align and scale the patient graphic for more accurate dose mapping. Methods: Currently, the DTS employs manual patient graphic selection and alignment. To improve the accuracy of dose mapping and automate the software, various methods are explored to extract information about the beam location and patient morphology from the procedure images. To match patient anatomy with a reference projection image, preprocessing is first used, including edge enhancement, edge detection, and contour detection. Template matching algorithms from OpenCV are then employed to find the location of the beam. Once a match is found, the reference graphic is scaled and rotated to fit the patient, using image registration correlation functions in Matlab. The algorithm runs correlation functions for all points and maps all correlation confidences to a surface map. The highest point of correlation is used for alignment and scaling. The transformation data is saved for later model scaling. Results: Anatomic recognition is used to find matching features between model and image and image registration correlation provides for alignment and scaling at any rotation angle with less than onesecond runtime, and at noise levels in excess of 150% of those found in normal procedures. Conclusion: The algorithm provides the necessary scaling and alignment tools to improve the accuracy of dose distribution mapping on the patient graphic with the DTS. Partial support from NIH Grant R01-EB002873 and Toshiba Medical Systems Corp.

A new model with an anatomically accurate human renal collecting system for training in fluoroscopy-guided percutaneous nephrolithotomy access.

Science.gov (United States)

Turney, Benjamin W

2014-03-01

Obtaining renal access is one of the most important and complex steps in learning percutaneous nephrolithotomy (PCNL). Ideally, this skill should be practiced outside the operating room. There is a need for anatomically accurate and cheap models for simulated training. The objective was to develop a cost-effective, anatomically accurate, nonbiologic training model for simulated PCNL access under fluoroscopic guidance. Collecting systems from routine computed tomography urograms were extracted and reformatted using specialized software. These images were printed in a water-soluble plastic on a three-dimensional (3D) printer to create biomodels. These models were embedded in silicone and then the models were dissolved in water to leave a hollow collecting system within a silicone model. These PCNL models were filled with contrast medium and sealed. A layer of dense foam acted as a spacer to replicate the tissues between skin and kidney. 3D printed models of human collecting systems are a useful adjunct in planning PCNL access. The PCNL access training model is relatively low cost and reproduces the anatomy of the renal collecting system faithfully. A range of models reflecting the variety and complexity of human collecting systems can be reproduced. The fluoroscopic triangulation process needed to target the calix of choice can be practiced successfully in this model. This silicone PCNL training model accurately replicates the anatomic architecture and orientation of the human renal collecting system. It provides a safe, clean, and effective model for training in accurate fluoroscopy-guided PCNL access.

Balloon dilatation for the treatment of stricture of gastrojejunostomy

Energy Technology Data Exchange (ETDEWEB)

Choi, Yeon Hwa [Lee Rha Hospital, Chungju (Korea, Republic of); Song, Ho Young [Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Han, Young Min; Chon, Su Bin; Chung, Gyung Ho; Kim, Chong Soo; Choi, Ki Chul [Chonbuk National University College of Medicine, Chungju (Korea, Republic of)

1993-07-15

Enteroenteric anastomotic strictures of UGI tract are common and require treatment if significant obstruction occurs. We performed fluoroscopic guided balloon dilatation in 6 patients who had symptomatic stricture of gastrojejunostomy. The stricture was successfully resolved in 4 patients with benign stricture. But 2 patients with malignant stricture had recurrence of obstructive symptoms 2 weeks later, and they required a stent. Asymptomatic balloon rupture was seen in one patients, but other procedural complications did not occur. We found that fluoroscopic guided balloon dilatation is an effective and safe method in the treatment of anastomotic stricture of gastrojejunostomy. We also found transient effect in malignant gastrojejunal anastomotic strictures, which required an interventional procedure, such as placement of a stent.

Evaluation

Directory of Open Access Journals (Sweden)

Ayman Galhom

2015-12-01

Conclusions: Fluoroscopic guided injection and surgery have the highest efficacy and satisfaction rates in managing chronic coccygodynia. Hypermobility and spicules are predictors of failure of conservative therapy.

Patients exposure from fluoroscopic guided pacemaker implantation procedures

International Nuclear Information System (INIS)

Alkhorayef, M.; Babikir, E.; Sulieman, A.; Daar, E.; Alnaaimi, M.; Alduaij, M.; Bradley, D.

2016-10-01

A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm 2 ) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

Patients exposure from fluoroscopic guided pacemaker implantation procedures

Energy Technology Data Exchange (ETDEWEB)

Alkhorayef, M.; Babikir, E. [King Saud University, College of Applied Sciences, Radiological Sciences Department, P. O. Box 10219, Riyadh 11433 (Saudi Arabia); Sulieman, A. [Prince Sattam bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P. O. Box 422, Alkharj 11942 (Saudi Arabia); Daar, E. [University of Jordan, Faculty of Science, Department of Physics, Amman 11942 (Jordan); Alnaaimi, M.; Alduaij, M. [Kuwait Cancer Control Centre, Department of Nuclear Medicine, Shwiekh (Kuwait); Bradley, D., E-mail: malkhorayef@ksu.edu.sa [University of Surrey, Centre for Nuclear and Radiation Physics, Guildford, Surrey, GU2 7XH (United Kingdom)

2016-10-15

A pacemaker, which is used for heart re synchronization with electrical impulses, is used to manage many clinical conditions. Recently, the frequency of the pacemaker implantation procedures increased 50% worldwide. During this procedure, patients and staff can be exposed to excessive radiation exposure. Wide range of doses was reported in previous studies, suggesting that optimization of this procedure is not fulfilled yet. This study aims to evaluate the patient and staff radiation doses during cardiac pacemaker procedure and quantify the patient effective dose. A total of 145 procedures were performed for five pacemakers procedures (VVI, VVIR, VVD, VVDR and DDDR) two hospitals were evaluated. Patients doses were measured using the kerma-area product meter. Effective doses were estimated using software based on Monte Carlo simulation from National Radiological Protection Board. The effective dose values were used to estimate the cancer risk from pacemaker procedure. Patients demographic data, exposure parameters for both fluoroscopy and radiography were quantified. The mean patients doses (Gy. cm{sup 2}) for VVI, VVIR, VVD, VVDR and DDDR was 1.52±0.13 (1.43-1.61), 3.28±2.34 (0.29-8.73), 3.04±1.67 (1.57-4.86), 6.04±2.326 and 19.2±3.6 (5.43-30.2), respectively, per procedure. The overall patients effective dose is 1.1 mSv per procedure. (Author)

MR-guided MR arthrography of the shoulder

International Nuclear Information System (INIS)

Tratting, S.; Breitenseher, M.; Pretterklieber, M.; Kontaxis, G.; Rand, T.; Imhof, H.

1996-01-01

Purpose: To develop an MR-guided technique for joint puncture in MR arthrography of the shoulder and to confirm the intracapsular position of the needle tip by visualization of the flow of contrast media into the joint. Materials and methods: Three unfixed human shoulder joint specimens were examined on a 1.0 T unit. The optimal point of entrance and depth for joint puncture were estimated by means of MR-compatible markers on the skin. Needle orientation and localization of the needle tip (MR-compatible 22-gauge needle) in the shoulder joint were monitored by rapid localizer gradient-echo sequences in two orthogonal planes. To confirm the intracapsular position of the needle tip, diluted gadolinium-DTPA was administered via a long connecting tube and the flow of contrast media into the joint was viewed directly on an LCD screen using real-time MR imaging (local look technique). Results: The MR-compatible markers on the skin allowed determination of the optimal point of entrance and estimation of the depth for joint puncture. Passive visualization of the MR-compatible needle due to spin dephasing and signal loss provided adequate localization of the intra-articular needle tip position in all specimens, although significant artefacts were present on rapid localizer gradient-echo sequences with an increase in width of the apparent needle shaft. Real-time MR imaging of the flow of contrast media was possible using the local look technique and the LCD screen of the MR unit and allowed confirmation of the intracapsular position. Conclusion: MR-guided joint puncture and real-time MR-assisted contrast media application results in improved MR arthrography and may replace conventional fluoroscopic guidance. (orig.) [de

Pediatric patient and staff dose measurements in barium meal fluoroscopic procedures

Science.gov (United States)

Filipov, D.; Schelin, H. R.; Denyak, V.; Paschuk, S. A.; Porto, L. E.; Ledesma, J. A.; Nascimento, E. X.; Legnani, A.; Andrade, M. E. A.; Khoury, H. J.

2015-11-01

This study investigates patient and staff dose measurements in pediatric barium meal series fluoroscopic procedures. It aims to analyze radiographic techniques, measure the air kerma-area product (PKA), and estimate the staff's eye lens, thyroid and hands equivalent doses. The procedures of 41 patients were studied, and PKA values were calculated using LiF:Mg,Ti thermoluminescent dosimeters (TLDs) positioned at the center of the patient's upper chest. Furthermore, LiF:Mg,Cu,P TLDs were used to estimate the equivalent doses. The results showed a discrepancy in the radiographic techniques when compared to the European Commission recommendations. Half of the results of the analyzed literature presented lower PKA and dose reference level values than the present study. The staff's equivalent doses strongly depends on the distance from the beam. A 55-cm distance can be considered satisfactory. However, a distance decrease of ~20% leads to, at least, two times higher equivalent doses. For eye lenses this dose is significantly greater than the annual limit set by the International Commission on Radiological Protection. In addition, the occupational doses were found to be much higher than in the literature. Changing the used radiographic techniques to the ones recommended by the European Communities, it is expected to achieve lower PKA values ​​and occupational doses.

Self-Expandable Metallic Stent for the Palliative Treatment of Obstructing Left-Sided Colorectal Cancer under Fluoroscopic Guidance: A Comparison of the Clinical Results according to Stent Diameter

Energy Technology Data Exchange (ETDEWEB)

Kang, Pyeong Guk; Hong, Hyun Pyo; Choi, Yoon Jung; Lee, Min Hee; Park, Hae Won; Chung, Eun Chul [Kangbuk Samsung Hospital, Seoul (Korea, Republic of); Kim, Sam Soo [Kangwon National University College of Medicine, Chuncheon (Korea, Republic of)

2010-03-15

To evaluate the feasibility, effectiveness, and safety of self-expandable metallic stent for the palliative treatment of obstructing left-sided colorectal cancer under fluoroscopic guidance, and to compare results according to the stent diameter. Under fluoroscopic guidance, 31 self-expandable metallic stents were placed into 25 patients for palliative purposes. The rates of technical success, clinical success, complications associated with stent insertion, patient survival, and primary stent patency were evaluated. The results were also compared between two groups: 13 patients using stents with a diameter of 22 mm and 12 patients using stents with a diameter of 26 mm. The technical and clinical success rates were 93.5 and 90.3%, respectively. The complications included severe abdominal pain (6.5%), minor rectal bleeding (9.7%), stent migration (9.7%), and tumor ingrowth or overgrowth (9.7%). No statistical differences in technical were detected between the two groups for the clinical success rate and complication rates. The mean survival time was 5.5 +- 1.4 months. The primary stent patency rates were 91.3% at 5 months, 85.2% at 10 months, and 77.4% at 15 months. The mean period of stent patency was 12.4 +- 2.6 months. The mean period of primary stent patency was 16.4 +- 2.6 months in the 26 mm stent group, and significantly higher than 5.4 +- 1.4 months in the 22 mm stent group (p=0.031). A self-expandable metallic stent under fluoroscopic guidance, for the palliative treatment of obstructing left-sided colorectal cancer, was feasible and effective, and yielded good clinical results. The period of primary stent patency of the 26 mm stent group was longer than the 22 mm stent group, and the complication rate was not significantly different between the two stent groups

Self-Expandable Metallic Stent for the Palliative Treatment of Obstructing Left-Sided Colorectal Cancer under Fluoroscopic Guidance: A Comparison of the Clinical Results according to Stent Diameter

International Nuclear Information System (INIS)

Kang, Pyeong Guk; Hong, Hyun Pyo; Choi, Yoon Jung; Lee, Min Hee; Park, Hae Won; Chung, Eun Chul; Kim, Sam Soo

2010-01-01

To evaluate the feasibility, effectiveness, and safety of self-expandable metallic stent for the palliative treatment of obstructing left-sided colorectal cancer under fluoroscopic guidance, and to compare results according to the stent diameter. Under fluoroscopic guidance, 31 self-expandable metallic stents were placed into 25 patients for palliative purposes. The rates of technical success, clinical success, complications associated with stent insertion, patient survival, and primary stent patency were evaluated. The results were also compared between two groups: 13 patients using stents with a diameter of 22 mm and 12 patients using stents with a diameter of 26 mm. The technical and clinical success rates were 93.5 and 90.3%, respectively. The complications included severe abdominal pain (6.5%), minor rectal bleeding (9.7%), stent migration (9.7%), and tumor ingrowth or overgrowth (9.7%). No statistical differences in technical were detected between the two groups for the clinical success rate and complication rates. The mean survival time was 5.5 ± 1.4 months. The primary stent patency rates were 91.3% at 5 months, 85.2% at 10 months, and 77.4% at 15 months. The mean period of stent patency was 12.4 ± 2.6 months. The mean period of primary stent patency was 16.4 ± 2.6 months in the 26 mm stent group, and significantly higher than 5.4 ± 1.4 months in the 22 mm stent group (p=0.031). A self-expandable metallic stent under fluoroscopic guidance, for the palliative treatment of obstructing left-sided colorectal cancer, was feasible and effective, and yielded good clinical results. The period of primary stent patency of the 26 mm stent group was longer than the 22 mm stent group, and the complication rate was not significantly different between the two stent groups

Feasibility of differential quantification of 3D temporomandibular kinematics during various oral activities using a cone-beam computed tomography-based 3D fluoroscopic method

Directory of Open Access Journals (Sweden)

Chien-Chih Chen

2013-06-01

Conclusion: A new CBCT-based 3D fluoroscopic method was proposed and shown to be capable of quantitatively differentiating TMJ movement patterns among complicated functional activities. It also enabled a complete description of the rigid-body mandibular motion and descriptions of as many reference points as needed for future clinical applications. It will be helpful for dental practice and for a better understanding of the functions of the TMJ.

A review of two methods used in the USA to assess HE during fluoroscopic-based radiology

International Nuclear Information System (INIS)

Craig Yoder, R.; Salasky, Mark R.

2016-01-01

Dosemeter results for ∼81 500 people performing fluoroscopic and interventional radiology procedures were examined to identify differences between groups monitored either by using two dosemeters, one placed at the collar above the apron and a second placed under the apron on the torso (EDE1) or by using one single dosemeter placed at the collar above the apron (EDE2). The median annual HE was 0.17 mSv for those monitored using the EDE1 protocol and 0.26 mSv for the group using the EDE2 protocol. The EDE2 method was used most frequently with the EDE1 method preferred for those more highly exposed. Approximately, 22 % of dosemeter results for EDE1 were inconsistent with expected norms based on over and under apron dosemeter relationships. (authors)

Comparison of respiratory surrogates for gated lung radiotherapy without internal fiducials

International Nuclear Information System (INIS)

Korreman, S.; Mostafavi, H.; Le, Q.T.; Boyer, A.

2006-01-01

An investigation was carried out to compare the ability of two respiratory surrogates to mimic actual lung tumor motion during audio coaching. The investigation employed video clips acquired after patients had had fiducial markers implanted in lung tumors to be used for image-guided stereoscopic radiotherapy. The positions of the markers in the clips were measured within the video frames and used as the standard for tumor volume motion. An external marker was tracked optically during the fluoroscopic acquisitions. An image correlation technique was developed to compute a gating signal from the fluoroscopic images. The correlation gating trace was similar to the optical gating trace in the phase regions of the respiratory cycle used for gating. A cross correlation analysis and comparison of the external optical marker gating with internal fluoroscopic gating was performed. The fluoroscopic image correlation surrogate was found to be superior to the external optical surrogate in the AP-views in four out of six cases. In one of the remaining two cases, the two surrogates performed comparably, while in the last case, the external fiducial trace performed best. It was concluded that fluoroscopic gating based on correlation of native image features in the fluoroscopic images will be adequate for respiratory gating

Comparison of respiratory surrogates for gated lung radiotherapy without internal fiducials

Energy Technology Data Exchange (ETDEWEB)

Korreman, S. [Rigshospitalet, Copenhagen (Denmark). Dept. of Radiation Oncology; Mostafavi, H. [Varian Medical Systems, Mountain View, CA (United States). Gintzon Technology Center; Le, Q.T.; Boyer, A. [Stanford Univ. School of Medicine, CA (United States). Dept. of Radiation Oncology

2006-09-15

An investigation was carried out to compare the ability of two respiratory surrogates to mimic actual lung tumor motion during audio coaching. The investigation employed video clips acquired after patients had had fiducial markers implanted in lung tumors to be used for image-guided stereoscopic radiotherapy. The positions of the markers in the clips were measured within the video frames and used as the standard for tumor volume motion. An external marker was tracked optically during the fluoroscopic acquisitions. An image correlation technique was developed to compute a gating signal from the fluoroscopic images. The correlation gating trace was similar to the optical gating trace in the phase regions of the respiratory cycle used for gating. A cross correlation analysis and comparison of the external optical marker gating with internal fluoroscopic gating was performed. The fluoroscopic image correlation surrogate was found to be superior to the external optical surrogate in the AP-views in four out of six cases. In one of the remaining two cases, the two surrogates performed comparably, while in the last case, the external fiducial trace performed best. It was concluded that fluoroscopic gating based on correlation of native image features in the fluoroscopic images will be adequate for respiratory gating.

Quantification of the gravity-dependent change in the C-arm image center for image compensation in fluoroscopic spinal neuronavigation.

Science.gov (United States)

Hariri, S; Abbasi, H R; Chin, S; Steinberg, G; Shahidi, R

2001-01-01

In the quest to develop a viable, frameless spinal navigation system, many researchers are utilizing the C-arm fluoroscope. However, there is a significant problem with the C-arm that must be quantified: the gravity-dependent sag effect resulting from the geometry of the C-arm and aggravated by the inequity of weight at each end of the C-arm. This study quantified the C-arm sag effect, giving researchers the protocol and data needed to develop a program that accounts for this distortion. The development of spinal navigation algorithms that account for the C-arm sag effect should produce a more accurate spinal navigation system.

Comparison of conventional full spine radiographs and fluoroscopic scanning method in young patients with idiopathic scoliosis; Vergleich von konventioneller Wirbelsaeulenganzaufnahme und fluoroskopischer Scan-Methode bei jungen Patienten mit idiopathischer Skoliose

Energy Technology Data Exchange (ETDEWEB)

Schaefer, J.; Kottke, R.; Claussen, C. [Abt. fuer Radiologische Diagnostik, Universitaetsklinikum Tuebingen (Germany); Kluba, T.; Niemeyer, T.; Hahnfeldt, T. [Klinik und Poliklinik fuer Orthopaedie, Universitaetsklinikum Tuebingen (Germany); Vonthein, R. [Inst. fuer Medizinische Biometrie, Universitaetsklinikum Tuebingen (Germany); Kamm, K.F. [Philips Medizin Systeme GmbH, Hamburg (Germany)

2005-08-01

Purpose: evaluation of low-dose full spine radiographs using fluoroscopic images for the assessment of the Cobb angle measurement in patients with scoliosis. Material and methods: twenty-one consecutive patients (aged 10-27 years, mean age 14 years) with a conventional full spine examination (film speed class 800) underwent a follow-up exam using digital pulsed fluoroscopy (Multi Diagnost 4, Philips Medical Systems, Eindhoven, The Netherlands). The mean follow-up was 9 months. During a synchronized scan with a C-arm speed of 4 cm/sec fluoroscopic images were stored with a pulsed frequency of 3 images per second. The single images were merged and reconstructed to one image with the software easy spine (Philips medical Systems, Eindhoven, The Netherlands). The corresponding dose-area product values (DAP) of both methods were compared. Three independent observers assessed Cobb angles and image quality for each technique. Results: the mean DAP values for conventional imaging was 94.9 cGy x cm{sup 2} and for fluoroscopy 7.8 cGy x cm{sup 2}, respectively. A significant dose reduction of 91.8% (CI 91% to 95%) was calculated. The average absolute angle difference between the observers was found to be 2.7 for conventional imaging and 2.4 for the fluoroscopic method. Interobserver standard deviation of 2.9 was lower than the 5.3 for conventional images. Image quality was better in the conventional images. Conclusion: using the scanning method, we could achieve a mean reduction of the radiation dose of 92%, while the accuracy of the Cobb angle measurements was comparable for both techniques despite of reduced image quality of digital fluoroscopy. (orig.)

Long-term results of hysteroscopic myomectomy for abnormal uterine bleeding

NARCIS (Netherlands)

Emanuel, M. H.; Wamsteker, K.; Hart, A. A.; Metz, G.; Lammes, F. B.

1999-01-01

To analyze the efficacy of transcervical resection of submucous myomas and to identify prognostic factors for long-term results. Two-hundred eighty-five women were treated with transcervical resection of submucous myomas without endometrial ablation. In case of incomplete resection a repeat

Cancer mortality in women after repeated fluoroscopic examinations of the chest

International Nuclear Information System (INIS)

Boice, J.D.; Monson, R.R.; Rosenstein, M.

1981-01-01

Among 1,047 women fluoroscopically examined in average of 102 times during pneumothorax therapy for tuberculosis and followed up to 45 years (average . 27 yr), no increase in the total number of cancer deaths occurred when these women were compared to 717 women who received other treatments [relative risk (RR) . 0.8]. However, elevated risks of mortality from stomach cancer (RR . 2.3), rectal cancer (RR . 3.8), breast cancer (RR . 1.2), lung cancer (RR . 1.8), and leukemia (RR . 1.2) were observed, but none was statistically significant and all were based on very small numbers of deaths. These increases were balanced by decreases of genital cancer (RR . 0.2), pancreatic cancer (RR . 0.9), lymphoma (RR . 0.6), and all other cancers (RR . 0.1). Average cumulative absorbed doses were 110 rads for the lungs, 33 rads for the trunk, 13 rads for the active bone marrow, and 7 rads for the stomach. The following upper levels of excess risk could be excluded with 95% confidence: 3.5 deaths/10(6) woman-year (WY)-rad for lung cancer, 4.8 deaths/10(6) WY-rad for lymphoma, and 12 deaths/10(6) WY-rad for leukemia. These findings indicated that the carcinogenic effect of multiple low-dose X-ray exposures was not greater than that currently assumed

Interventional radiography and mortality risks in U.S. radiologic technologists

Energy Technology Data Exchange (ETDEWEB)

Linet, Martha S.; Freedman, D.M.; Sigurdson, Alice J.; Doody, Michele M. [National Cancer Institute, Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD (United States); Hauptmann, Michael [National Cancer Institute, Biostatistics Branch, Division of Cancer Epidemiology and Genetics, Bethesda, MD (United States); Alexander, Bruce H. [University of Minnesota, Division of Environmental Health Sciences, Minneapolis, MN (United States); Miller, Jeremy [Information Management Services, Inc., Rockville, MD (United States)

2006-09-15

With the exponential increase in minimally invasive fluoroscopically guided interventional radiologic procedures, concern has increased about the health effects on staff and patients of radiation exposure from these procedures. There has been no systematic epidemiologic investigation to quantify serious disease risks or mortality. To quantify all-cause, circulatory system disease and cancer mortality risks in U.S. radiologic technologists who work with interventional radiographic procedures, we evaluated mortality risks in a nationwide cohort of 88,766 U.S. radiologic technologists (77% female) who completed a self-administered questionnaire during 1994-1998 and were followed through 31 December 2003. We obtained information on work experience, types of procedures (including fluoroscopically guided interventional procedures), and protective measures plus medical, family cancer history, lifestyle, and reproductive information. Cox proportional hazards regression models were used to compute relative risks (RRs) with 95% confidence intervals (CIs). Between completion of the questionnaire and the end of follow-up, there were 3,581 deaths, including 1,209 from malignancies and 979 from circulatory system diseases. Compared to radiologic technologists who never or rarely performed or assisted with fluoroscopically guided interventional procedures, all-cause mortality risks were not increased among those working on such procedures daily. Similarly, there was no increased risk of mortality resulting from all circulatory system diseases combined, all cancers combined, or female breast cancer among technologists who daily performed or assisted with fluoroscopically guided interventional procedures. Based on small numbers of deaths (n=151), there were non-significant excesses (40%-70%) in mortality from cerebrovascular disease among technologists ever working with these procedures. The absence of significantly elevated mortality risks in radiologic technologists reporting the

A theoretical and experimental evaluation of the microangiographic fluoroscope: A high-resolution region-of-interest x-ray imager

International Nuclear Information System (INIS)

Jain, Amit; Bednarek, D. R.; Ionita, Ciprian; Rudin, S.

2011-01-01

Purpose: The increasing need for better image quality and high spatial resolution for successful endovascular image-guided interventions (EIGIs) and the inherent limitations of the state-of-the-art detectors provide motivation to develop a detector system tailored to the specific, demanding requirements of neurointerventional applications.Method: A microangiographic fluoroscope (MAF) was developed to serve as a high-resolution, region-of-interest (ROI) x-ray imaging detector in conjunction with large lower-resolution full field-of-view (FOV) state-of-the-art x-ray detectors. The newly developed MAF is an indirect x-ray imaging detector capable of providing real-time images (30 frames per second) with high-resolution, high sensitivity, no lag and low instrumentation noise. It consists of a CCD camera coupled to a Gen 2 dual-stage microchannel plate light image intensifier (LII) through a fiber-optic taper. A 300 μm thick CsI(Tl) phosphor serving as the front end is coupled to the LII. The LII is the key component of the MAF and the large variable gain provided by it enables the MAF to operate as a quantum-noise-limited detector for both fluoroscopy and angiography. Results: The linear cascade model was used to predict the theoretical performance of the MAF, and the theoretical prediction showed close agreement with experimental findings. Linear system metrics such as MTF and DQE were used to gauge the detector performance up to 10 cycles/mm. The measured zero frequency DQE(0) was 0.55 for an RQA5 spectrum. A total of 21 stages were identified for the whole imaging chain and each stage was characterized individually. Conclusions: The linear cascade model analysis provides insight into the imaging chain and may be useful for further development of the MAF detector. The preclinical testing of the prototype detector in animal procedures is showing encouraging results and points to the potential for significant impact on EIGIs when used in conjunction with a state

Scattered radiation dose to radiologist's cornea, thyroid and gonads while performing some x-ray fluoroscopic investigations

International Nuclear Information System (INIS)

Chougle, Arun

1993-01-01

The mankind has been immensely benefited from discovery of X-ray and it has found wide spread application in diagnosis and treatment. Radiation is harmful and can produce somatic and genetic effects in the exposed person. International Commission on Radiation Protection (ICRP) has recommended a system of dose limitation based on principle of ALARA. All the efforts should be made to keep the radiation dose to the radiation worker as low as possible. Fluoroscopy gives maximum dose to the patient and staff and hence we have attempted to quantify the scattered radiation dose to the cornea, thyroid and gonads of the radiologist performing fluoroscopic examinations such as barium meal, barium swallow, barium enema, myelography, histerosalpingography and fracture reduction. Thermoluminescence dosimetry (TLD) method using CaSO 4 :Dy TLD disc was employed for these measurements. Use of lead apron has reduced the dose to radiologist's gonad. (author). 3 refs., 4 tabs

Problems of dentistrical prophylactic medical examination of persons dealing with ionizing radiation sources

International Nuclear Information System (INIS)

Kalinin, V.I.; Ramzaeva, L.V.; Zamanova, L.V.

1988-01-01

A comparative study of data of individual dosimetric control of radiological personnel and additional radiation contribution of annual fluoroscopy of chest into radiation load was carried out. It is stated that chest fluoroscopy adds 13 % of collective dose to the occupational irradiation. Efficiency of preventive chest fluoroscopic examination was simultaneously analyzed in 1388 persons engaged in occupational radiology. Investigation results permit to state a question on advisability of transition to differential chest fluoroscopic examination in persons of A category, being guided by clinical indications and potential risk of carcinogenesis and tuberculosis. 5 refs

Contrast fluoroscopic evaluation of gastrointestinal transit times with and without the use of falconry hoods in red-tailed hawks (Buteo jamaicensis).

Science.gov (United States)

Doss, Grayson A; Williams, Jackie M; Mans, Christoph

2017-11-01

OBJECTIVE To evaluate gastrointestinal transit times in red-tailed hawks (Buteo jamaicensis) by use of contrast fluoroscopic imaging and investigate the effect of falconry hooding in these hawks on gastrointestinal transit time. DESIGN Prospective, randomized, blinded, complete crossover study. ANIMALS 9 healthy red-tailed hawks. PROCEDURES Hawks were gavage-fed a 30% weight-by-volume barium suspension (25 mL/kg [11.3 mL/lb]) into the crop. Fluoroscopic images were obtained at multiple time points after barium administration. Time to filling and emptying of various gastrointestinal tract organs and overall transit time were measured. The effect of hooding (hooded vs nonhooded) on these variables was assessed in a randomized complete crossover design. RESULTS In nonhooded birds, overall gastrointestinal transit time ranged from 30 to 180 minutes (mean ± SD, 100 ± 52 min). Time to complete crop emptying ranged from 30 to 180 minutes (83 ± 49 min). Contrast medium was present in the ventriculus in all birds within 5 minutes of administration and in the small intestines within 5 to 15 minutes (median, 5 min). Hooding of red-tailed hawks resulted in a significant delay of complete crop emptying (no hood, 83 ± 49 minutes; hood, 133 ± 48 minutes), but no significant effects of hooding were found on other measured variables. CONCLUSIONS AND CLINICAL RELEVANCE These results indicated that overall gastrointestinal transit times are faster in red-tailed hawks than has been reported for psittacines and that the use of a falconry hood in red-tailed hawks may result in delayed crop emptying. Hooding did not exert significant effects on overall gastrointestinal transit time in this raptorial species.

Proposed Optimal Fluoroscopic Targets for Cooled Radiofrequency Neurotomy of the Sacral Lateral Branches to Improve Clinical Outcomes: An Anatomical Study.

Science.gov (United States)

Stout, Alison; Dreyfuss, Paul; Swain, Nathan; Roberts, Shannon; Loh, Eldon; Agur, Anne

2017-11-23

Current sacroiliac joint (SIJ) cooled radiofrequency (RF) is based on fluoroscopic anatomy of lateral branches (LBs) in three specimens. Recent studies confirm significant variation in LB positions. To determine if common fluoroscopic needle placements for cooled SIJ RF are adequate to lesion all S1-3 LBs. If not, would different targets improve lesion accuracy? The LBs of 20 cadavers were dissected bilaterally (40 SIJs), and 26 G radiopaque wires were sutured to the LBs. With a 10-mm radius ruler centered at each foramen, standard targets were assessed, as judged by a clockface on the right, for S1 and S2 at 2:30, 4:00, and 5:30 positions and at S3 at 2:30 and 4:00. Mirror image targets were assessed on the left. Assuming an 8-mm lesion diameter, the percentage of LBs that would not be ablated for each level was determined. Imaging through the superior end plate of S1 was compared against segment specific (SS) imaging. Nine point four percent of LBs would not be ablated at S1 vs 0.99% at S2 vs 35% at S3, and 60% of the 40 SIJs would be completely denervated using current targets. SS imaging did not improve results. Alternate target locations could improve the miss rate to 2.8% at S1 and 0% at S3 and would ablate all LBs in 95% of SIJs. Using a conservative 8-mm lesion measurement, contemporary cooled RF needle targets are inadequate to lesion all target LBs. Modifications to current targets are recommended to increase the effectiveness of the procedure. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

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Garnon, Julien, E-mail: juliengarnon@gmail.com; Koch, Guillaume, E-mail: Guillaume.koch@gmail.com [University Hospital of Strasbourg, Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: Nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Caudrelier, Jean, E-mail: caudjean@yahoo.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France); Rao, Pramod, E-mail: pramodrao@me.com [University of Strasbourg, ICube (France); Tsoumakidou, Georgia, E-mail: Georgia.tsoumakidou@chru-strasbourg.fr; Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Gangi, Afshin, E-mail: Afshin.gangi@chru-strasbourg.fr [University Hospital of Strasbourg, Department of Interventional Radiology (France)

2016-09-15

ObjectiveTo review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.Materials and MethodsBetween May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.ResultsFour pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.ConclusionPercutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.

Percutaneous CT and Fluoroscopy-Guided Screw Fixation of Pathological Fractures in the Shoulder Girdle: Technical Report of 3 Cases

International Nuclear Information System (INIS)

Garnon, Julien; Koch, Guillaume; Ramamurthy, Nitin; Caudrelier, Jean; Rao, Pramod; Tsoumakidou, Georgia; Cazzato, Roberto Luigi; Gangi, Afshin

2016-01-01

ObjectiveTo review our initial experience with percutaneous CT and fluoroscopy-guided screw fixation of pathological shoulder-girdle fractures.Materials and MethodsBetween May 2014 and June 2015, three consecutive oncologic patients (mean age 65 years; range 57–75 years) with symptomatic pathological shoulder-girdle fractures unsuitable for surgery and radiotherapy underwent percutaneous image-guided screw fixation. Fractures occurred through metastases (n = 2) or a post-ablation cavity (n = 1). Mechanical properties of osteosynthesis were adjudged superior to stand-alone cementoplasty in each case. Cannulated screws were placed under combined CT and fluoroscopic guidance with complementary radiofrequency ablation or cementoplasty to optimise local palliation and secure screw fixation, respectively, in two cases. Follow-up was undertaken every few weeks until mortality or most recent appointment.ResultsFour pathological fractures were treated in three patients (2 acromion, 1 clavicular, 1 coracoid). Mean size of associated lesion was 2.6 cm (range 1–4.5 cm). Technical success was achieved in all cases (100 %), without complications. Good palliation and restoration of mobility were observed in two cases at 2–3 months; one case could not be followed due to early post-procedural oncologic mortality.ConclusionPercutaneous image-guided shoulder-girdle osteosynthesis appears technically feasible with good short-term efficacy in this complex patient subset. Further studies are warranted to confirm these promising initial results.

Fluoroscopically guided pyeloureteral interventions using a retrograde perurethral approach

International Nuclear Information System (INIS)

Amendola, M.A.; Banner, M.P.; Pollack, H.M.; Gordon, R.L.; Van Arsdalen, K.N.

1987-01-01

Employing standard interventional equipment, fluoroscopy, and partially or completely inserted ureteral catheters for access, the authors performed 168 perurethral interventional procedures since 1985. Procedures have included insertion of double (n = 42) or single pigtail stents (n = 47), advancement of retrograde ureteral catheters with or without displacement of a ureteral stone to the renal pelvis (n = 42), urothelial biopsy (n = 30), balloon dilation of ureteral structures (n = 3), ureteral stone extraction (n = 1), and conversion of retrograde to antegrade catheters for balloon dilation of ureteropelvic junction strictures (n = 3). This retrograde approach often obviates the need for antegrade interventional procedures (including percutaneous nephrostomy and ureteral stenting), ureteroscopy, or surgery. Indications, techniques, pitfalls, and complications are illustrated

The Usefulness of Virtual Fluoroscopic Preprocedural Planning During Percutaneous Transhepatic Biliary Drainage

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Kinoshita, Mitsuhiro, E-mail: kinoshita.3216@tokushima-u.ac.jp [Tokushima University Hospital, Department of Radiology (Diagnostic Radiology) (Japan); Shirono, Ryozo; Takechi, Katsuya [Tokushima Red Cross Hospital, Department of Radiology (Japan); Yonekura, Hironobu [Tokushima Red Cross Hospital, Department of Radiological Technology (Japan); Iwamoto, Seiji [Tokushima University Graduate School, Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences (Japan); Shinya, Takayoshi [Tokushima University Hospital, Department of Radiology (Diagnostic Radiology) (Japan); Takao, Shoichiro [Tokushima University Graduate School of Health Science, Department of Diagnostic Radiology (Japan); Harada, Masafumi [Tokushima University Graduate School, Department of Radiology and Radiation Oncology, Institute of Biomedical Sciences (Japan)

2017-06-15

Purpose To retrospectively evaluate the usefulness of virtual fluoroscopic preprocedural planning (VFPP) in the percutaneous transhepatic biliary drainage (PTBD) procedure.Materials and MethodsTwenty-two patients who were treated by PTBD were included in this study. Twelve patients were treated using PTBD intraoperative referencing coronal computed tomography (CT) images (i.e., coronal CT group), and ten patients were treated using PTBD intraoperative referencing VFPP images (i.e., VFPP group). To analyze the effect of the intraoperative referencing VFPP image, the VFPP group was retrospectively compared with the coronal CT group.ResultsThe characteristics of both patient groups were not statistically significantly different. There were no significant differences in the targeted bile duct, diameter and depth of the target bile, breath-holding ability, number of targeted bile duct puncture attempts, change in the targeted bile duct, and exchange of the drainage catheter. However, the X-ray fluoroscopy time and the procedure time were significantly shorter in the VFPP group than in the coronal CT group (196 vs. 334 s, P < 0.05; and 16.0 vs. 27.2 min, P < 0.05).ConclusionIntraoperative referencing using the VFPP imaging in PTBD intuitively can be a useful tool for better localization of the guidewire in the bile duct and thereby shorten the X-ray fluoroscopy time and procedure time while minimizing radiation exposure and complications.

Effects of intra-operative fluoroscopic 3D-imaging on peri-operative imaging strategy in calcaneal fracture surgery.

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Beerekamp, M S H; Backes, M; Schep, N W L; Ubbink, D T; Luitse, J S; Schepers, T; Goslings, J C

2017-12-01

Previous studies demonstrated that intra-operative fluoroscopic 3D-imaging (3D-imaging) in calcaneal fracture surgery is promising to prevent revision surgery and save costs. However, these studies limited their focus to corrections performed after 3D-imaging, thereby neglecting corrections after intra-operative fluoroscopic 2D-imaging (2D-imaging). The aim of this study was to assess the effects of additional 3D-imaging on intra-operative corrections, peri-operative imaging used, and patient-relevant outcomes compared to 2D-imaging alone. In this before-after study, data of adult patients who underwent open reduction and internal fixation (ORIF) of a calcaneal fracture between 2000 and 2014 in our level-I Trauma center were collected. 3D-imaging (BV Pulsera with 3D-RX, Philips Healthcare, Best, The Netherlands) was available as of 2007 at the surgeons' discretion. Patient and fracture characteristics, peri-operative imaging, intra-operative corrections and patient-relevant outcomes were collected from the hospital databases. Patients in whom additional 3D-imaging was applied were compared to those undergoing 2D-imaging alone. A total of 231 patients were included of whom 107 (46%) were operated with the use of 3D-imaging. No significant differences were found in baseline characteristics. The median duration of surgery was significantly longer when using 3D-imaging (2:08 vs. 1:54 h; p = 0.002). Corrections after additional 3D-imaging were performed in 53% of the patients. However, significantly fewer corrections were made after 2D-imaging when 3D-imaging was available (Risk difference (RD) -15%; 95% Confidence interval (CI) -29 to -2). Peri-operative imaging, besides intra-operative 3D-imaging, and patient-relevant outcomes were similar between groups. Intra-operative 3D-imaging provides additional information resulting in additional corrections. Moreover, 3D-imaging probably changed the surgeons' attitude to rely more on 3D-imaging, hence a 15%-decrease of

Contrast media for fluoroscopic examinations of the GI and GU tracts: current challenges and recommendations.

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Federle, Michael P; Jaffe, Tracy A; Davis, Peter L; Al-Hawary, Mahmoud M; Levine, Marc S

2017-01-01

One of the significant challenges facing radiologists who perform and interpret studies of the gastrointestinal and genitourinary systems have been periodic interruptions in the availability of barium and iodinated contrast media specially formulated for gastrointestinal (GI) and genitourinary (GU) studies. These interruptions are due to the US Food and Drug Administration's recent requirement for more stringent documentation of the safety and efficacy of contrast media and the consolidation among contrast manufacturers. Therefore, radiologists may be required to recommend an alternative means of evaluation, such as computed tomography, magnetic resonance, or endoscopy, or they may need to substitute a different formulation of a contrast agent not specifically developed for GI or GU use, for example the utilization of an agent designed and marketed for vascular use. This article reviews the current status of fluoroscopic contrast media, and provides suggestions and recommendations for the optimal and alternative use of contrast media formulations.

Relationship between source-surface distance and patient dose in fluoroscopic X-ray examinations

International Nuclear Information System (INIS)

Suzuki, Shoichi; Asada, Yasuki; Nishi, Kazuta; Mizuno, Emiko; Hara, Natsue; Orito, Takeo; Kamei, Tetsuya; Koga, Sukehiko

2000-01-01

The International Electrotechnical Commission, IEC provided in its standard IEC 60601-1-3 (1994) to prevent the use during radioscopic irradiation of focal spot to skin distances less than 20 cm if the X-RAY EQUIPMENT is specified for RADIOSCOPY during surgery or 30 cm for other specified applications. This standard was reflected in the Japanese Industrial Standard JIS Z 4701-1997, which provided the minimum distance from focal spot to skin to be 30 cm for the use of a fluoroscopic and radiographic table (Under-table type). However, JIS had formerly provided the minimum distance to be 40 cm and so does the current Medical Treatment Law. The draft revision for the Medical Treatment Law currently discussed has consideration to adopt the value 30 cm in accordance with the current JIS. Our research intended to investigate the impact on the entrance surface dose for the change of the focal spot to skin distance from 40 cm to 30 cm. The result was 20-30% increase of the entrance surface dose for the focal spot to skin distance 30 cm. Taking patient exposure dose into account, we need further and more sufficient discussion with this result before adopting this value to the Medical Treatment Law. (author)

Fluoroscopic position of the second-generation cryoballoon during ablation in the right superior pulmonary vein as a predictor of phrenic nerve injury.

Science.gov (United States)

Saitoh, Yukio; Ströker, Erwin; Irfan, Ghazala; Mugnai, Giacomo; Ciconte, Giuseppe; Hünük, Burak; Velagić, Vedran; Overeinder, Ingrid; Tanaka, Kaoru; Brugada, Pedro; de Asmundis, Carlo; Chierchia, Gian-Battista

2016-08-01

Phrenic nerve injury (PNI) is the most frequently observed complication during pulmonary vein isolation procedure using the second-generation cryoballoon (CB). Our objective was to analyse the correlation between the fluoroscopic position of the 28 mm CB during ablation in the right superior pulmonary vein (RSPV) and the occurrence of PNI. A total of 165 patients having undergone the large 28 mm CB ablation were retrospectively reviewed. Positioning of the CB relative to the cardiac silhouette was classified under fluoroscopic guidance in antero-posterior projection during RSPV ablation. Regarding the lower half of the balloon, CB positioning was defined as follows: (A) completely inside the cardiac shadow; (B1) Phrenic nerve injury occurred in 9.7% (16/165) during ablation in the RSPV. The occurrence of PNI was 0.9, 10.6, and 90.1% in positions A, B1, and B2, respectively (A vs. B1, P = 0.01; B1 vs. B2, P < 0.0001). Among other pre-procedural and procedural variables, the B2 position was the strongest independent determinant for predicting PNI at RSPV (P = 0.001, odds ratio: 119.9; 95% confidence interval: 11.6-1234.7) after multivariable analysis. The incidence of PNI at the RSPV significantly increased in case of more distal positioning of the CB relative to the cardiac shadow. This simple and straightforward intra-procedural indicator might prone the operators to attempt occluding the RPSV more proximally in order to avoid PNI. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Usefulness of sono-guided needle puncture for MR arthrography of the shoulder

International Nuclear Information System (INIS)

Choi, Jae Woong; Hong, Suk Ju; Suh, San Il; Yong, Hwan Suk; Kim, Jung Hyuk; Park, Cheol Min; Suh, Won Hyuck; Kim, Myung Gyu

2000-01-01

To evaluate the usefulness of sono-guided needle puncture for MR arthrography of the shoulder to locate the path of access and to control the correct placement of the needle into the shoulder. Fifteen patients with suspicion of shoulder pathology were included in this study. Patients were laid in supine positions with the arm extended and slightly abducted, the palm of the hand facing upward. A sonographic unit with a high resolution transducer with 7.5 MHz linear array was used. Axial images in the anterior aspect of the shoulder were obtained to localize the coracoid process and the anteromedical portion of the humerus. Using an aseptic technique, a 21-guage needle was advanced into the shoulder joint under ultrasonographic guidance. When the needle made contract with the articular cartilage of the humeral head, the needle was tiled to position is point in the articular cavity. Solution of 0.1 ml gadopentetate dimeglumine in 25 ml of normal saline was prepared and 12-16 ml was injected into the joint cavity. The intra-articular position of the needle and the compete distension of the shoulder joint were again confirmed by sonography. The needle was accurately placed in 14 out of 15 patients without damage to neighboring structures. It took 10 to 15 minutes to complete the procedure in 14 patients. No side effects attributable to gadopentetate dimeglumine were found. Sono-guided needle puncture for the shoulder MR arthrography can be a substitutable method for fluoroscopic guidance, with easy access, advantages of lacking radiation hazard and eliminating the need for iodized contrast agents.

Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

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Artner J

2012-08-01

Full Text Available Juraj Artner, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: The sacroiliac (SI joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study design: Comparative study with technical considerations.Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy-guidance levels.Conclusion: Radiation dose of CT-guided SI joint injections can be

Esophageal achalasia : results of balloon dilation

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Ki, Won Woo; Kang, Sung Gwon; Yoon, Kwon Ha; Kim, Nam Hyeon; Lee, Hyo Jeong; Yoon, Hyun Ki; Sung, Kyu Bo; Song, Ho Young [Ulsan Univ. College of Medicine, Seoul (Korea, Republic of)

1996-08-01

To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20 mm was used for the initial attempt.If the patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement,the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. Succesful dilation was achieved in 13 of 14 patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions per patient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up period of 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia.

Esophageal achalasia : results of balloon dilation

International Nuclear Information System (INIS)

Ki, Won Woo; Kang, Sung Gwon; Yoon, Kwon Ha; Kim, Nam Hyeon; Lee, Hyo Jeong; Yoon, Hyun Ki; Sung, Kyu Bo; Song, Ho Young

1996-01-01

To evaluate the clinical effectiveness of fluoroscopically guided balloon dilation in the treatment of esophageal achalasia. Under fluoroscopic guidance, 21 balloon dilation procedures were performed in 14 patients with achalasia. A balloon with a diameter of 20 mm was used for the initial attempt.If the patient tolerated this well, the procedure was repeated with a 10-20 mm balloon, placed alongside at the same session. If, however the patient complained of severe chest pain and/or a postprocedural esophagogram showed an improvement,the additional balloon was not used. For patients whose results were unsatisfactory, the dilation procedure was repeated at sessions three to seven days apart. Succesful dilation was achieved in 13 of 14 patients(92.9%), who needed a total of 20 sessions of balloon dilation, ranging from one to three sessions per patient(mean, 1.54 sessions). Esophageal rupture occured in one of 14 patients(7.1%) ; of the 13 patients who underwent a successful dilation procedure, 12(92.3%) were free of recurrent symptoms during the follow-up period of 1-56(mean, 18.5) months. The remaning patient(7.7%) had a recurrence seven months after dilation. Fluoroscopically guided balloon dilation seems to be safe and effective in the treatment of esophageal achalasia

A new image navigation system for MR-guided cryosurgery

International Nuclear Information System (INIS)

Mogami, Takuji; Dohi, Michiko; Harada, Junta

2002-01-01

The purpose of this study was to evaluate the feasibility of Interactive Scan Control (ISC), a new MR image navigation system, during percutaneous puncture in cryosurgery. With the ISC system in place, percutaneous MR-guided cryosurgery was performed in 26 cases, with the ISC system being used in 11 cases (five renal tumors, three uterine fibroids and three metastatic liver tumors). The ISC system comprised infrared cameras and an MR-compatible optical tracking tool that was directly connected to a cryoprobe. Tumor sizes ranged from 1.2 cm (metastatic liver tumor) to 9.0 cm (uterine fibroid), for a mean size of 3.9 cm. With ISC, one to three cryoprobes with a diameter of 2 mm or 3 mm were advanced into the tumors with the guidance of an MR fluoroscopic image. Two freeze-thaw cycles were used for cryosurgery. During the cryosurgery, the formation of iceballs was monitored on MR images. Follow-up dynamic CT or MRI as well as physical examinations were conducted after two weeks and six weeks. Placement of probes was successfully performed under the control of the ISC system. During cryosurgery, engulfment of the tumors by iceballs was carefully monitored by MRI. Necrosis of the cryoablated area was confirmed in all renal tumors by follow-up dynamic CT. The size regression of the uterine fibroids was observed through follow-up MRI. Two of the three cases of metastatic liver tumor were ablated completely. Additional therapy for a residual tumor was performed on one patient with a metastatic liver tumor. A small amount of pneumothorax was the only complication found in a patient with a metastatic liver tumor. MR-guided cryosurgery with this new navigation system was feasible with low morbidity and allowed for safe and accurate puncture with a cryoprobe. (author)

Combined ultrasound and fluoroscopy guided port catheter implantation-High success and low complication rate

International Nuclear Information System (INIS)

Gebauer, Bernhard; El-Sheik, Michael; Vogt, Michael; Wagner, Hans-Joachim

2009-01-01

Purpose: To evaluate peri-procedural, early and late complications as well as patients' acceptance of combined ultrasound and fluoroscopy guided radiological port catheter implantation. Materials and methods: In a retrospective analysis, all consecutive radiological port catheter implantations (n = 299) between August 2002 and December 2004 were analyzed. All implantations were performed in an angio suite under analgosedation and antibiotic prophylaxis. Port insertion was guided by ultrasonographic puncture of the jugular (n = 298) or subclavian (n = 1) vein and fluoroscopic guidance of catheter placement. All data of the port implantation had been prospectively entered into a database for interventional radiological procedures. To assess long-term results, patients, relatives or primary physicians were interviewed by telephone; additional data were generated from the hospital information system. Patients and/or the relatives were asked about their satisfaction with the port implantion procedure and long-term results. Results: The technical success rate was 99% (298/299). There were no major complications according to the grading system of SIR. A total of 23 (0.33 per 1000 catheter days) complications (early (n = 4), late (n = 19)) were recorded in the follow-period of a total of 72,727 indwelling catheter days. Infectious complications accounted for 0.15, thrombotic for 0.07 and migration for 0.04 complications per 1000 catheter days. Most complications were successfully treated by interventional measures. Twelve port catheters had to be explanted due to complications, mainly because of infection (n = 9). Patients' and relatives' satisfaction with the port catheter system was very high, even if complications occurred. Conclusion: Combined ultrasound and fluoroscopy guided port catheter implantation is a very safe and reliable procedure with low peri-procedural, early and late complication rate. The intervention achieves very high acceptance by the patients and

A surprise case of colonic interposition

International Nuclear Information System (INIS)

Law, Robert

2006-01-01

Blind nasogastric intubation failure as a result of changes to the normal anatomical pathway is not uncommon. This case report is of fluoroscopically guided intubation in a patient in whom blind intubation failed as a result of what was subsequently found to be a colonic interposition with associated late complications. Fluroscopically guided nasogastric intubation is a safe and effective procedure that should always be considered when blind intubation has failed

Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy

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Freitas, Ricardo Miguel Costa de, E-mail: ricardomcfreitas@gmail.com; Andrade, Celi Santos, E-mail: celis.andrade@hotmail.com; Caldas, José Guilherme Mendes Pereira, E-mail: jgmpcaldas@uol.com.br [Faculdade de Medicina da Universidade de São Paulo, Department of Radiology, Interventional Radiology Unit of the Instituto de Radiologia (Brazil); Tsunemi, Miriam Harumi, E-mail: miharumi@gmail.com [Universidade Estadual Paulista Júlio de Mesquita Filho, Department of Biostatistics, Biosciences Institute (Brazil); Ferreira, Lorraine Braga, E-mail: lorraine.braga@gmail.com; Arana-Chavez, Victor Elias, E-mail: vearana@usp.br [Faculdade de Odontologia da Universidade de São Paulo, Department of Oral Pathology (Brazil); Cury, Patrícia Maluf, E-mail: pmcury@hotmail.com [Faculdade de Medicina de São José do Rio Preto, Department of Pathology and Forensic Medicine (Brazil)

2015-10-15

PurposeThis study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body.MethodsThe institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO{sub 2}) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia.ResultsCBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO{sub 2} epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p < 0.004), with a significant Pearson’s correlation test (p < 0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed.ConclusionsCBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers.

Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy

International Nuclear Information System (INIS)

Freitas, Ricardo Miguel Costa de; Andrade, Celi Santos; Caldas, José Guilherme Mendes Pereira; Tsunemi, Miriam Harumi; Ferreira, Lorraine Braga; Arana-Chavez, Victor Elias; Cury, Patrícia Maluf

2015-01-01

PurposeThis study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body.MethodsThe institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO 2 ) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia.ResultsCBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO 2 epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p < 0.004), with a significant Pearson’s correlation test (p < 0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed.ConclusionsCBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers

Randomized trial for superiority of high field strength intra-operative magnetic resonance imaging guided resection in pituitary surgery.

Science.gov (United States)

Tandon, Vivek; Raheja, Amol; Suri, Ashish; Chandra, P Sarat; Kale, Shashank S; Kumar, Rajinder; Garg, Ajay; Kalaivani, Mani; Pandey, Ravindra M; Sharma, Bhawani S

2017-03-01

Till date there are no randomized trials to suggest the superiority of intra-operative magnetic resonance imaging (IOMRI) guided trans-sphenoidal pituitary resection over two dimensional fluoroscopic (2D-F) guided resections. We conducted this trial to establish the superiority of IOMRI in pituitary surgery. Primary objective was to compare extent of tumor resection between the two study arms. It was a prospective, randomized, outcome assessor and statistician blinded, two arm (A: IOMRI, n=25 and B: 2D-F, n=25), parallel group clinical trial. 4 patients from IOMRI group cross-over to 2D-F group and were consequently analyzed in latter group, based on modified intent to treat method. A total of 50 patients were enrolled till completion of trial (n=25 in each study arm). Demographic profile and baseline parameters were comparable among the two arms (p>0.05) except for higher number of endoscopic procedures and experienced neurosurgeons (>10years) in arm B (p=0.02, 0.002 respectively). Extent of resection was similar in both study arms (A, 94.9% vs B, 93.6%; p=0.78), despite adjusting for experience of operating surgeon and use of microscope/endoscope for surgical resection. We observed that use of IOMRI helped optimize the extent of resection in 5/20 patients (25%) for pituitary tumor resection in-group A. Present study failed to observe superiorty of IOMRI over conventional 2D-F guided resection in pituitary macroadenoma surgery. By use of this technology, younger surgeons could validate their results intra-operatively and hence could increase EOR without causing any increase in complications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fluoroscopy-guided hydrostatic reduction of intussusception in infancy: role of pharmacological premedication.

Science.gov (United States)

Esposito, Francesco; Ambrosio, Concetta; De Fronzo, Simona; Panico, Maria Rita; D'Aprano, Marilena; Giugliano, Anna Marcella; Noviello, Domenico; Oresta, Patrizia

2015-06-01

Intussusception is one of the most common causes of paediatric emergency. Fluoroscopy-guided hydrostatic reduction is a common nonoperative management strategy for the treatment of intussusception. The role of pharmacological premedication in increasing the success rate of hydrostatic reduction is still controversial. The purpose of this study was to verify the presence of a possible correlation between pharmacological premedication and the percentage of hydrostatic reduction of intussusception in paediatric patients. This study considered children with a diagnosis of idiopathic intussusception treated at our hospital between January 2007 and June 2013. One group of patients underwent hydrostatic reduction by barium enema without any preliminary therapy. A second group of patients received pharmacological premedication with both a sedative and an anti-oedematous agent before the procedure. A total of 398 patients were treated with barium enema for therapeutic purposes. In the group of patients who received no premedication (n = 254), 165 (65 %) children achieved hydrostatic reduction of the intussusception. Among the patients who received pharmacological premedication prior to barium enema (n = 144), 122 (85 %) children achieved resolution of the intussusception. Our study shows that the use of pharmacological premedication is effective for the reduction of the intussusception, as its limit patient stress, fluoroscopic time and radiation dose.

MR-guided facet joint injection therapy using an open 1.0-T MRI system: an outcome study

International Nuclear Information System (INIS)

Freyhardt, Patrick; Bucourt, Maximilian de; Maurer, Martin; Renz, Diane; Gebauer, Bernhard; Hamm, Bernd; Streitparth, Florian; Hartwig, Tony; Teichgraeber, Ulf K.M.

2013-01-01

To evaluate the accuracy, safety and efficacy of magnetic resonance imaging (MRI)-guided facet joint injection therapy using a 1.0-T open MRI. One hundred and sixty-six facet joint blocks in 45 patients with lower back pain were performed under MR fluoroscopic guidance using a proton-density-weighted turbo-spin-echo sequence. An in-room monitor, wireless MR-mouse for operator-controlled multiplanar navigation, a flexible surface coil and MR-compatible 20-G needle were used. Clinical outcome was evaluated by questionnaire before intervention and after 1 week, 3, 6 and 12 months using a numerical visual analogue scale (VAS). All facet joint blocks were considered technically successful with distribution of the injectant within and/or around the targeted facet joint. No major complications occurred. The final outcome analysis included 38 patients. An immediate effect was reported by 63 % of the patients. A positive mid-/long-term effect was seen in 13 patients (34 %) after 6 months and in 9 patients (24 %) after 12 months. Mean VAS was reduced from 7.1 ± 1.7 (baseline) to 3.5 ± 2.2, 4.1 ± 3.0, 3.8 ± 2.9 and 4.6 ± 2.9 at 1 week, 3, 6 and 12 months (P < 0.01). MR-guided facet joint injection therapy of the lumbosacral spine is accurate, safe and efficient in the symptomatic treatment of lower back pain. (orig.)

Fluoroscopic and CT enteroclysis in children: initial experience, technical feasibility, and utility

International Nuclear Information System (INIS)

Brown, Shanaree; Applegate, Kimberly E.; Sandrasegaran, Kumar; Jennings, S.G.; Garrett, Joshua; Maglinte, Dean T.; Skantharajah, Arunan

2008-01-01

Partial small-bowel obstruction can be difficult to diagnose on clinical examination. These obstructions might not be detected on routine abdominal/pelvic CT. To evaluate the feasibility, safety, and techniques of fluoroscopic enteroclysis (FE) and CT enteroclysis (CTE), and to review their indications and findings in children. We retrospectively reviewed all enteroclysis studies in children younger than 18 years performed between January 2002 and March 2007. We correlated the results with other abdominal imaging and surgical and pathological findings. The review revealed 112 FE and 74 CTE studies performed in 175 children (mean age 14 years, range 3-18 years). FE and CTE studies were performed most commonly for evaluation of known Crohn disease (FE 38%, CTE 29%) and abdominal pain (FE 26%, CTE 26%). One FE study was terminated because of patient anxiety, and one CTE study was terminated because of patient discomfort. No complications of FE or CTE were reported. The findings were normal in 54% of the FE studies and 46% of the CTE studies. The most common small bowel diagnoses were Crohn disease (FE 34%, CTE 28%) and partial small bowel obstruction (FE 3%, CTE 10%). Two FE studies (2%) and 14 CTE studies (19%) showed abnormalities outside the small bowel. In 54 patients with inflammatory bowel disease, 11 FE studies and 25 CTE studies showed additional bowel abnormalities. Overall, 14 and 21 patients had surgery as a result of the findings of FE and CTE, respectively. FE and CTE are safe, feasible, and accurate in depicting small-bowel pathology in children. These techniques can be particularly useful in children with Crohn disease involving the small bowel. (orig.)

Office-based Electromyography-guided Botulinum Toxin Injection to the Cricopharyngeus Muscle: Optimal Patient Selection and Technique.

Science.gov (United States)

Kim, Min-Su; Kim, Go-Woon; Rho, Young-Soo; Kwon, Kee-Hwan; Chung, Eun-Jae

2017-05-01

This retrospective study was carried out to investigate the effectiveness and safety of office-based electromyography-guided injection of botulinum toxin in the cricopharyngeus muscle of patients who did not show upper esophageal sphincter passage in a swallowing study in spite of maximal swallowing rehabilitation. Thirty-six patients who showed no or limited ability to oral feed after maximum swallowing rehabilitation were enrolled. Video fluoroscopic swallowing study, flexible endoscopic evaluation of swallowing, disability rating scale, penetration aspiration score, and National Institutes of Health swallowing safety scale were used in the evaluation of dysphagia. Success was defined as nondependence on gastrostomy for patients who previously were dependent on gastrostomy and improvement in disability rating scale score after botulinum toxin injections. The total success rate was 63.9%. The complication rate was very low, with only 1 patient showing temporary unilateral vocal fold paralysis. Botulinum toxin injection was more effective in patients with cranial nerve IX or X palsy than in those without it ( P = .006). This procedure can be a simple, safe, and effective tool in patients with cricopharyngeal dysfunction after swallowing rehabilitation, especially for cranial nerve IX or X palsy.

Upper ankle joint space detection on low contrast intraoperative fluoroscopic C-arm projections

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Thomas, Sarina; Schnetzke, Marc; Brehler, Michael; Swartman, Benedict; Vetter, Sven; Franke, Jochen; Grützner, Paul A.; Meinzer, Hans-Peter; Nolden, Marco

2017-03-01

Intraoperative mobile C-arm fluoroscopy is widely used for interventional verification in trauma surgery, high flexibility combined with low cost being the main advantages of the method. However, the lack of global device-to- patient orientation is challenging, when comparing the acquired data to other intrapatient datasets. In upper ankle joint fracture reduction accompanied with an unstable syndesmosis, a comparison to the unfractured contralateral site is helpful for verification of the reduction result. To reduce dose and operation time, our approach aims at the comparison of single projections of the unfractured ankle with volumetric images of the reduced fracture. For precise assessment, a pre-alignment of both datasets is a crucial step. We propose a contour extraction pipeline to estimate the joint space location for a prealignment of fluoroscopic C-arm projections containing the upper ankle joint. A quadtree-based hierarchical variance comparison extracts potential feature points and a Hough transform is applied to identify bone shaft lines together with the tibiotalar joint space. By using this information we can define the coarse orientation of the projections independent from the ankle pose during acquisition in order to align those images to the volume of the fractured ankle. The proposed method was evaluated on thirteen cadaveric datasets consisting of 100 projections each with manually adjusted image planes by three trauma surgeons. The results show that the method can be used to detect the joint space orientation. The correlation between angle deviation and anatomical projection direction gives valuable input on the acquisition direction for future clinical experiments.

Zero-fluoroscopy cryothermal ablation of atrioventricular nodal re-entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial).

Science.gov (United States)

Luani, Blerim; Zrenner, Bernhard; Basho, Maksim; Genz, Conrad; Rauwolf, Thomas; Tanev, Ivan; Schmeisser, Alexander; Braun-Dullaeus, Rüdiger C

2018-01-01

Stochastic damage of the ionizing radiation to both patients and medical staff is a drawback of fluoroscopic guidance during catheter ablation of cardiac arrhythmias. Therefore, emerging zero-fluoroscopy catheter-guidance techniques are of great interest. We investigated, in a prospective pilot study, the feasibility and safety of the cryothermal (CA) slow-pathway ablation in patients with symptomatic atrioventricular-nodal-re-entry-tachycardia (AVNRT) using solely intracardiac echocardiography (ICE) for endovascular and endocardial catheter visualization. Twenty-five consecutive patients (mean age 55.6 ± 12.0 years, 17 female) with ECG-documentation or symptoms suggesting AVNRT underwent an electrophysiology study (EPS) in our laboratory utilizing ICE for catheter navigation. Supraventricular tachycardia was inducible in 23 (92%) patients; AVNRT was confirmed by appropriate stimulation maneuvers in 20 (80%) patients. All EPS in the AVNRT subgroup could be accomplished without need for fluoroscopy, relying solely on ICE-guidance. CA guided by anatomical location and slow-pathway potentials was successful in all patients, median cryo-mappings = 6 (IQR:3-10), median cryo-ablations = 2 (IQR:1-3). Fluoroscopy was used to facilitate the trans-septal puncture and localization of the ablation substrate in the remaining 3 patients (one focal atrial tachycardia and two atrioventricular-re-entry-tachycardias). Mean EPS duration in the AVNRT subgroup was 99.8 ± 39.6 minutes, ICE guided catheter placement 11.9 ± 5.8 minutes, time needed for diagnostic evaluation 27.1 ± 10.8 minutes, and cryo-application duration 26.3 ± 30.8 minutes. ICE-guided zero-fluoroscopy CA in AVNRT patients is feasible and safe. Real-time visualization of the true endovascular borders and cardiac structures allow for safe catheter navigation during the ICE-guided EPS and might be an alternative to visualization technologies using geometry reconstructions. © 2017 Wiley Periodicals, Inc.

Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System

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Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr; Rao, Pramod, E-mail: pramodrao@me.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

2016-07-15

ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.

Estimation of entrance dose during selected fluoroscopic examinations in some hospitals in Khartoum state

International Nuclear Information System (INIS)

Mohammed, Heba Abdalkareem Osman

2016-01-01

A diagnostic fluoroscopy is a modality that involves visualizing the anatomy using radiation in real time. Therefore, patients doses have a potential for being great, increasing the chance of the radiation induced carcinogenesis. The objective of this study was to determine the mean entrance surface dose (ESD) from selected fluoroscopic examinations namely, hysterosalpingography (HSG) and ascendingurethogram (ASU) in three hospitals in Khartoum State. A total of 87 and 110 patents for HSG and ASU respectively were examined. The data were collected over four months. The mean ESD for patients who underwent HSG were 16.2 mGy, 20.6 mGy and 25.9 mGY respectively, while the ESD for patient who underwent ascendingurethrogram for AP view were 3.5mGy, 2.9mGy and 11.9mGy and for OB view 15.9 mGy, 18.3 mGy and 25.4 mGy. Patient doses were calculated using mathematical equation and the results were compared with the ESDs calculated using mathematical equation and the results were found to be comparable with the ESDs reported in previous studies and within the guidance level established by the ICRP. Fluoroscopy time, operator skills, x-ray machine type and clinical complexity of the procedures were shown to be major contributors to the variations reported in the measured ESDs. The study demonstrated the need for standardization of techniques throughout the hospitals and suggested that there ia a need to optimize the procedures.(Author)

Closed reduction and fluoroscopic-assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats.

Science.gov (United States)

Boekhout-Ta, Christina L; Kim, Stanley E; Cross, Alan R; Evans, Richard; Pozzi, Antonio

2017-01-01

To report complications and clinical outcome of dogs and cats that underwent fluoroscopic-assisted percutaneous pinning (FAPP) of physeal fractures. Retrospective study. Client-owned dogs (n = 37) and cats (n = 4). Records (August 2007-August 2014) of physeal fractures treated with FAPP in 3 hospitals were evaluated. Data collected included signalment, fracture characteristics (etiology, location, duration, Salter-Harris classification, preoperative and postoperative displacement), surgical information (implant size, surgical duration), and outcome assessment information (functional outcome, radiographic outcome, and complications). The majority of animals (92%) were classified as full functional outcome. No significant predictors of functional outcome were identified. The overall complication rate was 15% (n = 6). Elective pin removal rate was 41% (n = 17). Goniometry and limb circumference measurements of the affected and contralateral limbs were not significantly different in dogs for which measurements were obtained. Seventeen of 18 animals (16 dogs, 2 cats) measured had bone length changes on follow-up radiographs. FAPP is associated with an excellent functional outcome in a narrow selection of fracture configurations, specifically those with minimal displacement and for which anatomical alignment can be achieved with closed reduction. © 2016 The American College of Veterinary Surgeons.

Sacral-neuromodulation CT-guided

International Nuclear Information System (INIS)

Amoroso, Lamberto; Ricci, Stefano; Pelliccioni, Giuseppe; Scarpino, Osvaldo; Ghiselli, Roberto; Saba, Vittorio

2005-01-01

total of 38 centering. Eight patients underwent the PNE procedure on both the S3 foramina. The sacral foramen was centred at the first attempt in 36 out of 38 cases. Two cases required several attempts to centre correctly the foramen. In 4 patients out of 30 a second electrode was implanted. In one patient who had a non consolidated sacral fracture, CT guidance enabled insertion of the electrode inside the only practicable foramen, a manoeuvre that would have been impossible with fluoroscopic guidance. Only once was repositioned after a CT control. During the whole trial period we had a positive response to the PNE test in 18 out of 30 patients (60%), a partial response in 4 out of 30 patients and a negative response in the remaining 8 patients. None of the patients who underwent the PNE test had infectious complications and the procedure was well tolerated by all. The procedure lasted about 45 minutes. Conclusions: The PNE test under Ct guidance proved to be more efficient compared with the traditional technique as the direct view of the electrode position helped to define with greater reliability the patients who were non-responsive to sacral stimulation. Moreover, this method was particularly efficient in patients with sacral anomalies where the traditional guide might fail. The operators' reduced exposure to radiation is an advantage to be taken into consideration. Finally, the usage of mobile CT apparatus in an operating theatre can improve the technique for permanent implantations [it

Clinical significance of fluoroscopic patterns specific for the mitotic spindle in patients with reumatic diseases

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S. Todesco

2011-09-01

Full Text Available Objective: we proposed to determine the clinical significance of anti-NuMA and anti-HsEg5 antibodies in a group of patients affected with rheumatic diseases. Materials and methods: indirect immunofluorescence on HEp-2000 cells at serum dilution of 1:40 was used to examin 26 sera which had previously showed a “mitotic spindle” fluoroscopic pattern type during laboratory routine. Results: 21 sera (80,7% were identified with NuMA and 5 (19,3% with HsEg5 patterns alone or associated with other ANA patterns. However only patients with isolated positiveness and that is 15 with NuMA and 4 with HsEg5 stainings were included in this study. Of the NuMA positive patients 5 were affected with arthropathies associated to different forms of thyroiditis, 2 with seronegative arthritis, 2 with antiphospholipid syndrome, 1 with systemic lupus erythematosus (SLE, 1 with rheumatoid arthritis, 1 with sicca syndrome, 1 with undifferentiated connective tissue disease, 1 with Mycoplasma pneumaniae infection and 1 with retinal thrombosis. Of the HsEg5 positive patients 3 were affected with SLE and 1 with seronegative arthritis. Conclusions: NuMA does not prevail in any defined rheumatic disease, while HsEg5 staining were more frequent (75% in patients affected with SLE all of whom showing high antibody titres.

Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

International Nuclear Information System (INIS)

Wallace, Adam N.; Pacheco, Rafael A.; Tomasian, Anderanik; Hsi, Andy C.; Long, Jeremiah; Chang, Randy O.; Jennings, Jack W.

2016-01-01

BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact

Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series

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Wallace, Adam N., E-mail: wallacea@mir.wustl.edu; Pacheco, Rafael A., E-mail: pachecor@mir.wustl.edu; Tomasian, Anderanik, E-mail: tomasiana@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Hsi, Andy C., E-mail: hsia@path.wustl.edu [Washington University School of Medicine, Division of Anatomic Pathology, Department of Pathology & Immunology (United States); Long, Jeremiah, E-mail: longj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Chang, Randy O., E-mail: changr@wusm.wustl.edu [Washington University School of Medicine (United States); Jennings, Jack W., E-mail: jenningsj@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

2016-02-15

BackgroundA novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance.MethodsMedical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance.ResultsTwenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86 % (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28 weeks; range 5–115 weeks). The median total length of bone core obtained from drill-assisted biopsies was 28 mm (range 8–120 mm). This was longer than that obtained from manual biopsies (median, 20 mm; range 5–45 mm; P = 0.03). Crush artifact was present in 11 % (3/28) of drill-assisted biopsy specimens, which in one case (3.6 %; 1/28) precluded definitive diagnosis.ConclusionsA drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.

Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

International Nuclear Information System (INIS)

Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook

1995-01-01

To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy

Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

Energy Technology Data Exchange (ETDEWEB)

Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1995-10-15

To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy.

Amnioinfusion in thick meconium.

Science.gov (United States)

Sood, Mini; Charulata; Dimple; Aggarwal, Neera; Faridi, M M A

2004-08-01

There are conflicting reports regarding the results of amnioinfusion in the management of meconium passage in utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour. 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Transcervical amnioinfusion of one liter saline infused over 30-45 minutes. End points were relief of decelerations, incidence of vaginal delivery, presence of meconium below the neonatal cords, and X-ray evidence of meconium aspiration. Amnioinfusion resulted in relief of decelerations in 75% of cases as compared to 7% in the control group. Eighty-eight percent of patients delivered vaginally as compared to 58% in the control group (pamnioinfusion with positive X-rays for meconium aspiration in only 12.5% versus 26% (p amnioinfusion is a safe, simple and inexpensive technique that reduces operative intervention and improves neonatal outcome, and is of tremendous relevance in developing countries.

Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: a report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council.

Science.gov (United States)

Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen; Fukuda, Atsushi; Goode, Allen; Hartwell, Gary; LaFrance, Terry; Nickoloff, Edward; Shepard, Jeff; Strauss, Keith

2012-05-01

Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of this work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology "automatic dose rate and image quality" (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which measurement data were

Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: A Report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council

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Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen; Fukuda, Atsushi; Goode, Allen; Hartwell, Gary; LaFrance, Terry; Nickoloff, Edward; Shepard, Jeff; Strauss, Keith [Henry Ford Health System, Detroit, Michigan 48202 (United States); Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115 (United States); Columbia University Medical Center, New York, New York 10032 (United States); Shiga Medical Center for Children, Moriyama City, Shiga-Ken, Japan 524-0022 (Japan); University of Virginia Health Science Center, Charlottesville, Virginia 22908 (United States); Baystate Health Systems, Inc., Springfield, Massachusetts 01199 (United States); Columbia University Medical Center, New York, New York 10032 (United States); University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030 (United States); Cincinnati Children' s Hospital Medical Center, Cincinnati, Ohio 45229 (United States)

2012-05-15

Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of this work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology ''automatic dose rate and image quality'' (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which

Functionality and operation of fluoroscopic automatic brightness control/automatic dose rate control logic in modern cardiovascular and interventional angiography systems: A Report of Task Group 125 Radiography/Fluoroscopy Subcommittee, Imaging Physics Committee, Science Council

International Nuclear Information System (INIS)

Rauch, Phillip; Lin, Pei-Jan Paul; Balter, Stephen; Fukuda, Atsushi; Goode, Allen; Hartwell, Gary; LaFrance, Terry; Nickoloff, Edward; Shepard, Jeff; Strauss, Keith

2012-01-01

Task Group 125 (TG 125) was charged with investigating the functionality of fluoroscopic automatic dose rate and image quality control logic in modern angiographic systems, paying specific attention to the spectral shaping filters and variations in the selected radiologic imaging parameters. The task group was also charged with describing the operational aspects of the imaging equipment for the purpose of assisting the clinical medical physicist with clinical set-up and performance evaluation. Although there are clear distinctions between the fluoroscopic operation of an angiographic system and its acquisition modes (digital cine, digital angiography, digital subtraction angiography, etc.), the scope of this work was limited to the fluoroscopic operation of the systems studied. The use of spectral shaping filters in cardiovascular and interventional angiography equipment has been shown to reduce patient dose. If the imaging control algorithm were programmed to work in conjunction with the selected spectral filter, and if the generator parameters were optimized for the selected filter, then image quality could also be improved. Although assessment of image quality was not included as part of this report, it was recognized that for fluoroscopic imaging the parameters that influence radiation output, differential absorption, and patient dose are also the same parameters that influence image quality. Therefore, this report will utilize the terminology ''automatic dose rate and image quality'' (ADRIQ) when describing the control logic in modern interventional angiographic systems and, where relevant, will describe the influence of controlled parameters on the subsequent image quality. A total of 22 angiography units were investigated by the task group and of these one each was chosen as representative of the equipment manufactured by GE Healthcare, Philips Medical Systems, Shimadzu Medical USA, and Siemens Medical Systems. All equipment, for which measurement data were

Flouroscopically–guided transhepatic puncture for difficult TIPS re-do procedures utilizing the En Snare retrieval device: A new approach to occluded TIPS in patients with recurrent ascites

International Nuclear Information System (INIS)

Stambo, Glenn W.; Berlet, Matthew H.

2012-01-01

Portal hypertension and variceal bleeding are complications due to cirrhosis. Transjugular Intraphepatic Portosystemic shunt (TIPS) procedure is a well-established treatment for recurrent ascites and variceal bleeding related to portal hypertension. After a TIPS has been placed, the potential of TIPS occlusion or stenosis is high. A TIPS re-do procedure has been used in treatment of progressive clinical symptoms. The standard approach is via the jugular route to recannulate the TIPS shunt. Rarely, it cannot be performed from the jugular approach. Therefore, a fluoroscopically -guided transhepatic approach has been devised for these difficult situations. This case describes the use of the transhepatic route through an indwelling Viatorr covered stent utilizing an En-Snare device to help complete the TIPS re-do procedure. With this newer approach to TIPS re-do procedures, endovascular specialists can achieve TIPS patency despite difficult venous anatomical challenges and the various types of available TIPS stents presently on the market.

MRI-guided vacuum-assisted breast biopsy: comparison with stereotactically guided and ultrasound-guided techniques

Energy Technology Data Exchange (ETDEWEB)

Imschweiler, Thomas; Freiwald, Bianka; Kubik-Huch, Rahel A. [Kantonspital Baden AG, Institute for Radiology, Baden (Switzerland); Haueisen, Harald [Kantonspital Aarau AG, Institute for Radiology, Aarau (Switzerland); Kampmann, Gert [Clinica Sant' Anna, Lugano, Sorengo (Switzerland); Rageth, Luzi [Adjumed Services AG, Zurich (Switzerland); Seifert, Burkhardt [Institute for Social and Preventive Medicine, University of Zurich, Division of Biostatistics, Zuerich (Switzerland); Rageth, Christoph [Breast Centre, Zurich (Switzerland)

2014-01-15

To analyse the development of MRI-guided vacuum-assisted biopsy (VAB) in Switzerland and to compare the procedure with stereotactically guided and ultrasound-guided VAB. We performed a retrospective analysis of VABs between 2009 and 2011. A total of 9,113 VABs were performed. Of these, 557 were MRI guided. MRI-guided VAB showed the highest growth rate (97 %) of all three procedures. The technical success rates for MRI-guided, stereotactically guided and ultrasound-guided VAB were 98.4 % (548/557), 99.1 % (5,904/5,960) and 99.6 % (2,585/2,596), respectively. There were no significant differences (P = 0.12) between the MRI-guided and the stereotactically guided procedures. The technical success rate for ultrasound-guided VAB was significantly higher than that for MRI-guided VAB (P < 0.001). There were no complications using MRI-guided VAB requiring open surgery. The malignancy diagnosis rate for MRI-guided VAB was similar to that for stereotactically guided VAB (P = 0.35). MRI-guided VAB is a safe and accurate procedure that provides insight into clinical breast findings. (orig.)

The ALARA (as low as reasonably achievable) concept in pediatric interventional and fluoroscopic imaging: striving to keep radiation doses as low as possible during fluoroscopy of pediatric patients - a white paper executive summary

International Nuclear Information System (INIS)

Strauss, Keith J.; Kaste, Sue C.

2006-01-01

ALARA represents a practice mandate adhering to the principle of keeping radiation doses to patients and personnel As Low As Reasonably Achievable. This concept is strongly endorsed by the Society for Pediatric Radiology, particularly in the use of procedures and modalities involving higher radiation doses such as CT and fluoroscopic examinations of pediatric patients. There is no doubt that medical imaging, which has undergone tremendous technological advances in recent decades, is integral to patient care. However, these technological advances generally precede the knowledge of end-users concerning the optimal use and correct operation of the resulting imaging equipment, and such knowledge is essential to minimizing potential risks to the patients. Current imaging methods must be optimized for radiation dose reduction in pediatric patients who might be as much as ten times more radiosensitive than adults. Unlike straightforward radiographic examinations, radiation dose to the patient during fluoroscopy is dependent on the operator's training, experience with the fluoroscope, and efficiency in completing a diagnostic study. The range of pediatric radiation doses from fluoroscopy is wide because this examination is performed not only by pediatric radiologists but also by general radiologists who occasionally care for children, interventional cardiologists, gastroenterologists, urologists and others. Thus, a venue where multidisciplinary interaction by this variety of operators can occur serves to improve pediatric patient care

Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy

International Nuclear Information System (INIS)

Praveen, Alampath; Sreekumar, Karumathil Pullara; Nazar, Puthukudiyil Kader; Moorthy, Srikanth

2012-01-01

Thoracic duct embolization (TDE) is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct

Technical Note: Thoracic duct embolization for treatment of chylothorax: A novel guidance technique for puncture using combined MRI and fluoroscopy.

Science.gov (United States)

Praveen, Alampath; Sreekumar, Karumathil Pullara; Nazar, Puthukudiyil Kader; Moorthy, Srikanth

2012-04-01

Thoracic duct embolization (TDE) is an established radiological interventional procedure for thoracic duct injuries. Traditionally, it is done under fluoroscopic guidance after opacifying the thoracic duct with bipedal lymphangiography. We describe our experience in usinga heavily T2W sequence for guiding thoracic duct puncture and direct injection of glue through the puncture needle without cannulating the duct.

SU-G-BRA-05: Application of a Feature-Based Tracking Algorithm to KV X-Ray Fluoroscopic Images Toward Marker-Less Real-Time Tumor Tracking

Energy Technology Data Exchange (ETDEWEB)

Nakamura, M; Matsuo, Y; Mukumoto, N; Iizuka, Y; Yokota, K; Mizowaki, T; Hiraoka, M [Kyoto University, Graduate School of Medicine, Kyoto (Japan); Nakao, M [Kyoto University, Graduate School of Informatics, Kyoto (Japan)

2016-06-15

Purpose: To detect target position on kV X-ray fluoroscopic images using a feature-based tracking algorithm, Accelerated-KAZE (AKAZE), for markerless real-time tumor tracking (RTTT). Methods: Twelve lung cancer patients treated with RTTT on the Vero4DRT (Mitsubishi Heavy Industries, Japan, and Brainlab AG, Feldkirchen, Germany) were enrolled in this study. Respiratory tumor movement was greater than 10 mm. Three to five fiducial markers were implanted around the lung tumor transbronchially for each patient. Before beam delivery, external infrared (IR) markers and the fiducial markers were monitored for 20 to 40 s with the IR camera every 16.7 ms and with an orthogonal kV x-ray imaging subsystem every 80 or 160 ms, respectively. Target positions derived from the fiducial markers were determined on the orthogonal kV x-ray images, which were used as the ground truth in this study. Meanwhile, tracking positions were identified by AKAZE. Among a lot of feature points, AKAZE found high-quality feature points through sequential cross-check and distance-check between two consecutive images. Then, these 2D positional data were converted to the 3D positional data by a transformation matrix with a predefined calibration parameter. Root mean square error (RMSE) was calculated to evaluate the difference between 3D tracking and target positions. A total of 393 frames was analyzed. The experiment was conducted on a personal computer with 16 GB RAM, Intel Core i7-2600, 3.4 GHz processor. Results: Reproducibility of the target position during the same respiratory phase was 0.6 +/− 0.6 mm (range, 0.1–3.3 mm). Mean +/− SD of the RMSEs was 0.3 +/− 0.2 mm (range, 0.0–1.0 mm). Median computation time per frame was 179 msec (range, 154–247 msec). Conclusion: AKAZE successfully and quickly detected the target position on kV X-ray fluoroscopic images. Initial results indicate that the differences between 3D tracking and target position would be clinically acceptable.

SU-G-BRA-05: Application of a Feature-Based Tracking Algorithm to KV X-Ray Fluoroscopic Images Toward Marker-Less Real-Time Tumor Tracking

International Nuclear Information System (INIS)

Nakamura, M; Matsuo, Y; Mukumoto, N; Iizuka, Y; Yokota, K; Mizowaki, T; Hiraoka, M; Nakao, M

2016-01-01

Purpose: To detect target position on kV X-ray fluoroscopic images using a feature-based tracking algorithm, Accelerated-KAZE (AKAZE), for markerless real-time tumor tracking (RTTT). Methods: Twelve lung cancer patients treated with RTTT on the Vero4DRT (Mitsubishi Heavy Industries, Japan, and Brainlab AG, Feldkirchen, Germany) were enrolled in this study. Respiratory tumor movement was greater than 10 mm. Three to five fiducial markers were implanted around the lung tumor transbronchially for each patient. Before beam delivery, external infrared (IR) markers and the fiducial markers were monitored for 20 to 40 s with the IR camera every 16.7 ms and with an orthogonal kV x-ray imaging subsystem every 80 or 160 ms, respectively. Target positions derived from the fiducial markers were determined on the orthogonal kV x-ray images, which were used as the ground truth in this study. Meanwhile, tracking positions were identified by AKAZE. Among a lot of feature points, AKAZE found high-quality feature points through sequential cross-check and distance-check between two consecutive images. Then, these 2D positional data were converted to the 3D positional data by a transformation matrix with a predefined calibration parameter. Root mean square error (RMSE) was calculated to evaluate the difference between 3D tracking and target positions. A total of 393 frames was analyzed. The experiment was conducted on a personal computer with 16 GB RAM, Intel Core i7-2600, 3.4 GHz processor. Results: Reproducibility of the target position during the same respiratory phase was 0.6 +/− 0.6 mm (range, 0.1–3.3 mm). Mean +/− SD of the RMSEs was 0.3 +/− 0.2 mm (range, 0.0–1.0 mm). Median computation time per frame was 179 msec (range, 154–247 msec). Conclusion: AKAZE successfully and quickly detected the target position on kV X-ray fluoroscopic images. Initial results indicate that the differences between 3D tracking and target position would be clinically acceptable.

3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system

Science.gov (United States)

Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

2017-03-01

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg

Energy Technology Data Exchange (ETDEWEB)

Miraglia, Roberto; Maruzzelli, Luigi; Cortis, Kelvin; Gerasia, Roberta; Maggio, Simona; Luca, Angelo [Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Piazza, Marcello [Department of Anesthesia, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Tuzzolino, Fabio [Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy)

2014-09-10

Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm{sup 2} with the IIDS and 15.9 ± 44.6 cGy . cm{sup 2} with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy . cm{sup 2} with the IIDS and 37.1 ± 33.5 cGy cm{sup 2} with the FPDS (P = 0.02). The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement. (orig.)

Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (≤1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

Energy Technology Data Exchange (ETDEWEB)

Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it; Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr; Alberti, Nicolas, E-mail: nicoalbertibdx@gmail.com; Fonck, Mariane, E-mail: m.fonk@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France); Grasso, Rosario Francesco, E-mail: r.grasso@unicampus.it [Università “Campus Bio-Medico di Roma”, Department of Radiology and Diagnostic Imaging (Italy); Palussière, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France)

2015-02-15

PurposeThe aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors.Materials and MethodsPatients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients’ lesions and procedural variables were recorded and analyzed.ResultsThree patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up.ConclusionPercutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.

Fluoroscopic study of the normal gastrointestinal motility and measurements in the Hispaniolan Amazon parrot (Amazona ventralis).

Science.gov (United States)

Beaufrère, Hugues; Nevarez, Javier; Taylor, W Michael; Jankowski, Gwendolyn; Rademacher, Nathalie; Gaschen, Lorrie; Pariaut, Romain; Tully, Thomas N

2010-01-01

Contrast fluoroscopy is a valuable tool to examine avian gastrointestinal motility. However, the lack of a standardized examination protocol and reference ranges prevents the objective interpretation of motility disorders and other gastrointestinal abnormalities. Our goals were to evaluate gastrointestinal motility in 20 Hispaniolan Amazon parrots (Amazona ventralis) by contrast fluoroscopy. Each parrot was crop-fed an equal part mixture of barium sulfate and hand-feeding formula and placed in a cardboard box for fluoroscopy. Over a 3-h period, 1.5 minute segments of lateral and ventrodorsal fluoroscopy were recorded every 30 min. The gastric cycle and patterns of intestinal motility were described. The frequency of crop contractions, esophageal boluses, and gastric cycles were determined in lateral and ventrodorsal views. A range of 3.4-6.6 gastric cycles/min was noted on the lateral view and 3.0-6.6 gastric cycles/min on the ventrodorsal view. Circular measurements of the proventriculus diameter, ventriculus width, and length were obtained using the midshaft femoral diameter as a standard reference unit. The upper limits of the reference ranges were 3.6 and 4.7 femoral units for the proventriculus diameter in the lateral and ventrodorsal view, respectively. Two consecutive measurements were obtained and the measurement technique was found to have high reproducibility. In this study, we established a standardized protocol for contrast fluoroscopic examination of the gastrointestinal tract and a reliable measurement method of the proventriculus and ventriculus using femoral units in the Hispaniolan Amazon parrot.

Isthmocervical labelling and SPECT/CT for optimized sentinel detection in endometrial cancer: technique, experience and results.

Science.gov (United States)

Mücke, J; Klapdor, R; Schneider, M; Länger, F; Gratz, K F; Hillemanns, P; Hertel, H

2014-08-01

We evaluated the clinical feasibility of a new injection technique for sentinel detection in endometrial carcinoma (EC), transcervical subepithelial injection into the isthmocervical region of the myometrium. We compared detection of sentinel lymph nodes (SLN) by single photon emission computed tomography with CT (SPECT/CT) with planar lymphoscintigraphy. This is a unicentric prospective study. In all patients, transcervical injection of 10 MBq Technetium-99m-nanocolloid was performed into the isthmocervical myometrium without anaesthesia. After 40 (30-60) min, lymphoscintigraphy and SPECT/CT were performed. Patent blue was administered before surgery. The number and localisation of SLN detected in SPECT/CT and lymphoscintigraphy were recorded and compared to the SLN and non-SLN dissected intra-operatively. Between August 2008 and March 2012, 31 patients with EC were enrolled. The new transcervical injection of labelling substances led to high intra-operative (90.3%) detection rates, pelvic bilateral (57%), para-aortic (25%). SPECT/CT significantly identified more SLN than lymphoscintigraphy (mean 2.2 (1-8) to 1.3 (1-7)) in more patients (29/31 (93.5%) to 21/31 (68%), pnegative predictive value (NPV) 100%, and false negative results 0%. Transcervical SLN marking in combination with SPECT/CT is easily applicable and leads to high physiologic detection rates in pelvic and para-aortic lymphatic drainage areas. Non-affected SLN truly predicted a non-affected LN basin. Combining both methods SLN dissection may be a safe and feasible staging technique for clinical routine in EC. Copyright © 2014 Elsevier Inc. All rights reserved.

COATING ALTERNATIVES GUIDE (CAGE) USER'S GUIDE

Science.gov (United States)

The guide provides instructions for using the Coating Alternatives GuidE (CAGE) software program, version 1.0. It assumes that the user is familiar with the fundamentals of operating an IBM-compatible personal computer (PC) under the Microsoft disk operating system (MS-DOS). CAGE...

Promotion Guide – A guide for career reviews

CERN Multimedia

Staff Association

2017-01-01

On 8 February, the Standing Concertation Committee (SCC) approved the Promotion Guide, subtitled “A guide for career reviews”. The English version is already published on the HR website. This Promotion Guide is not very different from the Career Path Guide which it replaces following the implementation of the new career structure with benchmark jobs and grades. Structure The guide is composed of three parts: Section I – Introduction revisits the reference documents: the Staff Rules and Regulations (S&R) and the Administrative Circular No. 26 (AC 26). In the Staff Rules and Regulations, the term promotion is defined as a change of grade1 and in Administrative Circular No. 26, the Promotion Guide is referenced under paragraph 452. The objective of the Promotion Guide is laid out in Section I: “The Promotion Guide defines the criteria to be used as a reference for career reviews with a view to a potential promotion”. However, this guide do...

Is McMurray′s osteotomy obsolete?

Directory of Open Access Journals (Sweden)

Phaltankar P

1995-10-01

Full Text Available A review of the method of performing, advantages, disadvantages of McMurray′s displacement osteotomy with regard to treatment of nonunion of transcervical fracture neck femur with viable femoral head was carried out in this study of ten cases, in view of the abandonment of the procedure in favour of angulation osteotomy. Good results obtained in the series attest to the usefulness of McMurray′s osteotomy in the difficult problem of nonunion of transcervical fracture neck femur in well selected cases with certain advantages over the angulation osteotomy due to the ′Armchair effect′.

CIRSE Standards of Practice Guidelines on Gastrostomy

Energy Technology Data Exchange (ETDEWEB)

Sutcliffe, James, E-mail: jasutcliffe@gmail.com; Wigham, Andrew, E-mail: a.wigham@doctors.org.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom); Mceniff, Niall, E-mail: nmceniff@stjames.ie [St. James’s Hospital, Radiology (DiagIm) (Ireland); Dvorak, Petr, E-mail: petr-dvorak@email.cz [Faculty Hospital Charles University, Radiology Department (Czech Republic); Crocetti, Laura, E-mail: laura.crocetti@med.unipi.it [University of Pisa, Diagnostic Imaging and Intervention, Department of Hepatology and Liver Transplants (Italy); Uberoi, Raman, E-mail: Raman.Uberoi@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Radiology Department (United Kingdom)

2016-07-15

PurposeSurgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults.Material and MethodWe performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion.ResultsStudies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention.ConclusionRadiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.

[Arthroscopy-guided fracture management. Ankle joint and calcaneus].

Science.gov (United States)

Schoepp, C; Rixen, D

2013-04-01

Arthroscopic fracture management of the ankle and calcaneus requires a differentiated approach. The aim is to minimize surgical soft tissue damage and to visualize anatomical fracture reduction arthroscopically. Moreover, additional cartilage damage can be detected and treated. The arthroscopic approach is limited by deep impressions of the joint surface needing cancellous bone grafting, by multiple fracture lines on the articular side and by high-grade soft tissue damage. An alternative to the minimally invasive arthroscopic approach is open arthroscopic reduction in conventional osteosynthesis. This facilitates correct assessment of surgical reduction of complex calcaneal fractures, otherwise remaining non-anatomical reduction might not be fluoroscopically detected during surgery.

Upper cervical spine movement during intubation: fluoroscopic comparison of the AirWay Scope, McCoy laryngoscope, and Macintosh laryngoscope.

Science.gov (United States)

Maruyama, K; Yamada, T; Kawakami, R; Kamata, T; Yokochi, M; Hara, K

2008-01-01

The AirWay Scope (AWS) is a new fibreoptic intubation device, which allows visualization of the glottic structures without alignment of the oral, pharyngeal, and tracheal axes, and thus may be useful in patients with limited cervical spine (C-spine) movement. We fluoroscopically evaluated upper C-spine movement during intubation with the AWS or Macintosh or McCoy laryngoscope. Forty-five patients, with normal C-spine, scheduled for elective surgery were randomly assigned to one of the three intubation devices. Movement of the upper C-spine was examined by measuring angles formed by adjacent vertebrae during intubation. Time to intubation was also recorded. Median cumulative upper C-spine movement was 22.3 degrees, 32.3 degrees, and 36.5 degrees with the AWS, Macintosh laryngoscope, and McCoy laryngoscope, respectively (Pmovement of the C-spine at C1/C2 in comparison with the Macintosh or McCoy laryngoscope (P=0.012), and at C3/C4 in comparison with the McCoy laryngoscope (P=0.019). Intubation time was significantly longer in the AWS group than in the Macintosh group (P=0.03). Compared with the Macintosh or McCoy laryngoscope, the AWS produced less movement of upper C-spine for intubation in patients with a normal C-spine.

TH-E-209-01: Fluoroscopic Dose Monitoring and Patient Follow-Up Program at Massachusetts General Hospital

International Nuclear Information System (INIS)

Liu, B.

2016-01-01

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilities over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.

TH-E-209-01: Fluoroscopic Dose Monitoring and Patient Follow-Up Program at Massachusetts General Hospital

Energy Technology Data Exchange (ETDEWEB)

Liu, B. [Massachusetts General Hospital (United States)

2016-06-15

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilities over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.

EUS-guided drainage of pancreatic fluid collections using a novel lumen-apposing metal stent on an electrocautery-enhanced delivery system: a large retrospective study (with video).

Science.gov (United States)

Rinninella, Emanuele; Kunda, Rastislav; Dollhopf, Markus; Sanchez-Yague, Andres; Will, Uwe; Tarantino, Ilaria; Gornals Soler, Joan; Ullrich, Sebastian; Meining, Alexander; Esteban, Josè Miguel; Enz, Thomas; Vanbiervliet, Geoffroy; Vleggaar, Frank; Attili, Fabia; Larghi, Alberto

2015-12-01

A lumen-apposing, self-expanding metal stent incorporated in an electrocautery-enhanced delivery system for EUS-guided drainage of pancreatic fluid collections (PFCs) recently has become available. The aim of this study was to analyze the safety and clinical effectiveness of this newly developed device in this clinical setting. This was a retrospective analysis of all consecutive patients with PFCs who underwent EUS-guided drainage using the study device in 13 European centers. Ninety-three patients with PFCs (80% with complex collections) underwent drainage using the study device. Penetration of the PFC was accomplished directly with the study device in 74.2% of patients, and successful stent placement was accomplished in all but 1 patient, mostly without fluoroscopic assistance. Direct endoscopic necrosectomy (DEN) was carried out in 31 of 52 cases (59.6%) of walled-off necrosis and in 2 of 4 cases (50%) of acute peripancreatic fluid collection. Complete resolution of the PFC was obtained in 86 cases (92.5%), with no recurrence during follow-up. Treatment failure occurred in 6 patients because of persistent infection requiring surgery (n = 3), perforation and massive bleeding caused by the nasocystic drainage catheter (NCDC) (n = 2), and the need for a larger opening to extract large necrotic tissue pieces (n = 1). Major adverse events occurred in 5 patients (perforation and massive bleeding caused by the NCDC in 2 patients, 1 pneumoperitoneum and 1 stent dislodgement during DEN, and 1 postdrainage infection) and were mostly not related to the drainage procedure. EUS-guided drainage with the electrocautery-enhanced delivery system is a safe, easy to perform, and a highly effective minimally invasive treatment modality for PFCs. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Clinical Conundrum: Killian-Jamieson Diverticulum with Paraesophageal Hernia.

Science.gov (United States)

Bock, Jonathan M; Knabel, Michael J; Lew, Daniel A; Knechtges, Paul M; Gould, Jon C; Massey, Benson T

2016-08-01

Killian-Jamieson diverticulum is a outpouching of the lateral cervical esophageal wall adjacent to the insertion of the recurrent laryngeal to the larynx and is much less common in clinical practice than Zenkers Diverticulum. Surgical management of Killian-Jamieson diverticulum requires open transcervical diverticulectomy due to the proximity of the recurrent laryngeal nerve to the base of the pouch. We present a case of a Killian-Jamieson diverticulum associated with a concurrent large type III paraesophageal hernia causing significant solid-food dysphagia, post-prandial regurgitation of solid foods, and chronic cough managed with open transcervical diverticulectomy and laparoscopic paraesophageal hernia repair with Nissen fundoplication.

Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis

International Nuclear Information System (INIS)

Miller, A.B.; Howe, G.R.; Sherman, G.J.; Lindsay, J.P.; Yaffe, M.J.; Dinner, P.J.; Risch, H.A.; Preston, D.L.

1989-01-01

The increasing use of mammography to screen asymptomatic women makes it important to know the risk of breast cancer associated with exposure to low levels of ionizing radiation. We examined the mortality from breast cancer in a cohort of 31,710 women who had been treated for tuberculosis at Canadian sanatoriums between 1930 and 1952. A substantial proportion (26.4 percent) had received radiation doses to the breast of 10 cGy or more from repeated fluoroscopic examinations during therapeutic pneumothoraxes. Women exposed to greater than or equal to 10 cGy of radiation had a relative risk of death from breast cancer of 1.36, as compared with those exposed to less than 10 cGy (95 percent confidence interval, 1.11 to 1.67; P = 0.001). The data were most consistent with a linear dose-response relation. The risk was greatest among women who had been exposed to radiation when they were between 10 and 14 years of age; they had a relative risk of 4.5 per gray, and an additive risk of 6.1 per 10(4) person-years per gray. With increasing age at first exposure, there was substantially less excess risk, and the radiation effect appeared to peak approximately 25 to 34 years after the first exposure. Our additive model for lifetime risk predicts that exposure to 1 cGy at the age of 40 increases the number of deaths from breast cancer by 42 per million women. We conclude that the risk of breast cancer associated with radiation decreases sharply with increasing age at exposure and that even a small benefit to women of screening mammography would outweigh any possible risk of radiation-induced breast cancer

Percutaneous Placement of Central Venous Catheters: Comparing the Anatomical Landmark Method with the Radiologically Guided Technique for Central Venous Catheterization Through the Internal Jugular Vein in Emergent Hemodialysis Patients

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Koroglu, M.; Demir, M.; Koroglu, B.K.; Sezer, M.T.; Akhan, O.; Yildiz, H.; Yavuz, L.; Baykal, B.; Oyar, O. [Suleyman Demirel Univ., Isparta (Turkey). Depts. of Radiology, Internal Medicine and Anesthesiology

2006-02-15

Purpose: To compare the success and immediate complication rates of the anatomical landmark method (group 1) and the radiologically (combined real-time ultrasound and fluoroscopy) guided technique (group 2) in the placement of central venous catheters in emergent hemodialysis patients. Material and Methods: The study was performed prospectively in a randomized manner. The success and immediate complication rates of radiologically guided placement of central venous access catheters through the internal jugular vein (n = 40) were compared with those of the anatomical landmark method (n 40). The success of placement, the complications, the number of passes required, and whether a single or double-wall puncture occurred were also noted and compared. Results: The groups were comparable in age and sex. The indication for catheter placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in 1 (2.5%) patient in group 1. All catheters functioned adequately and immediately after the placement (0% initial failure rate) in group 2, but 3 catheters (7.5% initial failure rate) were non-functional just after placement in group 1. The total number of needle passes, double venous wall puncture, and complication rate were significantly lower in group 2. Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous catheterization for emergent dialysis should be performed under both real-time ultrasound and fluoroscopic guidance.

SAGE 2.1: SOLVENT ALTERNATIVES GUIDE: USER'S GUIDE

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The guide provides instruction for using the SAGE (Solvent Alternatives GuidE) software system, version 2.1. SAGE recommends solvent replacements in cleaning and degreasing operations. It leads the user through a question-and-answer session. The user's responses allow the system ...

Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty

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Tzanakakis George

2009-11-01

Full Text Available Abstract Background In oncologic patients with metastatic spinal disease, the ideal treatment should be well tolerated, relieve the pain, and preserve or restore the neurological function. The combination of fluoroscopic guided radiofrequency ablation (RFA and kyphoplasty may fulfill these criteria. Methods We describe three pathological vertebral fractures treated with a combination of fluoroscopic guided RFA and kyphoplasty in one session: a 62-year-old man suffering from a painful L4 pathological fracture due to a plasmocytoma, a 68-year-old man with a T12 pathological fracture from metastatic hepatocellular carcinoma, and a 71-year-old man with a Th12 and L1 pathological fracture from multiple myeloma. Results The choice of patients was carried out according to the classification of Tomita. Visual analog score (VAS and Oswestry disability index (ODI were used for the evaluation of the functional outcomes. The treatment was successful in all patients and no complications were reported. The mean follow-up was 6 months. Marked pain relief and functional restoration was observed. Conclusion In our experience the treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty is safe and effective for immediate pain relief in painful spinal lesions in neurologically intact patients.

A novel removable shield attached to C-arm units against scattered X-rays from a patient's side

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Mori, Hiroshige [Hokkaido Social Insurance Hospital, Department of Radiology, Sapporo, Hokkaido (Japan); Kanazawa University, Department of Quantum Medical Technology, Division of Health Sciences, Graduate School of Medical Science, Kanazawa, Ishikawa (Japan); Koshida, Kichiro; Matsubara, Kosuke [Kanazawa University, School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa, Ishikawa (Japan); Ishigamori, Osamu [Hokkaido Social Insurance Hospital, Department of Radiology, Sapporo, Hokkaido (Japan)

2014-08-15

We invented a drape-like shield against scattered X-rays that can safely come into contact with medical equipment or people during fluoroscopically guided procedures. The shield can be easily removed from a C-arm unit using one hand. We evaluated the use of the novel removable shield during the endoscopic retrograde cholangiopancreatography (ERCP) procedure. We measured the dose rate of scattered X-rays around endoscopists with and without this removable shield and surveyed the occupational doses to the ERCP staff. We also examined the endurance of the shield. The removable shield reduced the dose rate of scattered X-rays to one-tenth and reduced the monthly dose to an endoscopist by at least two-fifths. For 2.5 years, there was no damage to the shield and no loosening of the seam. The bonding of the hook-and-loop fasteners did not weaken, although the powerful double-sided tapes made especially for plastic did. The removable shield can reduce radiation exposure to the ERCP staff and may contribute to reducing the exposure to the eye lenses of operators. It would also be possible to expand its use to other fluoroscopically guided procedures besides ERCP because it is a light, simple, and useful device. (orig.)

Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS.

Science.gov (United States)

Imani, Farnad; Hemati, Karim; Rahimzadeh, Poupak; Kazemi, Mohamad Reza; Hejazian, Kokab

2016-01-01

Stellate Ganglion Block (SGB) is an effective technique which may be used to manage upper extremities pain due to Chronic Regional Pain Syndrome (CRPS), in this study we tried to evaluate the effectiveness of this procedure under two different guidance for management of this syndrome. The purpose of this study was to evaluate the effectiveness of ultrsound guide SGB by comparing it with the furoscopy guided SGB in upper extermities CRPS patients in reducing pain & dysfuction of the affected link. Fourteen patients with sympathetic CRPS in upper extremities in a randomized method with block randomization divided in two equal groups (with ultrasound or fluoroscopic guidance). First group was blocked under fluoroscopic guidance and second group blocked under ultrasound guidance. After correct positioning of the needle, a mixture of 5 ml bupivacaine 0.25% and 1 mL of triamcinolone was injected. These data represent no meaningful statistical difference between the two groups in terms of the number of pain attacks before the blocks, a borderline correlation between two groups one week and one month after the block and a significant statistical correlation between two groups three month after the block. These data represent no meaningful statistical difference between the patients of any group in terms of the pain intensity (from one week to six months after block), p-value = 0.61. These data represent a meaningful statistical difference among patients of any group and between the two groups in terms of the pain intensity (before the block until six months after block), p-values were 0.001, 0.031 respectively. According the above mentioned data, in comparison with fluoroscopic guidance, stellate ganglion block under ultrasound guidance is a safe and effective method with lower complication and better improvement in patient's disability indexes.

Comparative analysis of anterior and posterior contrast injection approaches for shoulder MR arthrograms in adolescents

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Gupton, Theodore B.; Cahill, Anne M. [The Children' s Hospital of Philadelphia, Division of Interventional Radiology, Department of Radiology, Philadelphia, PA (United States); Delgado, Jorge [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Jaramillo, Diego [Stanford University Medical Center, Diagnostic Radiology, Palo Alto, CA (United States); Chauvin, Nancy A. [The Children' s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Musculoskeletal Imaging, Department of Radiology, Philadelphia, PA (United States)

2016-12-15

There is no consensus in the literature concerning the optimal approach for performing a fluoroscopically guided shoulder arthrogram injection in a pediatric population. To compare adequacy of capsular injection and radiation doses between fluoroscopically guided anterior and posterior glenohumeral joint contrast injections in adolescents. We evaluated imaging in 67 adolescents (39 boys, 28 girls; mean age 16.0 years; range 11.7-19.1 years) who underwent an anterior approach glenohumeral contrast injection with subsequent MR imaging, and 67 age- and gender-matched subjects (39 boys, 28 girls; mean age 16.0 years; range 11.1-19.2 years) who underwent a posterior approach injection during the period June 2010 to September 2015. Two pediatric radiologists independently evaluated all MR shoulder arthrograms to assess adequacy of capsular distention and degree of contrast extravasation. We recorded total fluoroscopic time, dose-area product (DAP) and cumulative air kerma (CAK). There were no significant differences in age, gender, height, weight or body mass index between the populations (P-values > 0.6). The amount of contrast extravasation between the groups was not significantly different (P = 0.27). Three anterior injections (4.5%) and one posterior (1.5%) were suboptimal (P = 0.62). Fluoroscopy time was not different: 1.1 min anterior and 1.3 min posterior (P = 0.14). There was a significant difference in CAK (0.7 mGy anterior and 1.1 mGy posterior; P = 0.007) and DAP (5.3 μGym{sup 2} anterior and 9.4 μGym{sup 2} posterior; P = 0.008). Inter-rater agreement was excellent (Cohen kappa >0.81). Both techniques were technically successful. There was no difference in the fluoroscopy time for either approach. The radiation dose was higher with the posterior approach but this is of questionable clinical significance. (orig.)

Contrast-enhanced MR angiography of the carotid artery using 3D time-resolved imaging of contrast kinetics. Comparison with real-time fluoroscopic triggered 3D-elliptical centric view ordering

International Nuclear Information System (INIS)

Naganawa, Shinji; Koshikawa, Tokiko; Fukatsu, Hiroshi; Sakurai, Yasuo; Ishiguchi, Tsuneo; Ishigaki, Takeo; Ichinose, Nobuyasu

2001-01-01

The purpose of this study was to evaluate contrast-enhanced MR angiography using the 3D time-resolved imaging of contrast kinetics technique (3D-TRICKS) by direct comparison with the fluoroscopic triggered 3D-elliptical centric view ordering (3D-ELLIP) technique. 3D-TRICKS and 3D-ELLIP were directly compared on a 1.5-Tesla MR unit using the same spatial resolution and matrix. In 3D-TRICKS, the central part of the k-space is updated more frequently than the peripheral part of the k-space, which is divided in the slice-encoding direction. The carotid arteries were imaged using 3D-TRICKS and 3D-ELLIP sequentially in 14 patients. Temporal resolution was 12 sec for 3D-ELLIP and 6 sec for 3D-TRICKS. The signal-to-noise ratio (S/N) of the common carotid artery was measured, and the quality of MIP images was then scored in terms of venous overlap and blurring of vessel contours. No significant difference in mean S/N was seen between the two methods. Significant venous overlap was not seen in any of the patients examined. Moderate blurring of vessel contours was noted on 3D-TRICKS in five patients and on 3D-ELLIP in four patients. Blurring in the slice-encoding direction was slightly more pronounced in 3D-TRICKS. However, qualitative analysis scores showed no significant differences. When the spatial resolution of the two methods was identical, the performance of 3D-TRICKS was found to be comparable in static visualization of the carotid arteries with 3D-ELLIP, although blurring in the slice-encoding direction was slightly more pronounced in 3D-TRICKS. 3D-TRICKS is a more robust technique than 3D-ELLIP, because 3D-ELLIP requires operator-dependent fluoroscopic triggering. Furthermore, 3D-TRICKS can achieve higher temporal resolution. For the spatial resolution employed in this study, 3D-TRICKS may be the method of choice. (author)

COLLABORATIVE GUIDE: A REEF MANAGER'S GUIDE TO ...

Science.gov (United States)

Innovative strategies to conserve the world's coral reefs are included in a new guide released today by NOAA, and the Australian Great Barrier Reef Marine Park Authority, with author contributions from a variety of international partners from government agencies, non-governmental organizations, and academic institutions. Referred to as A Reef Manager's Guide to Coral Bleaching, the guide will provide coral reef managers with the latest scientific information on the causes of coral bleaching and new management strategies for responding to this significant threat to coral reef ecosystems. Innovative strategies to conserve the world's coral reefs are included in a new guide released today by NOAA, and the Australian Great Barrier Reef Marine Park Authority, with author contributions from a variety of international partners from government agencies, non-governmental organizations, and academic institutions. Dr. Jordan West, of the National Center for Environmental Assessment, was a major contributor to the guide. Referred to as

Investigation of first ray mobility during gait by kinematic fluoroscopic imaging-a novel method

Directory of Open Access Journals (Sweden)

Martin Heiner

2012-02-01

Full Text Available Abstract Background It is often suggested that sagittal instability at the first tarso-metatarsal joint level is a primary factor for hallux valgus and that sagittal instability increases with the progression of the deformity. The assessment of the degree of vertical instability is usually made by clinical evaluation while any measurements mostly refer to a static assessment of medial ray mobility (i.e. the plantar/dorsal flexion in the sagittal plane. Testing methods currently available cannot attribute the degree of mobility to the corresponding anatomical joints making up the medial column of the foot. The aim of this study was to develop a technique which allows for a quantification of the in-vivo sagittal mobility of the joints of the medial foot column during the roll-over process under full weight bearing. Methods Mobility of first ray bones was investigated by dynamic distortion-free fluoroscopy (25 frames/s of 14 healthy volunteers and 8 patients with manifested clinical instability of the first ray. A CAD-based evaluation method allowed the determination of mobility and relative displacements and rotations of the first ray bones within the sagittal plane during the stance phase of gait. Results Total flexion of the first ray was found to be 13.63 (SD 6.14 mm with the healthy volunteers and 13.06 (SD 8.01 mm with the patients (resolution: 0.245 mm/pixel. The dorsiflexion angle was 5.27 (SD 2.34 degrees in the healthy volunteers and increased to 5.56 (SD 3.37 degrees in the patients. Maximum rotations were found at the naviculo-cuneiform joints and least at the first tarso-metatarsal joint level in both groups. Conclusions Dynamic fluoroscopic assessment has been shown to be a valuable tool for characterisation of the kinematics of the joints of the medial foot column during gait. A significant difference in first ray flexion and angular rotation between the patients and healthy volunteers however could not be found.

The role of interventional radiology in obstetric and gynaecology practice

International Nuclear Information System (INIS)

Ganeshan, Arul; Nazir, Sarfraz Ahmed; Hon, Lye Quen; Upponi, Sara S.; Foley, Peter; Warakaulle, Dinuke R.; Uberoi, Raman

2010-01-01

Interventional radiology is continuing to reshape current practice in many specialties of clinical care. It is a relatively new and innovative branch of medicine in which physicians treat diseases non-operatively through small catheters guided to the target by fluoroscopic and other imaging modalities. The aim is to provide image-guided, minimally invasive alternatives to traditional surgical and medical procedures in suitable cohorts of patients. Procedures which previously required major surgery can now be performed by interventional radiologists, sometimes on an outpatient basis, with little patient discomfort. In this review, we highlight the importance of interventional radiology in treating a comprehensive range of obstetric and gynaecological pathologies.

Imaging and concomitant dose in radiotherapy

International Nuclear Information System (INIS)

Negi, P.S.

2008-01-01

Image guidance in radiotherapy now involves multiple imaging procedures for planning, simulation, set-up inter and intrafraction monitoring. Presently ALARA (i.e. as low as reasonable achievable) is the principle of management of dose to radiation workers and patients in any diagnostic imaging procedures including image guided surgery. The situation is different in repeated radiographic/fluoroscopic imaging performed for simulation, dose planning, patient positioning and set-up corrections during preparation/execution of Image guided radiotherapy (IGRT) as well as for Intensity Modulated Radiotherapy (IMRT). Reported imaging and concomitant doses will be highlighted and discussed for the management and optimization of imaging techniques in IMRT and IGRT

HBR guides

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Duarte, Nancy; Dillon, Karen

2015-01-01

Master your most pressing professional challenges with this seven-volume set that collects the smartest best practices from leading experts all in one place. "HBR Guide to Better Business Writing" and "HBR Guide to Persuasive Presentations" help you perfect your communication skills; "HBR Guide to Managing Up and Across" and "HBR Guide to Office Politics" show you how to build the best professional relationships; "HBR Guide to Finance Basics for Managers" is the one book you'll ever need to teach you about the numbers; "HBR Guide to Project Management" addresses tough questions such as how to manage stakeholder expectations and how to manage uncertainty in a complex project; and "HBR Guide to Getting the Right Work Done" goes beyond basic productivity tips to teach you how to prioritize and focus on your work. This specially priced set of the most popular books in the series makes a perfect gift for aspiring leaders looking for trusted advice. Arm yourself with the advice you need to succeed on the job, from ...

Lateral skull base approaches in the management of benign parapharyngeal space tumors.

Science.gov (United States)

Prasad, Sampath Chandra; Piccirillo, Enrico; Chovanec, Martin; La Melia, Claudio; De Donato, Giuseppe; Sanna, Mario

2015-06-01

To evaluate the role of lateral skull base approaches in the management of benign parapharyngeal space tumors and to propose an algorithm for their surgical approach. Retrospective study of patients with benign parapharyngeal space tumors. The clinical features, radiology and preoperative management of skull base neurovasculature, the surgical approaches and overall results were recorded. 46 patients presented with 48 tumors. 12 were prestyloid and 36 poststyloid. 19 (39.6%) tumors were paragangliomas, 15 (31.25%) were schwannomas and 11 (23%) were pleomorphic adenomas. Preoperative embolization was performed in 19, stenting of the internal carotid artery in 4 and permanent balloon occlusion in 2 patients. 19 tumors were approached by the transcervical, 13 by transcervical-transparotid, 5 by transcervical-transmastoid, 6, 1 and 2 tumors by the infratemporal fossa approach types A, B and D, respectively. Total radical tumor removal was achieved in 46 (96%) of the cases. Lateral skull base approaches have an advantage over other approaches in the management of benign tumors of the parapharyngeal space due to the fact that they provide excellent exposure with less morbidity. The use of microscope combined with bipolar cautery reduces morbidity. Stenting of internal carotid artery gives a chance for complete tumor removal with arterial preservation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Foley Catheter versus Vaginal Misoprostol for Labour Induction

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Nasreen Noor

2015-01-01

Full Text Available Objectives. To compare the efficacy and safety of intravaginal misoprostol with transcervical Foley catheter for labour induction. Material and Methods. One hundred and four women with term gestation, with Bishop score < 4, and with various indications for labour induction were randomly divided into two groups. In Group I, 25 μg of misoprostol tablet was placed intravaginally, 4 hourly up to maximum 6 doses. In Group II, Foley catheter 16F was placed through the internal os of the cervix under aseptic condition and then inflated with 50 cc of sterile saline. Statistical analysis was done using SPSS software. Results. The induction to delivery interval was 14.03 ± 7.61 hours versus 18.40 ± 8.02 hours (p<0.01. The rate of vaginal delivery was 76.7% versus 56.8% in misoprostol and transcervical Foley catheter group, respectively. Uterine hyperstimulation was more common with misoprostol. Neonatal outcome was similar in both the groups. Conclusion. Intravaginal misoprostol is associated with a shorter induction to delivery interval as compared to Foley’s catheter and it increases the rate of vaginal delivery in cases of unripe cervix at term. Transcervical Foley catheter is associated with a lower incidence of uterine hyperstimulation during labour.

Shoulder Magnetic Resonance Arthrography: A Prospective Randomized Study of Anterior and Posterior Ultrasonography-Guided Contrast Injections

Energy Technology Data Exchange (ETDEWEB)

Koivikko, M.P.; Mustonen, A.O.T. (Dept. of Radiology, Helsinki Univ. Central Hospital, Helsinki (Finland))

2008-10-15

Background: Magnetic resonance (MR) arthrography is an accurate imaging method for internal shoulder derangements and rotator cuff pathologies. Both anterior and posterior contrast injection techniques, under palpatory, fluoroscopic, or ultrasonographic guidance have been described in the literature. However, clinical comparisons of the injection techniques remain few. Purpose: To compare the performance of anterior and posterior ultrasonography (US)-guided arthrography injections of the shoulder regarding patient discomfort and influence on diagnostic MR reading, and to illustrate the typical artifacts resulting from contrast leakage in the respective techniques. Material and Methods: 43 MR arthrographies were prospectively randomized into anterior and posterior US-guided contrast injections and performed by two radiologists, with the study of artifacts from contrast leakage. Pain from the injections was assessed by a survey utilizing a 100-mm visual analogue scale (VAS). Results: Of the 23 anterior injections, nine caused contrast artifacts in the subscapular tendon, and in three the leakage extended further anteriorly. Of the 20 posterior injections, 12 showed injection artifacts of the rotator cuff, extending outside the cuff in seven. Two of the anterior and none of the posterior artifacts compromised diagnostic quality. In posterior injections, the leakage regularly occurred at the caudal edge of the infraspinatus muscle and was easily distinguishable from rotator cuff tears. All patients completed the pain survey. Mean VAS scores were 25.0 (median 18, SD 22) for anterior, and 25.4 (median 16, SD 25) for posterior injections. The two radiologists achieved different mean VAS scores but closely agreed as to anterior and posterior VAS scores. Conclusion: Arthrography injections were fairly simple to perform under US guidance. Patient discomfort for anterior and posterior injections was equally minor. A tailored approach utilizing anterior or posterior injections

Gaze strategies during visually-guided versus memory-guided grasping.

Science.gov (United States)

Prime, Steven L; Marotta, Jonathan J

2013-03-01

Vision plays a crucial role in guiding motor actions. But sometimes we cannot use vision and must rely on our memory to guide action-e.g. remembering where we placed our eyeglasses on the bedside table when reaching for them with the lights off. Recent studies show subjects look towards the index finger grasp position during visually-guided precision grasping. But, where do people look during memory-guided grasping? Here, we explored the gaze behaviour of subjects as they grasped a centrally placed symmetrical block under open- and closed-loop conditions. In Experiment 1, subjects performed grasps in either a visually-guided task or memory-guided task. The results show that during visually-guided grasping, gaze was first directed towards the index finger's grasp point on the block, suggesting gaze targets future grasp points during the planning of the grasp. Gaze during memory-guided grasping was aimed closer to the blocks' centre of mass from block presentation to the completion of the grasp. In Experiment 2, subjects performed an 'immediate grasping' task in which vision of the block was removed immediately at the onset of the reach. Similar to the visually-guided results from Experiment 1, gaze was primarily directed towards the index finger location. These results support the 2-stream theory of vision in that motor planning with visual feedback at the onset of the movement is driven primarily by real-time visuomotor computations of the dorsal stream, whereas grasping remembered objects without visual feedback is driven primarily by the perceptual memory representations mediated by the ventral stream.

A moving fluoroscope to capture tibiofemoral kinematics during complete cycles of free level and downhill walking as well as stair descent.

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Renate List

Full Text Available Videofluoroscopy has been shown to provide essential information in the evaluation of the functionality of total knee arthroplasties. However, due to the limitation in the field of view, most systems can only assess knee kinematics during highly restricted movements. To avoid the limitations of a static image intensifier, a moving fluoroscope has been presented as a standalone system that allows tracking of the knee during multiple complete cycles of level- and downhill-walking, as well as stair descent, in combination with the synchronous assessment of ground reaction forces and whole body skin marker measurements. Here, we assess the ability of the system to keep the knee in the field of view of the image intensifier. By measuring ten total knee arthroplasty subjects, we demonstrate that it is possible to maintain the knee to within 1.8 ± 1.4 cm vertically and 4.0 ± 2.6 cm horizontally of the centre of the intensifier throughout full cycles of activities of daily living. Since control of the system is based on real-time feedback of a wire sensor, the system is not dependent on repeatable gait patterns, but is rather able to capture pathological motion patterns with low inter-trial repeatability.

A moving fluoroscope to capture tibiofemoral kinematics during complete cycles of free level and downhill walking as well as stair descent.

Science.gov (United States)

List, Renate; Postolka, Barbara; Schütz, Pascal; Hitz, Marco; Schwilch, Peter; Gerber, Hans; Ferguson, Stephen J; Taylor, William R

2017-01-01

Videofluoroscopy has been shown to provide essential information in the evaluation of the functionality of total knee arthroplasties. However, due to the limitation in the field of view, most systems can only assess knee kinematics during highly restricted movements. To avoid the limitations of a static image intensifier, a moving fluoroscope has been presented as a standalone system that allows tracking of the knee during multiple complete cycles of level- and downhill-walking, as well as stair descent, in combination with the synchronous assessment of ground reaction forces and whole body skin marker measurements. Here, we assess the ability of the system to keep the knee in the field of view of the image intensifier. By measuring ten total knee arthroplasty subjects, we demonstrate that it is possible to maintain the knee to within 1.8 ± 1.4 cm vertically and 4.0 ± 2.6 cm horizontally of the centre of the intensifier throughout full cycles of activities of daily living. Since control of the system is based on real-time feedback of a wire sensor, the system is not dependent on repeatable gait patterns, but is rather able to capture pathological motion patterns with low inter-trial repeatability.

A moving fluoroscope to capture tibiofemoral kinematics during complete cycles of free level and downhill walking as well as stair descent

Science.gov (United States)

Postolka, Barbara; Schütz, Pascal; Hitz, Marco; Schwilch, Peter; Gerber, Hans

2017-01-01

Videofluoroscopy has been shown to provide essential information in the evaluation of the functionality of total knee arthroplasties. However, due to the limitation in the field of view, most systems can only assess knee kinematics during highly restricted movements. To avoid the limitations of a static image intensifier, a moving fluoroscope has been presented as a standalone system that allows tracking of the knee during multiple complete cycles of level- and downhill-walking, as well as stair descent, in combination with the synchronous assessment of ground reaction forces and whole body skin marker measurements. Here, we assess the ability of the system to keep the knee in the field of view of the image intensifier. By measuring ten total knee arthroplasty subjects, we demonstrate that it is possible to maintain the knee to within 1.8 ± 1.4 cm vertically and 4.0 ± 2.6 cm horizontally of the centre of the intensifier throughout full cycles of activities of daily living. Since control of the system is based on real-time feedback of a wire sensor, the system is not dependent on repeatable gait patterns, but is rather able to capture pathological motion patterns with low inter-trial repeatability. PMID:29016647

The establishment of local diagnostic reference levels in endoscopic retrograde cholangiopancreatography: a practical tool for the optimisation and for quality assurance management

International Nuclear Information System (INIS)

Saukko, E.; Henner, A.; Nieminen, M.T.; Ahonen, S.-M.

2017-01-01

Fluoroscopic procedures are an area of special concern in relation to radiation protection. The aim of this study was to describe the current level of patient radiation doses in endoscopic retrograde cholangiopancreatography (ERCP) collected from a single centre, as well as to establish and review local diagnostic reference levels (DRLs) in ERCP. A total of 100 patients' radiation doses in ERCP were recorded, and the third-quartile method was adopted to establish local DRLs for ERCP. The mean dose area product (DAP) was 2.05 Gy cm 2 , fluoroscopy time (FT) 1.7 min and the number of images was 3. The proposed local DRLs for ERCP were 3.00 Gy cm 2 and 3.0 min. Local DRLs were reviewed in a sample of 25 patients 5 y after they had been established. In reviewing data, the averages of DAP and FT were below the local DRLs. Local DRLs help in the optimisation process of fluoroscopic procedures and guides to a good clinical practice. (authors)

The clinical value of the special functions of DSA in interventional embolization for uterine fibroids

International Nuclear Information System (INIS)

He Yushen; Lu Dong; Lv Weifu; Zhang Jingsong

2009-01-01

Objective: To evaluate the special functions of DSA in interventional embolization therapy for uterine fibroids. Methods: The special functions of DSA, including 3D-DSA, the optimal working position and road-mapping technique, were utilized in performing interventional embolization therapy for uterine fibroids in twenty-six cases (experimental group). Routine DSA angiography was employed in twenty cases(control group). The volume of contrast media used, the time of completing the interventional procedure and the total fluoroscopic time in two groups were compared and the results were analyzed. Results: The difference in the volume of contrast agent used and in the total fluoroscopic time between two groups was statistically significant (P 0.05). Conclusion: In treating uterine fibroids with interventional embolization, the use of the special functions of DSA can reduce the manipulation time and lower the operation risk. Moreover, the technique of visible 3D reconstruction image is of great significance in guiding the procedure. (authors)

Balloon dilatation of tuberculous bronchial stenosis: immediate and long term effect

International Nuclear Information System (INIS)

Lee, Sang Yoon; Kwak, Byung Kook; Kang, Ho Yeong; Kim, Tae Hoon; Kim, Soo Rhan; Park, Hyun Sun; Lee, Shin Hyung; Lee, Chang Joon

1997-01-01

To evaluate the long-term immediate effects of balloon dilatation of the tuberculous bronchial stenosis. Twenty-three women with tuberculous bronchial stenosis (19, left main bronchus ; 4, right main bronchus) underwent balloon dilatation (13 bronchoscopically guided ; 10 fluoroscopically guided). Immediate (n=23) and long-term follow-up (mean, 17.2 months; range, 1month-6years 3months ; n=20) assessments focused on changes in the results of the pulmonary function test (PFT). An increase in FVC or FEVI of more than 10% after the procedure was considered effective. In all patients, any complications were evaluated. Balloon dilatation was effective at immediate follow-up in 69.5% of patients(16/23) and in 75.0%(15/20) at long-term follow-up. Bronchoscopically and fluoroscopically-guided balloon dilatation proved effective in 61.5%(8/13) and 80.0% of patients(8/10) on immediate follow-up respectively, but in 90.0%(9/10) and 60.0%(6/10) on long term follow-up respectively. Balloon dilatation was effective in the active(n 10) and inactive(n = 13) stage of tuberculous bronchitis in 80.0%(8/10) and 61.5% of cases(8/13) on immediate follow-up respectively, but in 66.6%(6/9) and 81.8%(9/11) on long term follow-up study, respectively. On immediate follow-up, balloon dilatation of tubular bronchial stenosis was more effective in the active than in the inactive stage, but on long-term follow-up was less effective ; long-term improvement in the inactive stage was, however, well-maintained

Impact of Duplex arterial mapping on decision making in non-acute ischemic limb patients.

Science.gov (United States)

Elbadawy, A; Aly, H; Ibrahim, M; Bakr, H

2015-12-01

The aim of this study was to demonstrate the impact of Duplex arterial mapping on decision making in non-acute ischemic limb patient group reporting pain onset between 15 days and 3 months. We prospectively evaluated patients presented with critical limb ischemia who reported pain onset of duration between 15 days and 3 months in one-year period. Our series included thirty cases (mean age=61.3 years old), as Duplex arterial mapping was the sole preoperative imaging tool performed in all of them. All patients, in whom duplex indicated thrombosis in long occluded segments, were candidates for fluoroscopically guided thrombectomy. When Duplex defined chronic arterial occlusions, patients underwent endovascular or bypass revascularisation procedures. Impact of Duplex wall interrogation on decision-making between the two groups (subacute and chronic) was measured. Duplex arterial mapping categorized correctly all 30 patients into either subacute ischemia with removable clot (N.=14) or chronic ischemia (N.=16). Fluoroscopic guided thrombectomy was performed in 14 cases when Duplex advised long occluded arterial segments as indicted by intact intima with echogenic thrombus inside. Bypass surgery was performed in 8 patients. Percutaneous transluminal angioplasty (PTA) was done in 7 cases and thrombendartrectomy of common femoral artery in a single case. One-year patency rate in our series was 86.6%. It was 71.4% in thrombosis group. Limb salvage rate was 93.3%. Duplex arterial mapping could be used to differentiate the subacute ischemia with removable thrombus and chronic arterial occlusions guiding for the best revascularization procedure accordingly.

Detection of organ movement in cervix cancer patients using a fluoroscopic electronic portal imaging device and radiopaque markers

International Nuclear Information System (INIS)

Kaatee, Robert S.J.P.; Olofsen, Manouk J.J.; Verstraate, Marjolein B.J.; Quint, Sandra; Heijmen, Ben J.M.

2002-01-01

Purpose: To investigate the use of a fluoroscopic electronic portal imaging device (EPID) and radiopaque markers to detect internal cervix movement. Methods and Materials: For 10 patients with radiopaque markers clamped to the cervix, electronic portal images were made during external beam irradiation. Bony structures and markers in the portal images were registered with the same structures in the corresponding digitally reconstructed radiographs of the planning computed tomogram. Results: The visibility of the markers in the portal images was good, but their fixation should be improved. Generally, the correlation between bony structure displacements and marker movement was poor, the latter being substantially larger. The standard deviations describing the systematic and random bony anatomy displacements were 1.2 and 2.6 mm, 1.7 and 2.9 mm, and 1.6 and 2.7 mm in the lateral, cranial-caudal, and dorsal-ventral directions, respectively. For the marker movement those values were 3.4 and 3.4 mm, 4.3 and 5.2 mm, 3.2 and 5.2 mm, respectively. Estimated clinical target volume to planning target volume (CTV-PTV) planning margins (∼11 mm) based on the observed overall marker displacements (bony anatomy + internal cervix movement) are only marginally larger than the margins required to account for internal marker movement alone. Conclusions: With our current patient setup techniques and methods of setup verification and correction, the required CTV-PTV margins are almost fully determined by internal organ motion. Setup verification and correction using radiopaque markers might allow decreasing those margins, but technical improvements are needed

Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial.

Science.gov (United States)

Gang, Yi; Gonna, Hanney; Domenichini, Giulia; Sampson, Michael; Aryan, Niloufar; Norman, Mark; Behr, Elijah R; Zuberi, Zia; Dhillon, Paramdeep; Gallagher, Mark M

2016-03-01

The purpose of this study is to establish the role of Achieve Mapping Catheter in cryoablation for paroxysmal atrial fibrillation (PAF) in a randomized trial. A total of 102 patients undergoing their first ablation for PAF were randomized at 2:1 to an Achieve- or Lasso-guided procedure. Study patients were systematically followed up for 12 months with Holter monitoring. Primary study endpoint was acute procedure success. Secondary endpoint was clinical outcomes assessed by AF free at 6 and 12 months after the procedure. Of 102 participants, 99 % of acute procedure success was achieved. Significantly shorter procedure duration with the Achieve-guided group than with the Lasso-guided group (118 ± 18 vs. 129 ± 21 min, p < 0.05) was observed as was the duration of fluoroscopy (17 ± 5 vs. 20 ± 7 min, p < 0.05) by subgroup analysis focused on procedures performed by experienced operators. In the whole study patients, procedure and fluoroscopic durations were similar in the Achieve- (n = 68) and Lasso-guided groups (n = 34). Transient phrenic nerve weakening was equally prevalent with the Achieve and Lasso. No association was found between clinical outcomes and the mapping catheter used. The use of second-generation cryoballoon (n = 68) reduced procedure time significantly compared to the first-generation balloon (n = 34); more patients were free of AF in the former than the latter group during follow-up. The use of the Achieve Mapping Catheter can reduce procedure and fluoroscopic durations compared with Lasso catheters in cryoablation for PAF after operators gained sufficient experience. The type of mapping catheter used does not affect procedure efficiency and safety by models of cryoballoon.

Agile practice guide

CERN Document Server

2017-01-01

Agile Practice Guide – First Edition has been developed as a resource to understand, evaluate, and use agile and hybrid agile approaches. This practice guide provides guidance on when, where, and how to apply agile approaches and provides practical tools for practitioners and organizations wanting to increase agility. This practice guide is aligned with other PMI standards, including A Guide to the Project Management Body of Knowledge (PMBOK® Guide) – Sixth Edition, and was developed as the result of collaboration between the Project Management Institute and the Agile Alliance.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases.

Science.gov (United States)

Oliveira, Leandro Benetti de; Gabrielli, Marisa Aparecida Cabrini; Gabrielli, Mario Francisco Real; Pereira-Filho, Valfrido Antonio Pereira

2015-12-01

The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (fractures. Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

Quality control of diagnostic x-ray equipment and film processing

International Nuclear Information System (INIS)

1993-01-01

According to the section 40 of the Radiation Act (592/92), the licensee is required in Finland to make the arrangements to control the function of the radiation equipment and related facilities used for medical procedures. The guide explains how quality control can be organized for diagnostic x-ray equipment. It also gives recommendations for constancy tests for conventional x-ray radiographic and fluoroscopic equipment and for film processing. The recommendations are based on the publications and statements of the International Committee for Radiation Protection (ICRP) and standardization organizations. The intention is that the operators of x-ray equipment or the maintenance personnel are able to perform the quality control tests presented in the guide

Electromagnetic ultrasonic guided waves

CERN Document Server

Huang, Songling; Li, Weibin; Wang, Qing

2016-01-01

This book introduces the fundamental theory of electromagnetic ultrasonic guided waves, together with its applications. It includes the dispersion characteristics and matching theory of guided waves; the mechanism of production and theoretical model of electromagnetic ultrasonic guided waves; the effect mechanism between guided waves and defects; the simulation method for the entire process of electromagnetic ultrasonic guided wave propagation; electromagnetic ultrasonic thickness measurement; pipeline axial guided wave defect detection; and electromagnetic ultrasonic guided wave detection of gas pipeline cracks. This theory and findings on applications draw on the author’s intensive research over the past eight years. The book can be used for nondestructive testing technology and as an engineering reference work. The specific implementation of the electromagnetic ultrasonic guided wave system presented here will also be of value for other nondestructive test developers.

Intro to Valve Guide Reconditioning. Automotive Mechanics. Valves. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Horner, W.

This instructional package, one in a series of individualized instructional units on tools and techniques for repairing worn valve guides in motor vehicles, provides practical experience for students in working on cylinder heads. Covered in the module are reaming valve guides that are oversized to match a new oversized valve, reaming valve guides…

Accuracy of CT chest without oral contrast for ruling out esophageal perforation using fluoroscopic esophagography as reference standard: a retrospective study.

Science.gov (United States)

Awais, Muhammad; Qamar, Saqib; Rehman, Abdul; Baloch, Noor Ul-Ain; Shafqat, Gulnaz

2018-02-26

Esophageal perforation has a high mortality rate. Fluoroscopic esophagography (FE) is the procedure of choice for diagnosing esophageal perforation. However, FE can be difficult to perform in seriously ill patients. We retrospectively reviewed charts and scans of all patients who had undergone thoracic CT (TCT) without oral contrast and FE for suspicion of esophageal perforation at our hospital between October, 2010 and December, 2015. Scans were interpreted by a single consultant radiologist having > 5 years of relevant experience. Statistical analysis was performed using SPSS version 20. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of TCT were computed using FE as reference standard. Of 122 subjects, 106 (83%) were male and their median age was 42 [inter-quartile range (IQR) 29-53] years. Esophageal perforation was evident on FE in 15 (8%) cases. Sensitivity, specificity, PPV and NPV of TCT for detecting esophageal perforation were 100, 54.6, 23.4 and 100%, respectively. When TCT was negative (n = 107), an alternative diagnosis was evident in 65 cases. Thoracic computed tomography (TCT) had 100% sensitivity and negative predictive value for excluding esophageal perforation. FE may be omitted in patients who have no evidence of mediastinal collection, pneumomediastinum or esophageal wall defect on TCT. However, in the presence of any of these features, FE is still necessary to confirm or exclude the presence of an esophageal perforation.

Guided Expectations: A Case Study of a Sound Collage Audio Guide

DEFF Research Database (Denmark)

Laursen, Ditte

This paper is a user evaluation of a mobile phone audio guide developed for visitors to use at the National Gallery of Denmark. The audio guide is offered as a downloadable MP3 file to every incoming visitor who is carrying a mobile phone with an open Bluetooth connection. The guide itself...... according to personal interest, and a conflict between the expectation of a learning experience rather than an aesthetic experience. Results indicate that most visitors are able to make sense of the guide and to use it successfully, in different ways, to enrich their visit. Evaluation also shows...... that visitors are fond of using their own mobile phones - but they have several problems with their phones in downloading the MP3 file. Read more: Guided Expectations: A Case Study of a Sound Collage Audio Guide | conference.archimuse.com...

SAGE 2.0 SOLVENT ALTERNATIVES GUIDE - USER'S GUIDE

Science.gov (United States)

The guide provides instruction for using the SAGE (Solvent Alternatives Guide) software system, version 2.O. It assumes that the user is familiar with the fundamentals of operating a personal computer under the Microsoft disk operating system (MS-DOS). AGE recommends solvent repl...

Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer

Science.gov (United States)

Hata, Nobuhiko; Song, Sang-Eun; Olubiyi, Olutayo; Arimitsu, Yasumichi; Fujimoto, Kosuke; Kato, Takahisa; Tuncali, Kemal; Tani, Soichiro; Tokuda, Junichi

2016-01-01

Purpose: Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient’s whole body motion. Methods: Keeping the device’s minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient’s body, even in the presence of the patient’s frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors’ validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. Results: The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth

Human factors guides

International Nuclear Information System (INIS)

Penington, J.

1995-10-01

This document presents human factors guides, which have been developed in order to provide licensees of the AECB with advice as to how to address human factors issues within the design and assessment process. This documents presents the results of a three part study undertaken to develop three guides which are enclosed in this document as Parts B, C and D. As part of the study human factors standards, guidelines, handbooks and other texts were researched, to define those which would be most useful to the users of the guides and for the production of the guides themselves. Detailed specifications were then produced to outline the proposed contents and format of the three guides. (author). 100 refs., 3 tabs., 11 figs

Human factors guides

Energy Technology Data Exchange (ETDEWEB)

Penington, J [PHF Services Inc., (Canada)

1995-10-01

This document presents human factors guides, which have been developed in order to provide licensees of the AECB with advice as to how to address human factors issues within the design and assessment process. This documents presents the results of a three part study undertaken to develop three guides which are enclosed in this document as Parts B, C and D. As part of the study human factors standards, guidelines, handbooks and other texts were researched, to define those which would be most useful to the users of the guides and for the production of the guides themselves. Detailed specifications were then produced to outline the proposed contents and format of the three guides. (author). 100 refs., 3 tabs., 11 figs.

Intraoperative dynamic dosimetry for prostate implants

Energy Technology Data Exchange (ETDEWEB)

Todor, D A [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Zaider, M [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Cohen, G N [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Worman, M F [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States); Zelefsky, M J [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021 (United States)

2003-05-07

This paper describes analytic tools in support of a paradigm shift in brachytherapy treatment planning for prostate cancer - a shift from standard pre-planning to intraoperative planning using dosimetric feedback based on the actual deposited seed positions within the prostate. The method proposed is guided by several desiderata: (a) bringing both planning and evaluation in the operating room (i.e. make post-implant evaluation superfluous) therefore making rectifications - if necessary - still achievable; (b) making planning and implant evaluation consistent by using the same imaging system (ultrasound); and (c) using only equipment commonly found in a hospital operating room. The intraoperative dosimetric evaluation is based on the fusion between ultrasound images and 3D seed coordinates reconstructed from fluoroscopic projections. Automatic seed detection and registration of the fluoroscopic and ultrasound information, two of the three key ingredients needed for the intraoperative dynamic dosimetry optimization (IDDO), are explained in detail. The third one, the reconstruction of 3D coordinates from projections, was reported in a previous article. The algorithms were validated using a custom-designed phantom with non-radioactive (dummy) seeds. Also, fluoroscopic images were taken at the conclusion of an actual permanent prostate implant and compared with data on the same patient obtained from radiographic-based post-implant evaluation. To offset the effect of organ motion the comparison was performed in terms of the proximity function of the two seed distributions. The agreement between the intra- and post-operative seed distributions was excellent.

Des Guides Joanne au Guide Vert Michelin : points, lignes, surfaces

Directory of Open Access Journals (Sweden)

Marie-Vic Ozouf-Marignier

2011-06-01

Full Text Available Cet article étudie la perception de l’espace dans les guides touristiques de la fin du XIXe siècle à nos jours. Il compare trois collections de guides français : les Guides Joanne, les Guides Bleus Hachette et les Guides Verts Michelin. Nous avons identifié trois moments majeurs. Dans une première période, le voyage en chemin de fer détermine une représentation linéaire de l’espace agrémentée de quelques coups d’œil à l’intérieur du paysage à l’endroit des stations. Dans une seconde période, le déplacement en voiture permet à une appréhension régionale de se développer. L’école française de géographie influence alors l’écriture des introductions de guide. Les rédacteurs introduisent de plus en plus de cartes dans ces ouvrages. L’unité régionale devient sensible, notamment du point de vue naturaliste. Toutefois, la recherche des curiosités, musées églises, châteaux et ruines se maintient également. De nos jours, l’autoroute, le train à grande vitesse et l’industrie touristique ont changé les pratiques et représentations de l’espace. Les touristes semblent apprécier le fait de collectionner les sites de visite et de faire des circuits à thème.This article deals with tourist perception of the space from the end of the nineteenth century to our days. It compares three collections of French tourist guides: Guides Joanne, blue guides Hachette and Guides Verts Michelin. Three main periods can be distinguished. First, railway travel determines linear representation of the landscape, with a few glances on the countryside at the stations. In a second period, the car mobility makes possible a surrounding vision of regions. French school of geography influences the prefaces of the guides. Editors introduce more and more maps inside the guides. Regional cohesion becomes perceptible, especially from a naturalistic point of view. Interesting sights, museums, churches, castles and ruins remain

Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

International Nuclear Information System (INIS)

Bercu, Zachary L.; Sheth, Sachin B.; Noor, Amir; Lookstein, Robert A.; Fischman, Aaron M.; Nowakowski, F. Scott; Kim, Edward; Patel, Rahul S.

2015-01-01

The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation

Percutaneous Mesocaval Shunt Creation in a Patient with Chronic Portal and Superior Mesenteric Vein Thrombosis

Energy Technology Data Exchange (ETDEWEB)

Bercu, Zachary L., E-mail: zachary.bercu@mountsinai.org; Sheth, Sachin B., E-mail: sachinsheth@gmail.com [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States); Noor, Amir, E-mail: amir.noor@gmail.com [The George Washington University School of Medicine and Health Sciences (United States); Lookstein, Robert A., E-mail: robert.lookstein@mountsinai.org; Fischman, Aaron M., E-mail: aaron.fischman@mountsinai.org; Nowakowski, F. Scott, E-mail: scott.nowakowski@mountsinai.org; Kim, Edward, E-mail: edward.kim@mountsinai.org; Patel, Rahul S., E-mail: rahul.patel@mountsinai.org [Icahn School of Medicine at Mount Sinai, Division of Interventional Radiology (United States)

2015-10-15

The creation of a transjugular intrahepatic portosystemic shunt (TIPS) is a critical procedure for the treatment of recurrent variceal bleeding and refractory ascites in the setting of portal hypertension. Chronic portal vein thrombosis remains a relative contraindication to conventional TIPS and options are limited in this scenario. Presented is a novel technique for management of refractory ascites in a patient with hepatitis C cirrhosis and chronic portal and superior mesenteric vein thrombosis secondary to schistosomiasis and lupus anticoagulant utilizing fluoroscopically guided percutaneous mesocaval shunt creation.

Maintainability design guide

International Nuclear Information System (INIS)

Pack, R.W.

1985-01-01

The Human Factors Design Guide for Maintainability provides guidance for systematically incorporating good human factors techniques into the design of power plants. The guide describes a means of developing a comprehensive program plan to ensure compliance with the human factors approaches specified by the utility. The guide also provides specific recommendations for design practices, with examples, bases, and references. The recommendations are formatted for easy use by nuclear power plant design teams and by utility personnel involved in specification and design review. The guide was developed under EPRI research project RP2166-4 and is currently being published

Spinal Cord Infarction after Cervical Transforaminal Epidural Steroid Injection: Case Report and Literature Review

Directory of Open Access Journals (Sweden)

Jangsup Moon

2017-01-01

Full Text Available Introduction: Transforaminal epidural steroid injection (TFESI is a widely used nonsurgical procedure in the treatment of patients with radiculopathy. It is efficacious in relieving pain, but a number of complications are being reported. Recently, increasing frequency of major complications, such as spinal cord infarction and cerebral infarction, has been reported with the use of a particulate steroid within fluoroscopic-guided procedures. Methods: We report a 49-year-old man with a history of chronic cervical radiculopathy, who experienced a devastating complication after TFESI. Results: After 2 min of regular TFESI, the patient abruptly experienced muscle weakness in both upper extremities and within 5 min the patient became quadriplegic. Despite active rehabilitation, the patient remained bed-ridden 4 years after the catastrophic event. To our knowledge, this is the first reported case of spinal cord infarction that occurred after TFESI in Korea. Conclusion: Considering the risk of dreadful complications, which appear in an unpredictable manner, TFESI with fluoroscopic guidance should be done only with a nonparticulate steroid.

Pocket Spending Guide

OpenAIRE

Poff, Karen

2015-01-01

Provides an example for how to set up a pocket spending guide. By filling out the guide and keeping it with you, you can easily see at any time how much money you have available to spend in each category. A pocket spending guide will help you adjust your spending plan to make your money go where you really want it to go.

Field Guides Made Easy. 4-H Leader's Guide L-5-21.

Science.gov (United States)

Phillips, Diane Held; Krasny, Marianne E.

This illustrated leader's guide describes activities for teaching children to use field guides to identify trees and birds. Background information for leaders explains the two types of field guides, those that use a series of steps in what is called a key to identify things in nature, such as trees, and those that use groupings based on…

Guide to Preparing SAND Reports and other communication products : quick reference guide.

Energy Technology Data Exchange (ETDEWEB)

2009-10-01

This Quick Reference Guide supplements the more complete Guide to Preparing SAND Reports and Other Communication Products. It provides limited guidance on how to prepare SAND Reports at Sandia National Laboratories. Users are directed to the in-depth guide for explanations of processes.

Radiological design guide

International Nuclear Information System (INIS)

Evans, R.A.

1994-01-01

The purpose of this design guide is to provide radiological safety requirements, standards, and information necessary for designing facilities that will operate without unacceptable risk to personnel, the public, or the environment as required by the US Department of Energy (DOE). This design guide, together with WHC-CM-4-29, Nuclear Criticality Safety, WHC-CM-4-46, Nonreactor Facility Safety Analysis, and WHC-CM-7-5, Environmental Compliance, covers the radiation safety design requirements at Westinghouse Hanford Company (WHC). This design guide applies to the design of all new facilities. The WHC organization with line responsibility for design shall determine to what extent this design guide shall apply to the modifications to existing facilities. In making this determination, consideration shall include a cost versus benefit study. Specifically, facilities that store, handle, or process radioactive materials will be covered. This design guide replaces WHC-CM-4-9 and is designated a living document. This design guide is intended for design purposes only. Design criteria are different from operational criteria and often more stringent. Criteria that might be acceptable for operations might not be adequate for design

SAGE FOR MACINTOSH (MSAGE) VERSION 1.0 SOLVENT ALTERNATIVES GUIDE - USER'S GUIDE

Science.gov (United States)

The guide provides instructions for using the Solvent Alternatives Guide (SAGE) for Macintosh, version 1.0. The guide assumes that the user is familiar with the fundamentals of operating aMacintosh personal computer under the System 7.0 (or higher) operating system. SAGE for ...

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

International Nuclear Information System (INIS)

Shortt, Conor P.; Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C.; Roberts, Catherine C.

2009-01-01

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

Shoulder, hip, and knee arthrography needle placement using fluoroscopic guidance: practice patterns of musculoskeletal radiologists in North America

Energy Technology Data Exchange (ETDEWEB)

Shortt, Conor P. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Morrison, William B.; Deely, Diane M.; Gopez, Angela G.; Zoga, Adam C. [Thomas Jefferson University Hospital, Department of Radiology, Philadelphia, PA (United States); Roberts, Catherine C. [Mayo Clinic College of Medicine, Department of Radiology, Phoenix, AZ (United States)

2009-04-15

The aim of this study was to evaluate the range of techniques used by radiologists performing shoulder, hip, and knee arthrography using fluoroscopic guidance. Questionnaires on shoulder, hip, and knee arthrography were distributed to radiologists at a national radiology meeting. We enquired regarding years of experience, preferred approaches, needle gauge, gadolinium dilution, and volume injected. For each approach, the radiologist was asked their starting and end needle position based on a numbered and lettered grid superimposed on a radiograph. Sixty-eight questionnaires were returned. Sixty-eight radiologists performed shoulder and hip arthrography, and 65 performed knee arthrograms. Mean experience was 13.5 and 12.8 years, respectively. For magnetic resonance arthrography, a gadolinium dilution of 1/200 was used by 69-71%. For shoulder arthrography, an anterior approach was preferred by 65/68 (96%). The most common site of needle end position, for anterior and posterior approaches, was immediately lateral to the humeral cortex. A 22-gauge needle was used by 46/66 (70%). Mean injected volume was 12.7 ml (5-30). For hip arthrography, an anterior approach was preferred by 51/68 (75%). The most common site of needle end position, for anterior and lateral approaches, was along the lateral femoral head/neck junction. A 22-gauge needle was used by 53/68 (78%). Mean injected volume was 11.5 ml (5-20). For knee arthrography, a lateral approach was preferred by 41/64 (64%). The most common site of needle end position, for lateral and medial approaches, was mid-patellofemoral joint level. A 22-gauge needle was used by 36/65 (56%). Mean injected volume was 28.2 ml (5-60). Arthrographic approaches for the shoulder, hip, and knee vary among radiologists over a wide range of experience levels. (orig.)

Guided labworks

DEFF Research Database (Denmark)

Jacobsen, Lærke Bang

For the last 40 years physics education research has shown poor learning outcomes of guided labs. Still this is found to be a very used teaching method in the upper secodary schools. This study explains the teacher's choice of guided labs throught the concept of redesign as obstacle dislodgement...

SAGE FOR WINDOWS (WSAGE) VERSION 1.0 SOLVENT ALTERNATIVES GUIDE - USER'S GUIDE

Science.gov (United States)

The guide provides instructions for using the Solvent Alternatives Guide (SAGE) for Windows, version 1.0. The guide assumes that the user is familiar with the fundamentals of operating Windows 3.1 (or higher) on a personal computer under the DOS 5.0 (or higher) operating system. ...

Guide to preparing SAND reports and other communication products : quick reference guide.

Energy Technology Data Exchange (ETDEWEB)

2007-03-01

This 'Quick Reference Guide' supplements the more complete 'Guide to Preparing SAND Reports and Other Communication Products'. It provides limited guidance on how to prepare SAND Reports at Sandia National Laboratories. Users are directed to the in-depth guide for explanations of processes.

A novel surgical management of hypopharyngeal branchial anomalies.

Science.gov (United States)

Givens, Daniel J; Buchmann, Luke O; Park, Albert H

2015-04-01

To review our experience treating hypopharyngeal branchial anomalies utilizing an open transcervical approach that: (1) includes recurrent laryngeal nerve (RLN) monitoring and identification if needed; (2) resection of tract if present; and (3) a superiorly based sternothyroid muscle flap for closure. A retrospective chart review was performed to identify all patients at a tertiary level children's hospital with branchial anomalies from 2005 to 2014. The clinical presentation, evaluation, treatment and outcome were analyzed for those patients with hypopharyngeal branchial anomalies. Forty-seven patients who underwent excision of branchial anomalies with a known origin were identified. Thirteen patients had hypopharyngeal branchial anomalies. Six of these patients were treated by the authors of this study and are the focus of this analysis. All six underwent an open transcervical procedure with a sternothyroid muscle flap closure of a piriform sinus opening over a nine year period. Definitive surgery included a microlaryngoscopy and an open transcervical approach to close a fistula between the piriform sinus and neck with recurrent laryngeal nerve monitoring or dissection. A superiorly based sternothyroid muscle flap was used to close the sinus opening. There were no recurrences, recurrent laryngeal nerve injuries or other complications from these procedures. This study supports complete surgical extirpation of the fistula tract using an open cervical approach, recurrent laryngeal nerve monitoring or identification, and rotational muscle flap closure to treat patients with hypopharyngeal branchial anomalies. Published by Elsevier Ireland Ltd.

Treatment of Zenker's diverticulum through a flexible endoscope with a transparent oblique-end hood attached to the tip and a monopolar forceps

NARCIS (Netherlands)

Christiaens, P.; de Roock, W.; van Olmen, A.; Moons, V.; D'Haens, G.

2007-01-01

Zenker's diverticulum was commonly treated by means of external transcervical diverticulectomy, myotomy or diverticulopexy, or by means of an endoscopic myotomy through a rigid endoscope. Gastroenterologists first described flexible endoscopic therapy for Zenker's diverticulum in 1995. In our

Assisting Handlers Following Attacks on Dog Guides: Implications for Dog Guide Teams

Science.gov (United States)

Godley, Cheryl A.; Gillard, Marc A.

2011-01-01

Attacks by dogs on dog guides are traumatic for dog guide teams. One variable that affects a team's recovery is how handlers cope with emotional responses to the attack. This article presents a three-stage model for assisting handlers that is useful for handlers and dog guide instructors.

GuideLiner™ as guide catheter extension for the unreachable mammary bypass graft.

Science.gov (United States)

Vishnevsky, Alec; Savage, Michael P; Fischman, David L

2018-03-09

Percutaneous coronary intervention (PCI) of mammary artery bypass grafts through a trans-radial (TR) approach can present unique challenges, including coaxial vessel engagement of the guiding catheter, adequate visualization of the target lesion, sufficient backup support for equipment delivery, and the ability to reach very distal lesions. The GuideLiner catheter, a rapid exchange monorail mother-in-daughter system, facilitates successful interventions in such challenging anatomy. We present a case of a patient undergoing PCI of a right internal mammary artery (RIMA) graft via TR access in whom the graft could not be engaged with any guiding catheter. Using a balloon tracking technique over a guidewire, a GuideLiner was placed as an extension of the guiding catheter and facilitated TR-PCI by overcoming technical challenges associated with difficult anatomy. © 2018 Wiley Periodicals, Inc.

Coastal Processes and Erosion, Student Guide and Teacher Guide. OEAGLS Investigation 7.

Science.gov (United States)

Kennedy, Beth A.; Fortner, Rosanne W.

This investigation focuses on the major erosional forces affecting the shoreline which cause it to wear away and build up. The types of devices that protect the shoreline are also discussed. The investigation is presented in the form of a teachers' guide and a students' guide, both of which are included. In the teachers' guide, an overview of the…

Case report

African Journals Online (AJOL)

abp

2016-04-22

Apr 22, 2016 ... she underwent an external transcervical polyp resection. Surgery included cervicoeosophagotomy, polyp resection and esophageal repair. Subsequently, she experienced a localized cutaneous infection at the cervicotomy site without fever or leucoytosis. At barium contrast esophagography a diverticulum ...

Managerial Accounting. Study Guide.

Science.gov (United States)

Plachta, Leonard E.

This self-instructional study guide is part of the materials for a college-level programmed course in managerial accounting. The study guide is intended for use by students in conjuction with a separate textbook, Horngren's "Accounting for Management Control: An Introduction," and a workbook, Curry's "Student Guide to Accounting for Management…

Manual on brachytherapy. Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1992-01-01

In addition to a basic guide to the principles of the production of ionizing radiation and to methods of radiation protection and dosimetry, this booklet includes information about radiation protection procedures for brachytherapy

Complications and Reoperations in Mandibular Angle Fractures.

Science.gov (United States)

Chen, Collin L; Zenga, Joseph; Patel, Ruchin; Branham, Gregory

2018-05-01

Mandible angle fractures can be repaired in a variety of ways, with no consensus on the outcomes of complications and reoperation rates. To analyze patient, injury, and surgical factors, including approach to the angle and plating technique, associated with postoperative complications, as well as the rate of reoperation with regard to mandible angle fractures. Retrospective cohort study analyzing the surgical outcomes of patients with mandible angle fractures between January 1, 2000, and December 31, 2015, who underwent open reduction and internal fixation. Patients were eligible if they were aged 18 years or older, had 3 or less mandible fractures with 1 involving the mandibular angle, and had adequate follow-up data. Patients with comminuted angle fractures, bilateral angle fractures, and multiple surgical approaches were excluded. A total of 135 patients were included in the study. All procedures were conducted at a single, large academic hospital located in an urban setting. Major complications and reoperation rates. Major complications included in this study were nonunion, malunion, severe malocclusion, severe infection, and exposed hardware. Of 135 patients 113 (83.7%) were men; median age was 29 years (range, 18-82 years). Eighty-seven patients (64.4%) underwent the transcervical approach and 48 patients (35.6%) received the transoral approach. Fifteen (17.2%) patients in the transcervical group and 9 (18.8%) patients in the transoral group experienced major complications (difference, 1%; 95% CI, -8% to 10%). Thirteen (14.9%) patients in the transcervical group and 8 (16.7%) patients in the transoral group underwent reoperations (difference, 2%; 95% CI, -13% to 17%). Active smoking had a significant effect on the rate of major complications (odds ratio, 4.04; 95% CI, 1.07 to 15.34; P = .04). During repair of noncomminuted mandibular angle fractures, both of the commonly used approaches-transcervical and transoral-can be used during treatment with equal

Marketing and Society. Study Guide.

Science.gov (United States)

Welsh, Robert S.; Blake, Rowland S.

This self-instructional study guide is part of the materials for a college-level programmed course entitled "Marketing and Society." The study guide is intended for use by students in conjunction with a related textbook, a workbook, a review guide, and a series of instructional tape casettes. The study guide contains a brief introductory section…

Image-guided procedures in brain biopsy.

Science.gov (United States)

Fujita, K; Yanaka, K; Meguro, K; Narushima, K; Iguchi, M; Nakai, Y; Nose, T

1999-07-01

Image-guided procedures, such as computed tomography (CT)-guided stereotactic and ultrasound-guided methods, can assist neurosurgeons in localizing the relevant pathology. The characteristics of image-guided procedures are important for their appropriate use, especially in brain biopsy. This study reviewed the results of various image-guided brain biopsies to ascertain the advantages and disadvantages. Brain biopsies assisted by CT-guided stereotactic, ultrasound-guided, Neuronavigator-guided, and the combination of ultrasound and Neuronavigator-guided procedures were carried out in seven, eight, one, and three patients, respectively. Four patients underwent open biopsy without a guiding system. Twenty of 23 patients had a satisfactory diagnosis after the initial biopsy. Three patients failed to have a definitive diagnosis after the initial procedure, one due to insufficient volume sampling after CT-guided procedure, and two due to localization failure by ultrasound because the lesions were nonechogenic. All patients who underwent biopsy using the combination of ultrasound and Neuronavigator-guided methods had a satisfactory result. The CT-guided procedure provided an efficient method of approaching any intracranial target and was appropriate for the diagnosis of hypodense lesions, but tissue sampling was sometimes not sufficient to achieve a satisfactory diagnosis. The ultrasound-guided procedure was suitable for the investigation of hyperdense lesions, but was difficult to localize nonechogenic lesions. The combination of ultrasound and Neuronavigator methods improved the diagnostic accuracy even in nonechogenic lesions such as malignant lymphoma. Therefore, it is essential to choose the most appropriate guiding method for brain biopsy according to the radiological nature of the lesions.

A Randomized Comparison Between Ultrasound- and Fluoroscopy-Guided Sacral Lateral Branch Blocks.

Science.gov (United States)

Finlayson, Roderick J; Etheridge, John-Paul B; Elgueta, Maria Francisca; Thonnagith, Atikun; De Villiers, Frederick; Nelems, Bill; Tran, De Q

proportional decrease in numerical rating scale between preblock and postblock analgesic testing) was similar in both groups. Furthermore, no statistical differences were found in the proportions of patients achieving complete analgesia at each test site. The level of experience (ie, expert vs novice operator) significantly affected performance time with US but not with fluoroscopy. No procedural complications were recorded with either imaging modality during the 30-day follow-up period. Compared with their fluoroscopic counterparts, US-guided SLB blocks require a shorter performance time as well as fewer needle passes and carry a lower risk of vascular breach.

Percutaneous radiologic gastrostomy versus percutaneous endoscopic gastrostomy: A comparison of indications, complications and outcomes in 370 patients

International Nuclear Information System (INIS)

Silas, Anne M.; Pearce, Lindsay F.; Lestina, Lisa S.; Grove, Margaret R.; Tosteson, Anna; Manganiello, Wendy D.; Bettmann, Michael A.; Gordon, Stuart R.

2005-01-01

Objective: Percutaneous access to the stomach can be achieved by endoscopic or fluoroscopic methods. Our objective was to compare indications, complications, efficacy and outcomes of these two techniques. Methods: Records of 370 patients with feeding tubes placed either endoscopically by gastroenterology, or fluoroscopically by radiology, at our university-based tertiary care center over a 54-month period were reviewed. Results: 177 gastrostomies were placed endoscopically and 193 fluoroscopically. Nutrition was the most common indication in each group (94 and 92%), but the most common underlying diagnosis was neurologic impairment in the endoscopic group (n = 89, 50%) and malignancy in the fluoroscopic group (n = 134, 69%) (p < 0.001). Complications in the first 30 days were more common with fluoroscopic placement (23% versus 11%, p = 0.002), with infection most frequent. Correlates of late complications were inpatient status (OR 0.26, 95%CI: 0.13-0.51) and a diagnosis of malignancy (OR 2.2, 95%CI: 1.03-4.84). Average follow-up time was 108 days in the fluoroscopic group and 174 days in the endoscopic group. Conclusions: Both endoscopic and fluoroscopic gastrostomy tube placement are safe and effective. Outpatient status was associated with greater early and late complication rates; minor complications such as infection were greater in the fluoroscopic group, while malignancy was associated with late complications

PrimeFaces beginner's guide

CERN Document Server

Reddy, K Siva Prasad

2013-01-01

A guide for beginner's with step-by-step instructions and an easy-to-follow approach.PrimeFaces Beginners Guide is a simple and effective guide for beginners, wanting to learn and implement PrimeFaces in their JSF-based applications. Some basic JSF and jQuery skills are required before you start working through the book.

Control system design guide

Energy Technology Data Exchange (ETDEWEB)

Sellers, David; Friedman, Hannah; Haasl, Tudi; Bourassa, Norman; Piette, Mary Ann

2003-05-01

The ''Control System Design Guide'' (Design Guide) provides methods and recommendations for the control system design process and control point selection and installation. Control systems are often the most problematic system in a building. A good design process that takes into account maintenance, operation, and commissioning can lead to a smoothly operating and efficient building. To this end, the Design Guide provides a toolbox of templates for improving control system design and specification. HVAC designers are the primary audience for the Design Guide. The control design process it presents will help produce well-designed control systems that achieve efficient and robust operation. The spreadsheet examples for control valve schedules, damper schedules, and points lists can streamline the use of the control system design concepts set forth in the Design Guide by providing convenient starting points from which designers can build. Although each reader brings their own unique questions to the text, the Design Guide contains information that designers, commissioning providers, operators, and owners will find useful.

Treatment of Women With an Endometrial Polyp and Heavy Menstrual Bleeding: A Levonorgestrel-Releasing Intrauterine Device or Hysteroscopic Polypectomy?

NARCIS (Netherlands)

van Dijk, Myrthe M.; van Hanegem, Nehalennia; de Lange, Maria E.; Timmermans, Anne

2015-01-01

We performed a literature review of reports comparing a levonorgestrel-releasing intrauterine device (LNG-IUD) with transcervical polyp resection (TCRP) as a treatment for heavy menstrual bleeding (HMB). Our second objective was to investigate the effectiveness of LNG-IUD and TCRP in reducing

Spine epidural and sacroiliac joints injections--when and how to perform.

Science.gov (United States)

D'Orazio, Federico; Gregori, Lorenzo Maria; Gallucci, Massimo

2015-05-01

To review the state-of-the-art of image-guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Visualizing guided tours

DEFF Research Database (Denmark)

Poulsen, Signe Herbers; Fjord-Larsen, Mads; Hansen, Frank Allan

This paper identifies several problems with navigating and visualizing guided tours in traditional hypermedia systems. We discuss solutions to these problems, including the representation of guided tours as 3D metro maps with content preview. Issues regarding navigation and disorientation...

Novel System for Real-Time Integration of 3-D Echocardiography and Fluoroscopy for Image-Guided Cardiac Interventions: Preclinical Validation and Clinical Feasibility Evaluation

Science.gov (United States)

Housden, R. James; Ma, Yingliang; Rajani, Ronak; Gao, Gang; Nijhof, Niels; Cathier, Pascal; Bullens, Roland; Gijsbers, Geert; Parish, Victoria; Kapetanakis, Stamatis; Hancock, Jane; Rinaldi, C. Aldo; Cooklin, Michael; Gill, Jaswinder; Thomas, Martyn; O'neill, Mark D.; Razavi, Reza; Rhode, Kawal S.

2014-01-01

Real-time imaging is required to guide minimally invasive catheter-based cardiac interventions. While transesophageal echocardiography allows for high-quality visualization of cardiac anatomy, X-ray fluoroscopy provides excellent visualization of devices. We have developed a novel image fusion system that allows real-time integration of 3-D echocardiography and the X-ray fluoroscopy. The system was validated in the following two stages: 1) preclinical to determine function and validate accuracy; and 2) in the clinical setting to assess clinical workflow feasibility and determine overall system accuracy. In the preclinical phase, the system was assessed using both phantom and porcine experimental studies. Median 2-D projection errors of 4.5 and 3.3 mm were found for the phantom and porcine studies, respectively. The clinical phase focused on extending the use of the system to interventions in patients undergoing either atrial fibrillation catheter ablation (CA) or transcatheter aortic valve implantation (TAVI). Eleven patients were studied with nine in the CA group and two in the TAVI group. Successful real-time view synchronization was achieved in all cases with a calculated median distance error of 2.2 mm in the CA group and 3.4 mm in the TAVI group. A standard clinical workflow was established using the image fusion system. These pilot data confirm the technical feasibility of accurate real-time echo-fluoroscopic image overlay in clinical practice, which may be a useful adjunct for real-time guidance during interventional cardiac procedures. PMID:27170872

Producing Organic Cotton: A Toolkit - Crop Guide, Projekt guide, Extension tools

OpenAIRE

Eyhorn, Frank

2005-01-01

The CD compiles the following extension tools on organic cotton: Organic Cotton Crop Guide, Organic Cotton Training Manual, Soil Fertility Training Manual, Organic Cotton Project Guide, Record keeping tools, Video "Organic agriculture in the Nimar region", Photos for illustration.

Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus

International Nuclear Information System (INIS)

Chellathurai, Amarnath; Kanhirat, Saneej; Chokkappan, Kabilan; Swaminathan, Thiruchendur S; Kulasekaran, Nadhamuni

2009-01-01

Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans

Lathe Operator. Coordinator's Guide. Individualized Study Guide. General Metal Trades.

Science.gov (United States)

East Texas State Univ., Commerce. Occupational Curriculum Lab.

This guide provides information to enable coordinators to direct learning activities for students using an individualized study guide on operating a lathe. The study material is designed for students enrolled in cooperative part-time training and employed, or desiring to be employed, as lathe operators. Contents include a sample progress chart,…

Neutron gain for converging guide tubes

International Nuclear Information System (INIS)

Mildner, D.F.R.

1982-01-01

The method of acceptance diagrams is used to obtain analytical expressions for the neutron gain of a one-dimensional converging guide tube. It is found that the results are more easily expressed by analyzing the acceptance diagram at the exit of the funnel. The results are compared with those for the straight guide. When both guides have the same dimensions at the guide exit, the converging guide has higher transmitted intensity but with greater divergence of the beam. This analytical method is useful to assess the performance of a converging guide, though numerical computations may be required for detailed analysis of a guide system. (orig.)

In Vivo Tooth-Supported Implant Surgical Guides Fabricated With Desktop Stereolithographic Printers: Fully Guided Surgery Is More Accurate Than Partially Guided Surgery.

Science.gov (United States)

Bencharit, Sompop; Staffen, Adam; Yeung, Matthew; Whitley, Daniel; Laskin, Daniel M; Deeb, George R

2018-02-21

Desktop stereolithographic printers combined with intraoral scanning and implant planning software promise precise and cost-effective guided implant surgery. The purpose of the present study was to determine the overall range of accuracy of tooth-supported guided implant surgery using desktop printed stereolithographic guides. A cross-sectional study comparing fully and partially guided implant surgery was conducted. Preoperative cone beam computed tomography (CBCT) and intraoral scans were used to plan the implant sites. Surgical guides were then fabricated using a desktop stereolithographic 3-dimensional printer. Postoperative CBCT was used to evaluate the accuracy of placement. Deviations from the planned positions were used as the primary outcome variables. The planning software used, implant systems, and anterior/posterior positions were the secondary outcome variables. The differences between the planned and actual implant positions in the mesial, distal, buccal, and lingual dimensions and buccolingual angulations were determined, and the accuracy was compared statistically using the 1-tail F-test (P = .01), box plots, and 95% confidence intervals for the mean. Sixteen partially edentulous patients requiring placement of 31 implants were included in the present study. The implant deviations from the planned positions for mesial, distal, buccal, and lingual dimensions and buccolingual angulations with the fully guided protocol (n = 20) were 0.17 ± 0.78 mm, 0.44 ± 0.78 mm, 0.23 ± 1.08 mm, -0.22 ± 1.44 mm, and -0.32° ± 2.36°, respectively. The corresponding implant deviations for the partially guided protocol (n = 11) were 0.33 ± 1.38 mm, -0.03 ± 1.59 mm, 0.62 ± 1.15 mm, -0.27 ± 1.61 mm, and 0.59° ± 6.83°. The difference between the variances for fully and partially guided surgery for the distal and angulation dimensions was statistically significant (P = .006 and P guided implant surgery is more accurate than

Manual on gamma radiography. Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1992-01-01

This booklet contains information about radiation protection procedures for gamma radiography as well as a basic guide to the principles of the production of ionizing radiation and to methods of radiation protection and dosimetry

The guiding center Lagrangian

International Nuclear Information System (INIS)

Larsson, J.

1986-01-01

Recursion relations determining the guiding center Langrangian Λ and the associated guiding center variables to all orders are derived. We consider some particularly simple forms of Λ obtainable by specific choices of certain arbitrary functions appearing as free parameters in the theory. It is, for example, possible to locally define the guiding center variables so that the expression for the corresponding Langrangian is unchanged by all higher order terms. (orig.)

Guide to Purchasing Green Power

Science.gov (United States)

The Guide for Purchasing Green Power is a comprehensive guide for current and potential buyers of green power with information about green power purchasing. The Guide is created cooperatively between the EPA, the U.S. Department of Energy, the World Resou

Manual on panoramic gamma irradiators (categories 2 and 4). Incorporating: Applications guide, procedures guide, basics guide

Energy Technology Data Exchange (ETDEWEB)

NONE

1996-03-01

The document is the first revision of a previous one published in 1993 to provide guidance on the safe use and regulation of self-contained gamma irradiators (Co-60 or Cs-137 sources) in different fields of application. It includes three parts: Applications Guide, which describes the main applications of self-contained gamma irradiators, the type of equipment, including safety systems, operation and maintenance, and how to deal with incidents. Procedures Guide, which gives step by step instructions on how to carry out the practice. Basics Guide, which explains the fundamentals of radiation, the system of units, interaction of radiation with matter radiation detection, etc. The manual is aimed primarily at persons handling such radiation sources on a daily routine basis, as well as at the competent authorities for training of workers in radiation protection or for setting up local radiation protection rules.

Manual on panoramic gamma irradiators (categories 2 and 4). Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1996-01-01

The document is the first revision of a previous one published in 1993 to provide guidance on the safe use and regulation of self-contained gamma irradiators (Co-60 or Cs-137 sources) in different fields of application. It includes three parts: Applications Guide, which describes the main applications of self-contained gamma irradiators, the type of equipment, including safety systems, operation and maintenance, and how to deal with incidents. Procedures Guide, which gives step by step instructions on how to carry out the practice. Basics Guide, which explains the fundamentals of radiation, the system of units, interaction of radiation with matter radiation detection, etc. The manual is aimed primarily at persons handling such radiation sources on a daily routine basis, as well as at the competent authorities for training of workers in radiation protection or for setting up local radiation protection rules

Occupational Health Risks in Cardiac Catheterization Laboratory Workers.

Science.gov (United States)

Andreassi, Maria Grazia; Piccaluga, Emanuela; Guagliumi, Giulio; Del Greco, Maurizio; Gaita, Fiorenzo; Picano, Eugenio

2016-04-01

Orthopedic strain and radiation exposure are recognized risk factors in personnel staff performing fluoroscopically guided cardiovascular procedures. However, the potential occupational health effects are still unclear. The purpose of this study was to examine the prevalence of health problems among personnel staff working in interventional cardiology/cardiac electrophysiology and correlate them with the length of occupational radiation exposure. We used a self-administered questionnaire to collect demographic information, work-related information, lifestyle-confounding factors, all current medications, and health status. A total number of 746 questionnaires were properly filled comprising 466 exposed staff (281 males; 44±9 years) and 280 unexposed subjects (179 males; 43±7years). Exposed personnel included 218 interventional cardiologists and electrophysiologists (168 males; 46±9 years); 191 nurses (76 males; 42±7 years), and 57 technicians (37 males; 40±12 years) working for a median of 10 years (quartiles: 5-24 years). Skin lesions (P=0.002), orthopedic illness (P16 years). In highly exposed physicians, adjusted odds ratio ranged from 1.7 for hypertension (95% confidence interval: 1-3; P=0.05), 2.9 for hypercholesterolemia (95% confidence interval: 1-5; P=0.004), 4.5 for cancer (95% confidence interval: 0.9-25; P=0.06), to 9 for cataract (95% confidence interval: 2-41; P=0.004). Health problems are more frequently observed in workers performing fluoroscopically guided cardiovascular procedures than in unexposed controls, raising the need to spread the culture of safety in the cath laboratory. © 2016 American Heart Association, Inc.

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

1990-01-01

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

1990-04-15

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

Security+ study guide study guide and practice exam

CERN Document Server

Dubrawsky, Ido; Dubrawsky

2007-01-01

Over 700,000 IT Professionals Have Prepared for Exams with Syngress Authored Study GuidesThe Security+ Study Guide & Practice Exam is a one-of-a-kind integration of text and and Web-based exam simulation and remediation. This system gives you 100% coverage of official CompTIA Security+ exam objectives plus test preparation software for the edge you need to achieve certification on your first try! This system is comprehensive, affordable, and effective!* Completely Guaranteed Coverage of All Exam ObjectivesAll five Security+ domains are covered in full: General Securi

Treatment of osteoid osteoma using CT-guided radiofrequency ablation versus MR-guided laser ablation: A cost comparison

International Nuclear Information System (INIS)

Maurer, M.H.; Gebauer, B.; Wieners, G.; De Bucourt, M.; Renz, D.M.; Hamm, B.; Streitparth, F.

2012-01-01

Objective: To compare the costs of CT-guided radiofrequency ablation (RFA) and MR-guided laser ablation (LA) for minimally invasive percutaneous treatment of osteoid osteoma. Materials and methods: Between November 2005 and October 2011, 20 patients (14 males, 6 females, mean age 20.3 ± 9.1 years) underwent CT-guided RFA and 24 patients (18 males, 6 females; mean age, 23.8 ± 13.8 years) MR-guided LA (open 1.0 Tesla, Panorama HFO, Philips, Best, Netherlands) for osteoid osteoma diagnosed on the basis of clinical presentation and imaging findings. Prorated costs of equipment use (purchase, depreciation, and maintenance), staff costs, and expenditure for disposables were identified for CT-guided RFA and MR-guided LA procedures. Results: The average total costs per patient were EUR 1762 for CT-guided RFA and EUR 1417 for MR-guided LA. These were (RFA/LA) EUR 92/260 for equipment use, EUR 149/208 for staff, and EUR 870/300 for disposables. Conclusion: MR-guided LA is less expensive than CT-guided RFA for minimally invasive percutaneous ablation of osteoid osteoma. The higher costs of RFA are primarily due to the higher price of the disposable RFA probes.

CT-guided puncture

International Nuclear Information System (INIS)

Noeldge, G.; Richter, G.M.; Grenacher, L.; Brado, M.; Kauffmann, G.W.

1996-01-01

Sonographic and CT-guided punctures allow the evaluation of suspected lesions in the head, thorax, abdomen, retroperitoneum and skeletal system. The size of the lesion to be evaluated determines the size and the diameter of the puncture needle. The quantity of the material obtained will be defined by the diameter of the needle, i.e. fine-needle biopsy is more adequate for cytological than for histological evaluation. Strict adherence to the indications and contraindications for puncture and painstaking performance of the procedure go a long why towards minimizing the complications. The advantage of CT-guided puncture, in contrast to an ultrasound-guided procedure, is visualization during the puncture procedure free from overshadowing. This permits punctures of lesions located deep in the thorax or the abdomen which are overshadowed by the lungs, by air in the small or large bowel or by bone structures. Moreover, this technique yields much more information about the tissues and organs surrounding the suspected lesion. This information is much more investigator-related with ultrasoundguided puncture. Therefore, the CT-guided puncture has become mandatory in the evaluation of suspected lesions. Moreover, using the same technique, percutaneous drainage of fluids in the interpleural space, abscesses in organs, hematomas, lymphoceles and urinomas; ablation of metastases; and sympathicolysis can be carried out. CT-guided puncture thus changes from a minimally invasive diagnostic procedure to a minimally invasive therapy. (orig./MG) [de

Pocket companion to PMI's PMBOK guide

CERN Document Server

Snijders, Paul; Zandhuis, Anton

2010-01-01

This pocket guide is based on the PMBOK Guide® Fourth Edition.This pocket guide supplies a summary of the PMBOK Guide® , to provide a quick introduction as well as a structured overview of this method for project management.This pocket guide deals with the key issues and themes within project management and PMBOK:A short overview of the activities of PMI Inc., The organization and its standards: PMBOK Guide®, Standard for Project Portfolio Management, Standard for Program Management, OPM3.The essentials of the Project Lifecycle and Organization.What are the key project management knowledge ar

Guides for intraoral x-rays

International Nuclear Information System (INIS)

Ogunsunlade, O.A.

1988-01-01

An h-shaped exterior guide for use in combination with a SNAP-A-RAY film holder for accurately aligning a beam from an X-ray cone with an X-ray film during the process of taking intraoral periapical dental X-rays of the maxillary and mandibular teeth is described comprising: a first guide arm laterally and detachably connectable through a housing means; a traverse arm extending from the midpoint of the first guide arm and parallel to the X-ray film; and a second guide arm extending perpendicularly from an end of the traverse arm toward a plane of the X-ray film and in parallel relation up to an end point of the first guide arm

Modern Surgical Management of Familial and Sporadic Parathyroid and Adrenal Disorders

NARCIS (Netherlands)

Scholten, A.

2013-01-01

Primary hyperparathyroidism (pHPT) is a common disease of the parathyroid glands. Multiple endocrine neoplasia (MEN) 1-related pHPT is most often caused by multiglandular disease and can best be treated with subtotal parathyroidectomy (3-3½ glands) and bilateral transcervical thymectomy to lower the

The comparative study of CT guided and ultrasound guided percutaneous ethanol injection in the treatment of intra-abdominal cyst

International Nuclear Information System (INIS)

Li Heping; Yang Jianyong; Chen Wei; Zhuang Wenquan; Huang Yulian; Chen Jianye

2005-01-01

Objective: An comparative study of the interventional approach of CT guided and ultiasound guided percutaneous ethanol injection(PEI) in the treatment of intra-abdominal cyst. Methods: CT guided PEI was performed in the treatment of intra-abdominal cyst in 38 patients while ultrasound guided PEI was performed in 45 cases. Results: The puncture procedure of CT guided PEI was totally performed 83 times in treating 56 intra-abdominal cysts in 38 patients and CT guided PEI was unsuccessful in 6 patients. The puncture procedure of ultrasound guided PEI were performed 87 times in treating 71 intra-abdominal cysts in 55 patients and ultrasound guided PEI only failed only in 1 patient. Conclusion: Ultrasound guided PEI is superior to CT guided PEI in the treatment of intra-abdominal cyst. (authors)

Guide device

International Nuclear Information System (INIS)

Brammer, C.M. Jr.

1977-01-01

Disclosed is a fuel handling guide tube centering device for use in nuclear reactors during fuel assembly handling operations. The device comprises an outer ring secured to the flange of a nuclear reactor pressure vessel, a rotatable table rotatably coupled to the outer ring, and a plurality of openings through the table. Truncated locating cones are positioned in each of the openings in the table, and the locating cones center the guide tube during fuel handling operations. The openings in the table are located such that each fuel assembly in the nuclear core may be aligned with one of the openings by a suitable rotation of the table. The locating cones thereby provide alignment between the fuel handling mechanism located in the guide tube and the individual fuel assemblies of the cone. The need for a device to provide alignment is especially critical for floating nuclear power plants, where wave motion may exist during fuel handling operations. 5 claims, 4 figures

Bottom nozzle to guide tube connection

International Nuclear Information System (INIS)

Bryan, W.J.

1991-01-01

This patent describes a nuclear fuel assembly which includes an upper end fitting and a lower end fitting spaced therefrom and connected thereto by elongated guide tubes of one alloy having an open upper end and a closed lower end with spaced fuel element retaining grids mounted on the guide tubes therebetween, the closed lower ends of the guide tubes including a threaded central passageway and the attachment of the guide tubes to the lower end fitting of another alloy. It comprises: an externally threaded bolt with a first end threadably received in the threaded central passageway of the lower end of the guide tube and a head at the other end of the side of the lower end fitting opposite the guide tube; an interruption in the external threads of the bolt which forms a groove which communicates the interior of the guide tube with the side of the lower end fitting opposite the guide tube and enhances its frictional engagement with the threaded central passageway, thereby to hold and attach the guide tube and lower end fitting firmly together, even through a series of temperature cycles

Joomla! 3 beginner's guide

CERN Document Server

Tiggeler, Eric

2014-01-01

An easy to use, step-by-step guide to creating professional, mobile-friendly websites with the free Joomla CMS. The Joomla! 3 Beginner's Guide Second Edition is the ultimate guide for web developers who wish to build upon their skills and knowledge on creating websites. Even if you're new to this subject, you won't have any difficulty understanding the clear and friendly instructions and explanations. No prior knowledge of HTML and CSS is required.

Moving Field Guides

Science.gov (United States)

Cassie Meador; Mark Twery; Meagan. Leatherbury

2011-01-01

The Moving Field Guides (MFG) project is a creative take on site interpretation. Moving Field Guides provide an example of how scientific and artistic endeavors work in parallel. Both begin with keen observations that produce information that must be analyzed, understood, and interpreted. That interpretation then needs to be communicated to others to complete the...

Thymectomy in Myasthenia Gravis

Science.gov (United States)

Aydin, Yener; Ulas, Ali Bilal; Mutlu, Vahit; Colak, Abdurrahim; Eroglu, Atilla

2017-01-01

In recent years, thymectomy has become a widespread procedure in the treatment of myasthenia gravis (MG). Likelihood of remission was highest in preoperative mild disease classification (Osserman classification 1, 2A). In absence of thymoma or hyperplasia, there was no relationship between age and gender in remission with thymectomy. In MG treatment, randomized trials that compare conservative treatment with thymectomy have started, recently. As with non-randomized trials, remission with thymectomy in MG treatment was better than conservative treatment with only medication. There are four major methods for the surgical approach: transcervical, minimally invasive, transsternal, and combined transcervical transsternal thymectomy. Transsternal approach with thymectomy is the accepted standard surgical approach for many years. In recent years, the incidence of thymectomy has been increasing with minimally invasive techniques using thoracoscopic and robotic methods. There are not any randomized, controlled studies which are comparing surgical techniques. However, when comparing non-randomized trials, it is seen that minimally invasive thymectomy approaches give similar results to more aggressive approaches. PMID:28416933

Follow the guide!

CERN Multimedia

2003-01-01

For once it was the turn of the CERN guides to be shown around. A special tour had been organised for their annual outing on 24 June 2003, the aim of which was to go behind the scenes at research centres similar to CERN and discover the secrets of their public communications activities. The first stop was the European Synchrotron Radiation Facility (ESRF) in Grenoble, where the twenty or so CERN guides were welcomed by Dominique Cornujeols, head of communication at ESRF, who explained the Facility's history and purpose and how it operates before they were taken on a tour of the actual installations. CERN guides are welcomed to the ESRF (European Synchrotron Radiation Facility).The second visit of this trip to the Grenoble region was to the centre for science, technology and industry (CCSTI). "The people in charge at CCSTI showed us their day-to-day work in science and technology workshops", explains Stephan Petit, one of the guides. These workshops allow the public to discuss fundamental issues relating to a ...

TRAC User's Guide

International Nuclear Information System (INIS)

Boyack, B.E.; Stumpf, H.; Lime, J.F.

1985-11-01

This guide has been prepared to assist users in applying the Transient Reactor Analysis Code (TRAC). TRAC is an advanced best-estimate systems code for analyzing transients in thermal-hydraulic systems. The code is very general. Because it is general, efforts to model specific nuclear power plants or experimental facilities often present a challenge to the TRAC user. This guide has been written to assist first-time or intermediate users. It is specifically written for the TRAC version designated TRAC-PF1/MOD1. The TRAC User's Guide should be considered a companion document to the TRAC Code Manual; the user will need both documents to use TRAC effectively. 18 refs., 45 figs., 19 tabs

Guiding Design: Exposing Librarian and Student Mental Models of Research Guides

Science.gov (United States)

Sinkinson, Caroline; Alexander, Stephanie; Hicks, Alison; Kahn, Meredith

2012-01-01

This article details an open card sort study administered to undergraduate students, graduate students, and librarians at the University of Colorado at Boulder in order to reveal perceptions of library research guides. The study identifies user group preferences for organization and content of research guides, as well as themes emerging from the…

Specifications for human factors guiding documents

Energy Technology Data Exchange (ETDEWEB)

Rhodes, W; Szlapetis, I; MacGregor, C [Rhodes and Associates Inc., Toronto, ON (Canada)

1995-04-01

This report specifies the content, function and appearance of three proposed human factors guiding documents to be used by the Atomic Energy Control board and its licensees. These three guiding documents, to be developed at a later date, are: (a) Human Factors Process Guide; (b) Human Factors Activities Guide; and (c) Human Factors Design Integration Guide. The specifications were developed by examining the best documents as identified in a previous contract with the AECB (Review of Human Factors Guidelines and Methods by W. Rhodes, I. Szlapetis et al. 1992), and a brief literature review. The best features and content were selected from existing documents and used to develop specifications for the guiding documents. The developer of the actual guides would use these specifications to produce comprehensive and consolidated documents at a later date. (author). 128 ref., 7 figs.

Specifications for human factors guiding documents

International Nuclear Information System (INIS)

Rhodes, W.; Szlapetis, I.; MacGregor, C.

1995-04-01

This report specifies the content, function and appearance of three proposed human factors guiding documents to be used by the Atomic Energy Control board and its licensees. These three guiding documents, to be developed at a later date, are: (a) Human Factors Process Guide; (b) Human Factors Activities Guide; and (c) Human Factors Design Integration Guide. The specifications were developed by examining the best documents as identified in a previous contract with the AECB (Review of Human Factors Guidelines and Methods by W. Rhodes, I. Szlapetis et al. 1992), and a brief literature review. The best features and content were selected from existing documents and used to develop specifications for the guiding documents. The developer of the actual guides would use these specifications to produce comprehensive and consolidated documents at a later date. (author). 128 ref., 7 figs

Data and methods to estimate fetal dose from fluoroscopically guided prophylactic hypogastric artery balloon occlusion

Energy Technology Data Exchange (ETDEWEB)

Solomou, G.; Stratakis, J. [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete 71003 (Greece); Perisinakis, K.; Tsetis, D.; Damilakis, J., E-mail: john.damilakis@med.uoc.gr [Department of Medical Physics, Faculty of Medicine, University of Crete, P.O. Box 2208, Heraklion, Crete 71003, Greece and Department of Medical Physics, University Hospital of Heraklion, P.O. Box 1352, Heraklion, Crete 71110 (Greece)

2016-06-15

Purpose: To provide data for estimation of fetal radiation dose (D{sub F}) from prophylactic hypogastric artery balloon occlusion (HABO) procedures. Methods: The Monte-Carlo-N-particle (MCNP) transport code and mathematical phantoms representing a pregnant patient at the ninth month of gestation were employed. PA, RAO 20° and LAO 20° fluoroscopy projections of left and right internal iliac arteries were simulated. Projection-specific normalized fetal dose (NFD) data were produced for various beam qualities. The effects of projection angle, x-ray field location relative to the fetus, field size, maternal body size, and fetal size on NFD were investigated. Presented NFD values were compared to corresponding values derived using a physical anthropomorphic phantom simulating pregnancy at the third trimester and thermoluminescence dosimeters. Results: NFD did not considerably vary when projection angle was altered by ±5°, whereas it was found to markedly depend on tube voltage, filtration, x-ray field location and size, and maternal body size. Differences in NFD < 7.5% were observed for naturally expected variations in fetal size. A difference of less than 13.5% was observed between NFD values estimated by MCNP and direct measurements. Conclusions: Data and methods provided allow for reliable estimation of radiation burden to the fetus from HABO.

Fluoroscopically Guided Interventional Procedures: A Review of Radiation Effects on Patients’ Skin and Hair

Science.gov (United States)

2010-02-01

severe radiation injuries can extend into the subcutaneous fat and muscle ( 21 ). Patients may face years of associated pain , multiple surgical...skin injury has been reviewed in detail ( 9 ). Tissues at risk include the skin, hair, subcutaneous fat, and muscle . The expression of this injury...bleomycin, epirubicin, and gemcitabine), antibiot- ics (cefotetan), statins (simvastatin), and herbal preparations (hypericin, otherwise known as St

GreyGuide. Poster presentation

OpenAIRE

Biagioni, Stefania; Farace, Dominic

2014-01-01

Welcome to the GreyGuide, a repository of good practices and resources in grey literature. The GreyGuide seeks to capture proposed as well as published practices dealing with the supply and demand sides of grey literature. This is a collaborative project involving GreyNet International and ISTI-CNR. The launch of the GreyGuide Repository took place in December 2013 at the Fifteenth International Conference on Grey Literature. Since then, the acquisition of both proposed and published good pra...

Guiding of short, intense laser pulses through solid guides and preformed plasma channels

International Nuclear Information System (INIS)

Borghesi, M.; Mackinnon, A.J.; Gaillard, R.; Malka, G.; Vickers, C.; Willi, O.; Blanchot, N.; Miquel, J.L.; Canaud, B.; Davies, J.R.; Malka, G.; Offenberger, A.A.

2000-01-01

In a series of experiments carried out at the Rutherford Appleton Laboratory, Chilton (UK) and at the Commissariat a l'Energie Atomique, Limeil (France), various techniques of guiding ultra-intense laser pulses over distances exceeding the natural diffraction length were investigated. Efficient guiding was demonstrated both through density channels formed in an underdense plasma by an intense prepulse and through solid guides (hollow capillary tubes). Indication of collimated fast electron propagation though solid targets has also been obtained. (authors)

C-arm cone-beam CT combined with a new electromagnetic navigation system for guidance of percutaneous needle biopsies. Initial clinical experience

Energy Technology Data Exchange (ETDEWEB)

Kickuth, R.; Reichling, C.; Bley, T.; Hahn, D.; Ritter, C. [University Hospital of Wuerzburg (Germany). Inst. of Diagnostic and Interventional Radiology

2015-07-15

To evaluate the feasibility and efficacy of C-arm fluoroscopic cone-beam computed tomography (CACT) in combination with a new electromagnetic tracking (EMT) system for needle guidance during percutaneous biopsies. 53 patients were referred for biopsy of thoracic (n = 19) and abdominal (n = 34) lesions. CT-like images of the anatomical region of interest (ROI) were generated using a flat panel-based angiographic system. These images were transmitted to an EMT system. A coaxial puncture needle with a sensor in its tip was connected with the navigation system and tracked into an electromagnetic field created via a field generator. Data generated within this field were merged with the CACT images. On a monitor both the anatomical ROI and needle tip position were displayed to enable precise needle insertion into the target. Through the coaxial needle, biopsy specimens for the histologic evaluation were extracted. Number of representative biopsy samples, number of core biopsies/patient, total procedure time, dose-area product, fluoroscopic time, and complications were recorded. 53 CACT/EMT-guided biopsy procedures were performed, 48 of which (91 %) yielded representative tissue samples. Four core biopsies were obtained from each patient. 40 (75 %) lesions were malignant and 13 (25 %) lesions were benign. The total procedure time was 9 ± 5 min (range, 3 - 23 min), fluoroscopic time was 0.8 ± 0.4 min (range, 0.4 - 2 min). The mean dose-area product (cGy cm{sup 2}) was 7373 (range, 895 - 26 904). The rate of complications (1 pneumothorax, 2 hemoptyses) was 6 %. CACT combined with EMT appears to be a feasible and effective technique for the guidance of percutaneous biopsies with a low rate of therapeutically relevant complications.

C-arm cone-beam CT combined with a new electromagnetic navigation system for guidance of percutaneous needle biopsies. Initial clinical experience

International Nuclear Information System (INIS)

Kickuth, R.; Reichling, C.; Bley, T.; Hahn, D.; Ritter, C.

2015-01-01

To evaluate the feasibility and efficacy of C-arm fluoroscopic cone-beam computed tomography (CACT) in combination with a new electromagnetic tracking (EMT) system for needle guidance during percutaneous biopsies. 53 patients were referred for biopsy of thoracic (n = 19) and abdominal (n = 34) lesions. CT-like images of the anatomical region of interest (ROI) were generated using a flat panel-based angiographic system. These images were transmitted to an EMT system. A coaxial puncture needle with a sensor in its tip was connected with the navigation system and tracked into an electromagnetic field created via a field generator. Data generated within this field were merged with the CACT images. On a monitor both the anatomical ROI and needle tip position were displayed to enable precise needle insertion into the target. Through the coaxial needle, biopsy specimens for the histologic evaluation were extracted. Number of representative biopsy samples, number of core biopsies/patient, total procedure time, dose-area product, fluoroscopic time, and complications were recorded. 53 CACT/EMT-guided biopsy procedures were performed, 48 of which (91 %) yielded representative tissue samples. Four core biopsies were obtained from each patient. 40 (75 %) lesions were malignant and 13 (25 %) lesions were benign. The total procedure time was 9 ± 5 min (range, 3 - 23 min), fluoroscopic time was 0.8 ± 0.4 min (range, 0.4 - 2 min). The mean dose-area product (cGy cm 2 ) was 7373 (range, 895 - 26 904). The rate of complications (1 pneumothorax, 2 hemoptyses) was 6 %. CACT combined with EMT appears to be a feasible and effective technique for the guidance of percutaneous biopsies with a low rate of therapeutically relevant complications.

Memory-guided saccades show effect of a perceptual illusion whereas visually guided saccades do not.

Science.gov (United States)

Massendari, Delphine; Lisi, Matteo; Collins, Thérèse; Cavanagh, Patrick

2018-01-01

The double-drift stimulus (a drifting Gabor with orthogonal internal motion) generates a large discrepancy between its physical and perceived path. Surprisingly, saccades directed to the double-drift stimulus land along the physical, and not perceived, path (Lisi M, Cavanagh P. Curr Biol 25: 2535-2540, 2015). We asked whether memory-guided saccades exhibited the same dissociation from perception. Participants were asked to keep their gaze centered on a fixation dot while the double-drift stimulus moved back and forth on a linear path in the periphery. The offset of the fixation was the go signal to make a saccade to the target. In the visually guided saccade condition, the Gabor kept moving on its trajectory after the go signal but was removed once the saccade began. In the memory conditions, the Gabor disappeared before or at the same time as the go-signal (0- to 1,000-ms delay) and participants made a saccade to its remembered location. The results showed that visually guided saccades again targeted the physical rather than the perceived location. However, memory saccades, even with 0-ms delay, had landing positions shifted toward the perceived location. Our result shows that memory- and visually guided saccades are based on different spatial information. NEW & NOTEWORTHY We compared the effect of a perceptual illusion on two types of saccades, visually guided vs. memory-guided saccades, and found that whereas visually guided saccades were almost unaffected by the perceptual illusion, memory-guided saccades exhibited a strong effect of the illusion. Our result is the first evidence in the literature to show that visually and memory-guided saccades use different spatial representations.

7 CFR 1942.20 - Community Facility Guides.

Science.gov (United States)

2010-01-01

... Commitment. (2) Guide 2—Water Users Agreement. (3) Guide 3—Service Declination Statement. (4) Guide 4—Bylaws. (5) Guide 5—Financial Feasibility Report. (6) Guide 6—Preliminary Architectural Feasibility Report... 12—Memorandum of Understanding Between the Economic Development Administration—Department of Commerce...

Mind over Matter. Teacher's Guide.

Science.gov (United States)

National Inst. on Drug Abuse (DHHS/PHS), Rockville, MD.

This teacher's guide aims to develop an understanding among students in grades 5-9 about the biological effects of drug use. The guide provides background information on the anatomy of the brain, nerve cells and neurotransmission, and the effects of drugs on the brain. Drugs described in this guide include marijuana, opiates, inhalants,…

Manual on high energy teletherapy. Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1992-01-01

Apart from a basic guide to the principles of the production of ionizing radiation and to methods of radiation protection and dose measurements, this booklet contains information about radiation protection measures for high-energy teletherapy

Manual on shielded enclosures. Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1992-01-01

This booklet contains a basic guide to the principles of the production of ionizing radiation and to methods of radiation protection and dosimetry, and a discussion of the need for shielded enclosures. Shielding materials and the design of the enclosures are described

A Guide to the Field Guides.

Science.gov (United States)

Natural History, 1987

1987-01-01

Provides a compilation of recommended field guides which deal with birds, mammals, trees, and wildflowers. Each recommended volume is described, noting its distinguishing features and evaluating its organization, photography, and text. Includes the author, publisher, and suggested retail price. (TW)

Apparatus for guiding workpieces

International Nuclear Information System (INIS)

Misty, G.C.

1984-01-01

Workpieces are guided to the tool by a resiliently mounted support guide which accommodates irregularities in the profiles of the workpieces to maintain the axes of the workpieces in alignment with the centre line of the tool. (author)

Guide-Plane Retention in Designing Removable Partial Dentures.

Science.gov (United States)

Mothopi-Peri, Matshediso; Owen, C Peter

To compare the influence of abutment teeth guide planes and guiding surfaces on retention of a removable partial denture (RPD). Extracted teeth embedded into a maxillary cast in the first premolar and second molar positions simulated two bounded saddles. Acrylic resin RPDs were made with no guide planes, then with guide planes, then with guiding surfaces added to directly contact the guide planes. The maximum loads on removal from the cast were recorded. There was a significant increase in retention force of 1.6 times when only guide planes were present and of 10.2 times when guiding surfaces intimately contacted the guide planes. The retention of acrylic resin RPDs can be substantially increased by making their guiding surfaces intimately contact the guide planes of the teeth.

CCNA Wireless Study Guide

CERN Document Server

Lammle, Todd

2010-01-01

A complete guide to the CCNA Wireless exam by leading networking authority Todd Lammle. The CCNA Wireless certification is the most respected entry-level certification in this rapidly growing field. Todd Lammle is the undisputed authority on networking, and this book focuses exclusively on the skills covered in this Cisco certification exam. The CCNA Wireless Study Guide joins the popular Sybex study guide family and helps network administrators advance their careers with a highly desirable certification.: The CCNA Wireless certification is the most respected entry-level wireless certification

Manual on self-contained gamma irradiators (categories 1 and 3). Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1996-01-01

The document is the first revision of a previous one published in 1993 to provide guidance on the safe use and regulation of panoramic gamma irradiators (Co-60 or Cs-137 sources) in different fields of application. It includes three parts: Applications Guide, which describes the main applications of panoramic gamma irradiators, the type of equipment, including safety systems, operation and maintenance, and how to deal with incidents. Procedures Guide, which gives step by step instructions on how to carry out the practice. Basics Guide, which explains the fundamentals of radiation, the system of units, interaction of radiation with matter radiation detection, etc. and which is common to all documents in the series. The manual is aimed primarily at persons handling such radiation sources on a daily routine basis, as well as at the competent authorities for training of workers in radiation protection or for setting up local radiation protection rules

MyPlate Food Guide

Science.gov (United States)

... Safe Videos for Educators Search English Español MyPlate Food Guide KidsHealth / For Teens / MyPlate Food Guide What's ... and other sugary drinks. Avoid large portions . Five Food Groups Different food groups have different nutrients and ...

78 FR 42071 - Updates to Protective Action Guides Manual: Protective Action Guides (PAGs) and Planning Guidance...

Science.gov (United States)

2013-07-15

... Guides Manual: Protective Action Guides (PAGs) and Planning Guidance for Radiological Incidents AGENCY... guidance ``PAG Manual: Protective Action Guides (PAGs) and Planning Guidance for Radiological Incidents... ``anonymous access'' system, which means the EPA will not know your identity or contact information unless you...

Experimental MR-guided cryotherapy of the brain with almost real-time imaging by radial k-space scanning; Experimentelle MR-gesteuerte Kryotherapie des Gehirns mit nahezu Echtzeitdarstellung durch radiale k-Raum-Abtastung

Energy Technology Data Exchange (ETDEWEB)

Tacke, J.; Schorn, R.; Glowinski, A.; Grosskortenhaus, S.; Adam, G.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Speetzen, R.; Rau, G. [Helmholtz-Institut fuer Biomedizinische Technik, Aachen (Germany); Rasche, V. [Philips GmbH Forschungslaboratorium, Hamburg (Germany)

1999-02-01

Purpose: To test radial k-space scanning by MR fluoroscopy to guide and control MR-guided interstitial cryotherapy of the healthy pig brain. Methods: After MR tomographic planning of the approach, an MR-compatible experimental cryotherapy probe of 2.7 mm diameter was introduced through a 5 mm burr hole into the right frontal brain of five healthy pigs. The freeze-thaw cycles were imaged using a T{sub 1}-weighted gradient echo sequence with radial k-space scanning in coronal, sagittal, and axial directions. Results: The high temporal resolution of the chosen sequence permits a continuous representation of the freezing process with good image quality and high contrast between ice and unfrozen brain parenchyma. Because of the interactive conception of the sequence the layer plane could be chosen as desired during the measurement. Ice formation was sharply demarcated, spherically configurated, and was free of signals. Its maximum diameter was 13 mm. Conclusions: With use of the novel, interactively controllable gradient echo sequence with radial k-space scanning, guidance of the intervention under fluoroscopic conditions with the advantages of MRT is possible. MR-guided cryotherapy allows a minimally-invasive, precisely dosable focal tissue ablation. (orig.) [Deutsch] Ziel: Erprobung der radialen k-Raum-Abtastung bei der MR-Fluoroskopie zur Steuerung und Kontrolle MR-gesteuerter interstitieller Kryotherapie des gesunden Schweinegehirns. Methoden: Nach MR-tomographischer Planung des Zugangsweges wurde eine MR-kompatible experimentelle Kryotherapiesonde von 2,7 mm Durchmesser ueber ein 5 mm Bohrloch in das rechte Frontalhirn von fuenf gesunden Schweinen eingebracht. Die Frier-/Tauzyklen wurden anhand einer T{sub 1}-gewichteten Gradientenechosequenz mit radialer k-Raum-Abtastung in koronarer, sagittaler und axialer Schichtfuehrung dargestellt. Ergebnisse: Die hohe zeitliche Aufloesung der gewaehlten Sequenz erlaubte eine kontinuierliche Darstellung des Friervorgangs bei

Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions.

Science.gov (United States)

Khosla, Rahul; McLean, Anna W; Smith, Jessica A

2016-01-01

Computed tomography (CT) guided biopsies have long been the standard technique to obtain tissue from the thoracic cavity and is traditionally performed by interventional radiologists. Ultrasound (US) guided biopsy of pleural-based lesions, performed by pulmonologists is gaining popularity and has the advantage of multi-planar imaging, real-time technique, and the absence of radiation exposure to patients. In this study, we aim to determine the diagnostic accuracy, the time to diagnosis after the initial consult placement, and the complications rates between the two different modalities. A retrospective study of electronic medical records was done of patients who underwent CT-guided biopsies and US-guided biopsies for pleural-based lesions between 2005 and 2014 and the data collected were analyzed for comparing the two groups. A total of 158 patients underwent 162 procedures during the study period. 86 patients underwent 89 procedures in the US group, and 72 patients underwent 73 procedures in the CT group. The overall yield in the US group was 82/89 (92.1%) versus 67/73 (91.8%) in the CT group (P = 1.0). Average days to the procedure was 7.2 versus 17.5 (P = 0.00001) in the US and CT group, respectively. Complication rate was higher in CT group 17/73 (23.3%) versus 1/89 (1.1%) in the US group (P guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate and a significantly reduced time to the procedure.

Freehand biopsy guided by electromagnetic needle tracking

DEFF Research Database (Denmark)

Ewertsen, C; Nielsen, Marie Kristina Rue; Nielsen, M Bachmann

2011-01-01

To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking.......To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking....

Alignment Adjustment Procedures. Automotive Mechanics. Steering & Suspension. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Spignesi, B.

This instructional package, one in a series of individualized instructional units on automotive steering and suspension, consists of a student guide and an instructor guide dealing with automobile alignment and adjustment procedures. Covered in the module are identifying positive and negative cambers, positive and negative casters, and toe-ins;…

Manual on nuclear gauges. Incorporating: Applications guide, procedures guide, basics guide

International Nuclear Information System (INIS)

1992-01-01

In addition to a basic guide to the principles of production of ionizing radiation and to the methods of radiation protection and dosimetry, this booklet considers the procedures that should be employed when using nuclear gauges. Applications for such gauges are described and radiation protection procedures discussed

The Higgs hunter's guide

CERN Document Server

Gunion, John F; Haber, Howard E; Kane, Gordon L

1989-01-01

The Higgs Hunter's Guide is a definitive and comprehensive guide to the physics of Higgs bosons. In particular, it discusses the extended Higgs sectors required by those recent theoretical approaches that go beyond the Standard Model, including supersymmetry and superstring-inspired models.

RADTRAN 4: User guide

International Nuclear Information System (INIS)

Neuhauser, K.S.; Kanipe, F.L.

1992-01-01

RADTRAN 4 is used to evaluate radiological consequences of incident-free transportation, as well as the radiological risks from vehicular accidents occurring during transportation. This User Guide is Volume 3 in a series of four volume of the documentation of the RADTRAN 4 computer code for transportation risk analysis. The other three volumes are Volume 1, the Executive Summary; Volume 2, the Technical Manual; and Volume 4, the Programmer's Manual. The theoretical and calculational basis for the operations performed by RADTRAN 4 are discussed in Volume 2. Throughout this User Guide the reader will be referred to Volume 2 for detailed discussions of certain RADTRAN features. This User Guide supersedes the document ''RADTRAN III'' by Madsen et al. (1983). This RADTRAN 4 User Guide specifies and describes the required data, control inputs, input sequences, user options, program limitations, and other activities necessary for execution of the RADTRAN 4 computer code

Training Cambodian Village Health Support Guides in Diabetes Prevention: Effects on Guides' Knowledge and Teaching Activities Over 6 Months.

Science.gov (United States)

Wagner, Julie; Keuky, Lim; Fraser-King, Lorraine; Kuoch, Theanvy; Scully, Mary

2016-04-01

Type 2 diabetes is a pressing public health concern in Cambodia, a country with limited human resource capacity due to genocide. Cambodian village health support guides (Guides) promote health at the local level. This paper reports preliminary results of training Guides in diabetes prevention. The curriculum, called Eat, Walk, Sleep was delivered to Guides in Siem Reap province once over 3 h. Participants completed a pretest and posttest on diabetes knowledge. Guides were offered continuing education through Eat, Walk, Sleep resources and were encouraged to teach Eat, Walk, Sleep in their villages. For each of 6 months following their training, Guides completed a checklist regarding their activities. One hundred eighty-five Guides attended one of ten trainings. Knowledge scores increased significantly from pretest to posttest. During 6 months of follow-up, n = 159 Guides (85 %) completed at least one monthly checklist. Guides reported high rates of uptake and delivery of the Eat, Walk, Sleep curriculum and moderate rates of continuing education about diabetes. Diabetes prevention in Cambodia is nascent. Guides show excellent uptake and dissemination of the curriculum. Future research should examine effect of support for Guide activities and the effect of the curriculum on villager health behaviors, and ultimately, on rates of type 2 diabetes.

Guided acoustic wave inspection system

Science.gov (United States)

Chinn, Diane J.

2004-10-05

A system for inspecting a conduit for undesirable characteristics. A transducer system induces guided acoustic waves onto said conduit. The transducer system detects the undesirable characteristics of the conduit by receiving guided acoustic waves that contain information about the undesirable characteristics. The conduit has at least two sides and the transducer system utilizes flexural modes of propagation to provide inspection using access from only the one side of the conduit. Cracking is detected with pulse-echo testing using one transducer to both send and receive the guided acoustic waves. Thinning is detected in through-transmission testing where one transducer sends and another transducer receives the guided acoustic waves.

Teens Working: Turning Earning into Learning. Facilitator Guide [and] Critical Workplace Issues [and] Student Guide.

Science.gov (United States)

Northwest Regional Educational Lab., Portland, OR. Education, Career, and Community Program.

These guides are part of a toolkit designed to help young people make connections between the jobs they now hold, the classes they are taking, and the goals they may have for the near and distant future. The guides contain a variety of materials and activities appropriate for all skill levels. The activities in the student guide are grounded in…

Ethanol Fuels Reference Guide: A Decision-Makers Guide to Ethanol Fuels

Energy Technology Data Exchange (ETDEWEB)

1982-10-01

This guide is a compendium of information on alcohol fuel production and use. Chapter titles are: facts about ethanol; gasohol-answers to the basic questions; feedstocks and their coproducts; ethanol production processes; and vehicle fuel use and performance. In addition, there are 8 appendices which include fermentation guides for common grains and potatoes, component and enzyme manufacturers, and information on regulations and permits. (DMC)

Air Conditioner Charging. Automotive Mechanics. Air Conditioning. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Spignesi, B.

This instructional package, one in a series of individualized instructional units on automobile air conditioning, consists of a student guide and an instructor guide dealing with air conditioning charging. Covered in the module are checking the air conditioning system for leaks, checking and adding refrigerant oil as needed, evacuating the system,…

Principles of Refrigeration. Automotive Mechanics. Air Conditioning. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Spignesi, B.

This instructional package, one in a series of individualized instructional units on automobile air conditioning, consists of a student guide and an instructor guide dealing with the principles of refrigeration. Covered in the module are defining the term heat, defining the term British Thermal Unit (BTU), defining the term latent heat, listing…

Advanced geometries for ballistic neutron guides

International Nuclear Information System (INIS)

Schanzer, Christian; Boeni, Peter; Filges, Uwe; Hils, Thomas

2004-01-01

Sophisticated neutron guide systems take advantage of supermirrors being used to increase the neutron flux. However, the finite reflectivity of supermirrors becomes a major loss mechanism when many reflections occur, e.g. in long neutron guides and for long wavelengths. In order to reduce the number of reflections, ballistic neutron guides have been proposed. Usually linear tapered sections are used to enlarge the cross-section and finally, focus the beam to the sample. The disadvantages of linear tapering are (i) an inhomogeneous phase space at the sample position and (ii) a decreasing flux with increasing distance from the exit of the guide. We investigate the properties of parabolic and elliptic tapering for ballistic neutron guides, using the Monte Carlo program McStas with a new guide component dedicated for such geometries. We show that the maximum flux can indeed be shifted away from the exit of the guide. In addition we explore the possibilities of parabolic and elliptic geometries to create point like sources for dedicated experimental demands

Biopsy system for CT-guided biopsies

International Nuclear Information System (INIS)

Onik, G.; Cosman, E.; Wells, T.; Goldberg, H.I.; Moss, A.; Costello, P.; Kane, R.

1987-01-01

CT stereotaxic brain biopsies have made brain biopsies safe and minimally invasive. CT-guided biopsies of the body, however, have traditionally used a hand-guidance method. CT biopsy guidance systems for the body have recently become available that have similar capabilities as those of brain biopsy systems. To compare the clinical utility of stereotaxically guided biopsies with hand-guided biopsies, the authors prospectively compared 40 biopsies performed with each method. In the stereotaxic method, a localizor grid was placed on the patient to define a reference point, and a frame was used to guide the needle along the intended path. Computer software programs calculated complex paths from one scan plane to another. Although the results disclosed no significant differences in lesion size or path length between the two groups, the stereotaxically guided biopsies required 75% fewer needle manipulations to hit the intended target. Consequently, the stereotaxically guided biopsies required 40% less time and 80% fewer localization scans to find the biopsy needle than did the hand-guided biopsies

Nutrition Guide for Toddlers

Science.gov (United States)

... Staying Safe Videos for Educators Search English Español Nutrition Guide for Toddlers KidsHealth / For Parents / Nutrition Guide ... español Guía de nutrición para sus hijos pequeños Nutrition Through Variety Growth slows somewhat during the toddler ...

Guided Learning at Work.

Science.gov (United States)

Billett, Stephen

2000-01-01

Guided learning (questioning, diagrams/analogies, modeling, coaching) was studied through critical incident interviews in five workplaces. Participation in everyday work activities was the most effective contributor to workplace learning. Organizational readiness and the efficacy of guided learning in resolving novel tasks were also important. (SK)

Safety guides development process in Spain

International Nuclear Information System (INIS)

Butragueno, J.L.; Perello, M.

1979-01-01

Safety guides have become a major factor in the licensing process of nuclear power plants and related nuclear facilities of the fuel cycle. As far as the experience corroborates better and better engineering methodologies and procedures, the results of these are settled down in form of standards, guides, and similar issues. This paper presents the actual Spanish experience in nuclear standards and safety guides development. The process to develop a standard or safety guide is shown. Up to date list of issued and on development nuclear safety guides is included and comments on the future role of nuclear standards in the licensing process are made. (author)

2014 Australasian sky guide

CERN Document Server

Lomb, Nick

2013-01-01

Compact, easy to use and reliable, this popular guide contains everything you need to know about the southern night sky with monthly astronomy maps, viewing tips and highlights, and details of all the year's exciting celestial events. Wherever you are in Australia or New Zealand, easy calculations allow you to estimate local rise and set times for the Sun, Moon and planets. The 2014 Australasian Sky Guide also provides information on the solar system, updated with the latest findings from space probes. Published annually since 1991, the Sky Guide continues to be a favourite with photographers,

2015 Australasian sky guide

CERN Document Server

Lomb, Nick

2014-01-01

Compact, easy to use and reliable, this popular guide has been providing star gazers with everything they need to know about the southern night sky for the past 25 years. The 2015 guide will celebrate this landmark with highlights from the past as well as monthly astronomy maps, viewing tips and highlights, and details of the year's exciting celestial events.Wherever you are in Australia or New Zealand, easy calculations allow you to estimate local rise and set times for the Sun, Moon and planets. The 2015 Australasian Sky Guide also provides information on the solar system, updated with the l

32 CFR 2001.15 - Classification guides.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Classification guides. 2001.15 Section 2001.15..., NATIONAL ARCHIVES AND RECORDS ADMINISTRATION CLASSIFIED NATIONAL SECURITY INFORMATION Classification § 2001.15 Classification guides. (a) Preparation of classification guides. Originators of classification...

Front-End Types. Automotive Mechanics. Steering & Suspension. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Spignesi, B.

This instructional package, one in a series of individualized instructional units on automotive steering and suspension, consists of a student guide and an instructor guide dealing with automobile front-end types. Covered in the module are three common types of passenger car front suspension systems and their major components as well as two types…

Pre-Alignment Checks. Automotive Mechanics. Steering & Suspension. Instructor's Guide [and] Student Guide.

Science.gov (United States)

Spignesi, B.

This instructional package, one in a series of individualized instructional units on automotive steering and suspension, consists of a student guide and an instructor guide dealing with prealignment checks. Covered in the module are the following steps in a prealignment check: checking the ride height of a vehicle, checking the ball joints and the…

Drafting Lab Management Guide.

Science.gov (United States)

Ohio State Univ., Columbus. Instructional Materials Lab.

This manual was developed to guide drafting instructors and vocational supervisors in sequencing laboratory instruction and controlling the flow of work for a 2-year machine trades training program. The first part of the guide provides information on program management (program description, safety concerns, academic issues, implementation…

concrete5 Beginner's Guide

CERN Document Server

Laubacher, Remo

2011-01-01

This book is part of Packt's Beginner's Guide series. You will be guided through the set up of a Concrete5 site with step-by-step practical examples. This book is ideal for developers who would like to build their first site with Concrete5. Some k

Guided and Unguided Student Reflections

OpenAIRE

Matheson, Amanda; Wood, Laura; Franklin, Scott V.

2017-01-01

Self-reflection is important metacognitive skill, enabling students to build coherence into their learning and embed content in a broader context. While various pedagogical techniques exist to encourage student reflection, little research has examined the differences between formally guided, partially guided and unguided reflections. This study focuses on student responses to online Guided Reflection Forms (GRFs) from students in a first-semester non-physics class and, separately, a sophomore...

32 CFR 2400.15 - Classification guides.

Science.gov (United States)

2010-07-01

... REGULATIONS TO IMPLEMENT E.O. 12356; OFFICE OF SCIENCE AND TECHNOLOGY POLICY INFORMATION SECURITY PROGRAM Derivative Classification § 2400.15 Classification guides. (a) OSTP shall issue and maintain classification guides to facilitate the proper and uniform derivative classification of information. These guides shall...

7 CFR 3430.31 - Guiding principles.

Science.gov (United States)

2010-01-01

... 7 Agriculture 15 2010-01-01 2010-01-01 false Guiding principles. 3430.31 Section 3430.31 Agriculture Regulations of the Department of Agriculture (Continued) COOPERATIVE STATE RESEARCH, EDUCATION... § 3430.31 Guiding principles. The guiding principle for Federal assistance application review and...

Usability of FDA-approved medication guides.

Science.gov (United States)

Wolf, Michael S; King, Jennifer; Wilson, Elizabeth A H; Curtis, Laura M; Bailey, Stacy Cooper; Duhig, James; Russell, Allison; Bergeron, Ashley; Daly, Amanda; Parker, Ruth M; Davis, Terry C; Shrank, William H; Lambert, Bruce

2012-12-01

Medication guides are required documents to be distributed to patients in order to convey serious risks associated with certain prescribed medicines. Little is known about the effectiveness of this information to adequately inform patients on safe use. To examine the readability, suitability, and comprehensibility of medication guides, particularly for those with limited literacy. Assessments of suitability and readability of 185 medication guides, and a sub-study examining change in suitability and readability from 2006 to 2010 among 32 of the medication guides (Study 1); 'open book' comprehension assessment of medication guides (Study 2). Two general internal medicine clinics in Chicago, IL. Four hundred and forty-nine adults seeking primary care services, ages 18-85. For Study 1, the Suitability Assessment of Materials (SAM) and Lexile score for readability. For Study 2, a tailored comprehension assessment of content found in three representative medication guides. The 185 analyzed medication guides were on average 1923 words (SD = 1022), with a mean reading level of 10-11th grade. Only one medication guide was deemed suitable in SAM analyses. None provided summaries or reviews, or framed the context first, while very few were rated as having made the purpose evident (8 %), or limited the scope of content (22 %). For Study 2, participants' comprehension of medication guides was poor (M = 52.7 % correct responses, SD = 22.6). In multivariable analysis, low and marginal literacy were independently associated with poorer understanding (β = -14.3, 95 % CI -18.0 - -10.6, p < 0.001; low: β = -23.7, 95 % CI -28.3 - -19.0, p < 0.001). Current medication guides are of little value to patients, as they are too complex and difficult to understand especially for individuals with limited literacy. Explicit guidance is offered for improving these print materials.

Top-nozzle mounted replacement guide pin assemblies

International Nuclear Information System (INIS)

Gilmore, C.B.; Andrews, W.H.

1993-01-01

A replacement guide pin assembly is provided for aligning a nuclear fuel assembly with an upper core plate of a nuclear reactor core. The guide pin assembly includes a guide pin body having a radially expandable base insertable within a hole in the top nozzle, a ferrule insertable within the guide pin base and capable of imparting a radially and outwardly directed force on the expandable base to expand it within the hole of the top nozzle and thereby secure the guide pin body to the top nozzle in response to a predetermined displacement of the ferrule relative to the guide pin body along its longitudinal axis, and a lock screw interfitted with the ferrule and threaded into the guide pin body so as to produce the predetermined displacement of the ferrule. (author)

CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

Energy Technology Data Exchange (ETDEWEB)

Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

2011-10-15

Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

International Nuclear Information System (INIS)

Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel

2011-01-01

Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 ± 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 ± 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 ± 33 vs. n = 126 ± 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

SU-C-210-04: Considerable Pancreatic Tumor Motion During Breath-Hold Measured Using Intratumoral Fiducials On Fluoroscopic Movies

Energy Technology Data Exchange (ETDEWEB)

Lens, E; Horst, A van der; Versteijne, E; Tienhoven, G van; Bel, A [Academic Medical Center, Amsterdam (Netherlands)

2015-06-15

Purpose: Using a breath hold (BH) technique during radiotherapy of pancreatic tumors is expected to reduce intra-fractional motion. The aim of this study was to evaluate the tumor motion during BH. Methods: In this pilot study, we included 8 consecutive pancreatic cancer patients. All had 2– 4 intratumoral gold fiducials. Patients were asked to perform 3 consecutive 30-second end-inhale BHs on day 5, 10 and 15 of their three-week treatment. During BH, airflow through a mouthpiece was measured using a spirometer. Any inadvertent flow of air during BH was monitored for all patients. We measured tumor motion on lateral fluoroscopic movies (57 in total) made during BH. In each movie the fiducials as a group were tracked over time in superior-inferior (SI) and anterior-posterior (AP) direction using 2-D image correlation between consecutive frames. We determined for each patient the range of intra-BH motion over all movies; we also determined the absolute means and standard deviations (SDs) for the entire patient group. Additionally, we investigated the relation between inadvertent airflow during BH and the intra-BH motion. Results: We found intra-BH tumor motion of up to 12.5 mm (range, 1.0–12.5 mm) in SI direction and up to 8.0 mm (range, 1.0–8.0 mm) in AP direction. The absolute mean motion over the patient population was 4.7 (SD: 3.0) mm and 2.8 (SD: 1.2) mm in the SI and AP direction, respectively. Patients were able to perform stable consecutive BHs; during only 20% of the movies we found very small airflows (≤ 65 ml). These were mostly stepwise in nature and could not explain the continuous tumor motions we observed. Conclusion: We found substantial (up to 12.5 mm) pancreatic tumor motion during BHs. We found minimal inadvertent airflow, seen only during a minority of BHs, and this did not explain the obtained results. This work was supported by the foundation Bergh in het Zadel through the Dutch Cancer Society (KWF Kankerbestrijding) project No. UVA 2011-5271.