WorldWideScience

Sample records for intraoperative fluoroscopic dose

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

    Science.gov (United States)

    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.

  2. 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

  3. 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

  4. 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)

  5. 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.

  6. 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

  7. Intraoperative three-dimensional fluoroscopy after transpedicular positioning of Kirschner-wire versus conventional intraoperative biplanar fluoroscopic control: A retrospective study of 345 patients and 1880 pedicle screws

    Directory of Open Access Journals (Sweden)

    Ghassan Kerry

    2014-01-01

    Full Text Available Study Design: Retrospective study. Objective: The aim was to find out whether intraoperative three-dimensional imaging after transpedicular positioning of Kirschner wire (K-wire in lumbar and thoracic posterior instrumentation procedures is of benefit to the patients and if this technique is accurately enough to make a postoperative screw position control through computer tomography (CT dispensable. Patients and Methods: Lumbar and thoracic posterior instrumentation procedures conducted at our department between 2002 and 2012 were retrospectively reviewed. The patients were divided into two groups: group A, including patients who underwent intraoperative three-dimensional scan after transpedicular positioning of the K-wire and group B, including patients who underwent only intraoperative biplanar fluoroscopy. An early postoperative CT of the instrumented section was done in all cases to assess the screw position. The rate of immediate intraoperative correction of the K-wires in cases of mal-positioning, as well as the rate of postoperative screw revisions, was measured. Results: In general, 345 patients (1880 screws were reviewed and divided into two groups; group A with 225 patients (1218 screws and group B with 120 patients (662 screws. One patient (0.44% (one screw [0.082%] of group A underwent postoperative screw correction while screw revisions were necessary in 14 patients (11.7% (28 screws [4.2%] of group B. Twenty-three patients (10.2% (28 K-wires [2.3%] of group A underwent intraoperative correction due to primary intraoperative detected K-wire mal-position. None of the corrected K-wires resulted in a corresponding neurological deficit. Conclusion: Three-dimensional imaging after transpedicular K-wire positioning leads to solid intraoperative identification of misplaced K-wires prior to screw placement and reduces screw revision rates compared with conventional fluoroscopic control. When no clinical deterioration emerges, a

  8. 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

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

    Science.gov (United States)

    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

  10. 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

  11. Radiation dose to the operator during fluoroscopically guided spine procedures

    Energy Technology Data Exchange (ETDEWEB)

    Roccatagliata, Luca; Pravata, Emanuele; Cianfoni, Alessandro [Department of Neuroradiology, Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano (Switzerland); Presilla, Stefano [Unita di Fisica Medica, Ente Ospedaliero Cantonale (EOC), Bellinzona (Switzerland)

    2017-09-15

    Fluoroscopy is widely used to guide diagnostic and therapeutic spine procedures. The purpose of this study was to quantify radiation incident on the operator (operator Air Kerma) during a wide range of fluoroscopy-guided spine procedures and its correlation with the amount of radiation incident on the patient (Kerma Area Product - KAP). We retrospectively included 57 consecutive fluoroscopically guided spine procedures. KAP [Gy cm{sup 2}] and total fluoroscopy time were recorded for each procedure. An electronic dosimeter recorded the operator Air Kerma [μGy] for each procedure. Operator Air Kerma for each procedure, correlation between KAP and operator Air Kerma, and between KAP and fluoroscopy time was obtained. Operator Air Kerma was widely variable across procedures, with median value of 6.4 μGy per procedure. Median fluoroscopy time and median KAP per procedure were 2.6 min and 4.7 Gy cm{sup 2}, respectively. There was correlation between operator Air Kerma and KAP (r{sup 2} = 0.60), with a slope of 1.6 μGy Air Kerma per unit Gy cm{sup 2} KAP incident on the patient and between fluoroscopy time and KAP (r{sup 2} = 0.63). Operator Air Kerma during individual fluoroscopy-guided spine procedures can be approximated from the commonly and readily available information of the total amount of radiation incident on the patient, measured as KAP. (orig.)

  12. 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

  13. 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)

  14. 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.

  15. 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)

  16. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  18. 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

  19. 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.)

  20. 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.

  1. 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

  2. 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)

  3. 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.

  4. 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

  5. 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.

  6. 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)

  7. 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

  8. 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)

  9. 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)

  10. 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.

  11. 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

  12. 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

  13. 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.

  14. 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.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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

  1. Dose volume relationships for intraoperatively irradiated saphenous nerve

    International Nuclear Information System (INIS)

    Gillette, E.L.; Powers, B.E.; Gillette, S.M.; Thames, H.D.; Childs, G.; Vujaskovic, Z.; LaRue, S.M.

    1995-01-01

    Purpose/Objective: Intraoperative radiation therapy (IORT) is used to deliver high single doses of radiation to the tumor bed following surgical removal of various abdominal malignancies. The advantage of IORT is the ability to remove sensitive normal tissues from the treatment field and to limit the volume of normal tissue irradiated. The purpose of this study was to determine dose-volume relationships for retroperitoneal tissues. Materials and methods: 134 adult beagle dogs were irradiated to the surgically exposed paraaortic area. Normal tissues included in the treatment field were aorta, peripheral nerve, ureter, bone and muscle. Groups of 4 - 8 dogs were irradiated to doses ranging from 18 - 54 Gy for a 2x5 cm field, from 12 - 46 Gy for a 4x5 cm field, and 12 - 42 Gy to an 8x5 cm field. The radiations were done using 6 MeV electrons from a linear accelerator. Dogs were observed for three years after radiation. Electrophysiologic procedures were done prior to irradiation and annually following irradiation. The procedures included electromyography of the pelvic limb and paralumbar muscles supplied by the L1 to S1 spinal nerves to determine presence and degree of motor unit disease. Motor nerve conduction velocities of the proximal and distal sciatic nerves were determined. Sensory nerve conduction velocities of the saphenous nerve were also determined. Evoked lumbosacral and thoraco-lumbar spinal cord potentials were evaluated following stimulation of the left sciatic nerve. In addition to electrophysiologic studies, neurologic examinations were done prior to treatment and at six month intervals for the three year observation period. At the three year time period, dogs were euthanatized, sections of peripheral nerve taken, routinely processed, stained with Masson's trichrome and evaluated histomorphometrically using point count techniques. Results: Twenty-two dogs were euthanatized prior to the three year observation period due to peripheral nerve damage

  2. Influence of Flat-Panel Fluoroscopic Equipment Variables on Cardiac Radiation Doses

    International Nuclear Information System (INIS)

    Nickoloff, Edward L.; Lu Zhengfeng; Dutta, Ajoy; So, James; Balter, Stephen; Moses, Jeffrey

    2007-01-01

    Purpose. To assess the influence of physician-selectable equipment variables on the potential radiation dose reductions during cardiac catheterization examinations using modern imaging equipment. Materials. A modern bi-plane angiography unit with flat-panel image receptors was used. Patients were simulated with 15-30 cm of acrylic plastic. The variables studied were: patient thickness, fluoroscopy pulse rates, record mode frame rates, image receptor field-of-view (FoV), automatic dose control (ADC) mode, SID/SSD geometry setting, automatic collimation, automatic positioning, and others. Results. Patient radiation doses double for every additional 3.5-4.5 cm of soft tissue. The dose is directly related to the imaging frame rate; a decrease from 30 pps to 15 pps reduces the dose by about 50%. The dose is related to [(FoV) -N ] where 2.0 < N < 3.0. Suboptimal positioning of the patient can nearly double the dose. The ADC system provides three selections that can vary the radiation level by 50%. For pediatric studies (2-5 years old), the selection of equipment variables can result in entrance radiation doses that range between 6 and 60 cGy for diagnostic cases and between 15 and 140 cGy for interventional cases. For adult studies, the equipment variables can produce entrance radiation doses that range between 13 and 130 cGy for diagnostic cases and between 30 and 400 cGy for interventional cases. Conclusions. Overall dose reductions of 70-90% can be achieved with pediatric patients and about 90% with adult patients solely through optimal selection of equipment variables

  3. Single high dose intraoperative electrons for advanced stage pancreatic cancer: Phase I pilot study

    International Nuclear Information System (INIS)

    Goldson, A.L.; Ashaveri, E.; Espinoza, M.C.

    1981-01-01

    Phase I toxicity studies with intraoperative radiotherapy proved to be a feasible adjunct to surgery for unresectable malignancies of the pancreas at Howard University Hospital. There have been minimal side effects or complications related to the combination of limited surgical decompression and intraoperative radiotherapy alone. The toxic effects of intraoperative radiotherapy on normal tissues is being assessed on a dose volume basis. Doses of 2000 to 2500 rad in a single exposure to include the pancreas, regional nodes and duodenum are acceptable if the total treatment volume is less than or equal to 100 cm. The tumoricidal effects on the cancer are demonstratable when one reviews the pathological specimens that illustrate massive tumor necrosis and fibros replacement, but in all cases reviewed, viable cancer was noted. Intraoperative radiotherapy, therefore, represents a significant boost dose for resectable, partially resectable or non-resectable tumors when added to conventional external beam irradiation and/or chemotherapy. Preliminary clinical data and minimal toxicity justifies further investigation

  4. Dose optimization of intra-operative high dose rate interstitial brachytherapy implants for soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Jamema Swamidas

    2009-01-01

    Full Text Available Objective : A three dimensional (3D image-based dosimetric study to quantitatively compare geometric vs. dose-point optimization in combination with graphical optimization for interstitial brachytherapy of soft tissue sarcoma (STS. Materials and Methods : Fifteen consecutive STS patients, treated with intra-operative, interstitial Brachytherapy, were enrolled in this dosimetric study. Treatment plans were generated using dose points situated at the "central plane between the catheters", "between the catheters throughout the implanted volume", at "distances perpendicular to the implant axis" and "on the surface of the target volume" Geometrically optimized plans had dose points defined between the catheters, while dose-point optimized plans had dose points defined at a plane perpendicular to the implant axis and on the target surface. Each plan was graphically optimized and compared using dose volume indices. Results : Target coverage was suboptimal with coverage index (CI = 0.67 when dose points were defined at the central plane while it was superior when the dose points were defined at the target surface (CI=0.93. The coverage of graphically optimized plans (GrO was similar to non-GrO with dose points defined on surface or perpendicular to the implant axis. A similar pattern was noticed with conformity index (0.61 vs. 0.82. GrO were more conformal and less homogeneous compared to non-GrO. Sum index was superior for dose points defined on the surface of the target and relatively inferior for plans with dose points at other locations (1.35 vs. 1.27. Conclusions : Optimization with dose points defined away from the implant plane and on target results in superior target coverage with optimal values of other indices. GrO offer better target coverage for implants with non-uniform geometry and target volume.

  5. Retrospective analysis of dose delivery in intra-operative high dose rate brachytherapy

    International Nuclear Information System (INIS)

    Oh, M.; Avadhani, J.S.; Malhotra, H.K.; Cunningham, B.; Tripp, P.; Jaggernauth, W.; Podgorsak, M.B.

    2007-01-01

    Background. This study was performed to quantify the inaccuracy in clinical dose delivery due to the incomplete scatter conditions inherent in intra-operative high dose rate (IOHDR) brachytherapy. Methods. Treatment plans of 10 patients previously treated in our facility, which had irregular shapes of treated areas, were used. Treatment geometries reflecting each clinical case were simulated using a phantom assembly with no added build-up on top of the applicator. The treatment planning geometry (full scatter surrounding the applicator) was subsequently simulated for each case by adding bolus on top of the applicator. Results. For geometries representing the clinical IOHDR incomplete scatter environment, measured doses at the 5 mm and 10 mm prescription depths were lower than the corresponding prescribed doses by about 7.7% and 11.1%, respectively. Also, for the two prescription methods, an analysis of the measured dose distributions and their corresponding treatment plans showed average decreases of 1.2 mm and 2.2 mm in depth of prescription dose, respectively. Conclusions. Dosimetric calculations with the assumption of an infinite scatter environment around the applicator and target volume have shown to result in dose delivery errors that significantly decrease the prescription depth for IOHDR treatment.(author)

  6. Radiation dose reduction in fluoroscopic procedures: left varicocele embolization as a model

    Energy Technology Data Exchange (ETDEWEB)

    Verstandig, Anthony G.; Shraibman, Vladimir [Shaare Zedek Medical Center, Department of Radiology, Interventional Radiology Unit, POB 3235, Jerusalem (Israel); Shamieh, Bashar [St. Joseph Hospital, Department of Radiology, Jerusalem (Israel); Raveh, David [Shaare Zedek Medical Center, Infectious Diseases Unit, POB 3235, Jerusalem (Israel)

    2015-06-01

    To investigate the effect of a radiation reduction program on total dose, fluoroscopy dose per second corrected for body habitus and degree of collimation in left varicocele embolizations (LVE). A radiation reduction program for LVE was implemented, consisting of a technique minimizing fluoroscopy time, using low-dose presets, virtual collimation, and virtual patient positioning. Height, weight, fluoroscopy time, kerma area product (KAP) and reference air kerma (Ka,r) were recorded for 100 consecutive cases satisfying the inclusion criteria. For each patient, a device specific dose correction factor, determined using a phantom, was used to standardize the KAP to that of the cylindrical diameter of the standard man and a collimation index was derived from the KAP and Ka,r. Median fluoroscopy time was 3 minutes (mean 4.5, range 1-23.8). Median KAP was 0.54 Gy/cm{sup 2} (mean 0.82, range 0.12-6.52). There was a significant decrease in KAP/second corrected for cylindrical diameter (p < 0.001) and the collimation index (p < 0.001) over time. This study shows that a dedicated dose reduction program can achieve very low total radiation dose rates for LVE. The significant decrease in collimation index and standardized KAP per second during this study suggest a learning curve for collimation. (orig.)

  7. 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)

  8. 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)

  9. 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)

  10. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model

    International Nuclear Information System (INIS)

    Kinsella, T.J.; DeLuca, A.M.; Barnes, M.; Anderson, W.; Terrill, R.; Sindelar, W.F.

    1991-01-01

    Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy

  11. 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

  12. Measurements of surgeons' exposure to ionizing radiation dose during intraoperative use of C-arm fluoroscopy.

    Science.gov (United States)

    Lee, Kisung; Lee, Kyoung Min; Park, Moon Seok; Lee, Boram; Kwon, Dae Gyu; Chung, Chin Youb

    2012-06-15

    Measurement of radiation dose from C-arm fluoroscopy during a simulated intraoperative use in spine surgery. OBJECTIVE.: To investigate scatter radiation doses to specific organs of surgeons during intraoperative use of C-arm fluoroscopy in spine surgery and to provide practical intraoperative guidelines. There have been studies that reported the radiation dose of C-arm fluoroscopy in various procedures. However, radiation doses to surgeons' specific organs during spine surgery have not been sufficiently examined, and the practical intraoperative radioprotective guidelines have not been suggested. Scatter radiation dose (air kerma rate) was measured during the use of a C-arm on an anthropomorphic chest phantom on an operating table. Then, a whole body anthropomorphic phantom was located besides the chest phantom to simulate a surgeon, and scatter radiation doses to specific organs (eye, thyroid, breast, and gonads) and direct radiation dose to the surgeon's hand were measured using 4 C-arm configurations (standard, inverted, translateral, and tube translateral). The effects of rotating the surgeon's head away from the patient and of a thyroid shield were also evaluated. Scatter radiation doses decreased as distance from the patient increased during C-arm fluoroscopy use. The standard and translateral C-arm configurations caused lower scatter doses to sensitive organs than inverted and tube translateral configurations. Scatter doses were highest for breast and lowest for gonads. The use of a thyroid shield and rotating the surgeon's head away from the patient reduced scatter radiation dose to the surgeon's thyroid and eyes. The direct radiation dose was at least 20 times greater than scatter doses to sensitive organs. The following factors could reduce radiation exposure during intraoperative use of C-arm; (1) distance from the patient, (2) C-arm configuration, (3) radioprotective equipments, (4) rotating the surgeons' eyes away from the patient, and (5) avoiding

  13. Patient dose assessment from fluoroscopic procedures at Korle-Bu Teaching Hospital

    International Nuclear Information System (INIS)

    Gyekye, P. K.

    2008-06-01

    Organ and effective dose to ninety (90) patients undergoing myelogram, urethrogram, barium swallow, barium meal and barium enema examinations at the KorIe-Bu Teaching Hospital was estimated using the Monte Carlo Code (PCXMC). Free in air measurements were made with a calibrated ionisation chamber to estimate the entrance surface air kerma for each examination. Evaluation of fluoroscopy beam on time and number of radiographs taken per patient was done for all the examinations considered and studies were done on how they affect patient dose. Dose area product (DAP) was calculated from the entrance surface air kerma and the area of the beam on the surface of the patient and compared with internationally accepted reference levels. Excess relative risk of site specific solid cancer and all solid cancers excluding thyroid and Non-melanoma skin cancers incidences were estimated for the various examinations using Biological Effects of Ionising Radiation VII Committee risk model from the knowledge of the mean effective doses for each examination. The mean effective dose was found to be 0.29 :±: 0.07 mSv for urethrogram, 0.84:±: 0.13 mSv for barium swallow, 3.15 :±: 0.44 mSv for barium meal, 6.24 :±: 0.7 mSv for barium enema and 0.38 :I: 0.05 mSv for myelogram examinations. The estimated mean dose area product (DAP) was found to be 3.55 :±: 0.95 Gycm2 for urethrogram, 16.44:1: 2.60 Gycm2 for barium swallow, 50.81 :±: 7.04 Gycm2 for barium meal, 99.69 :±: 10.85 Gycm2 for barium enema and 9.32 :±: 0.99 Gycm2 for myelogram examinations. The estimated excess relative risk for the occurrence of all solid cancer was found to be 9.5700E-S and 1.6530E-4 for males and females respectively undergoing urethrogram examination, 2.7720E-4 and 4.7880E-4 for males and females respectively undergoing barium swallow examination, 1.0395E-3 and 1.7955E-3 for males and females respectively undergoing barium meal examination, 2.0592E-3 and 3.5568E-3 for males and females respectively

  14. Contemporary Australian dose area product levels in the fluoroscopic investigation of paediatric congenital heart disease

    International Nuclear Information System (INIS)

    Jones, T.; Brennan, P.C.; Mello-Thoms, C.; Ryan, E.

    2017-01-01

    This study examines radiation dose levels delivered to children from birth to 15 y of age in the investigation of congenital heart disease (CHD) at a major Sydney children's hospital. The aims are to compare values with those derived from similar studies, to provide a template for more consistent dose reporting, to establish local and national diagnostic reference levels and to contribute to the worldwide paediatric dosimetry database. A retrospective review of 1007 paediatric procedural records was undertaken. The cohort consisted of 795 patients over a period from January 2007 to December 2012 who have undergone cardiac catheterisation for the investigation of CHD. The age range included was from the day of birth to 15 y. Archived dose area product (DAP) and fluoroscopy time (FT) readings were retrieved and analysed. The mean, median, 25. and 75. percentile DAP levels were calculated for six specific age groupings. The 75. percentile DAP values for the specific age categories were as follows: 0-30 d-1.9 Gy cm 2 , 1-12 months-2.9 Gy cm 2 , 1-3 y-5.3 Gy cm 2 , 3-5 y-6.2 Gy cm 2 , 5-10 y-7.5 Gy cm 2 and 10-15 y-17.3 Gy cm 2 . These levels were found to be lower than the values reported in comparable overseas studies. Individual year-specific levels were determined, and it is proposed that these are more useful than the common grouping method. The age-specific 75. percentile DAP levels outlined in this study can be used as baseline local diagnostic reference levels. The needs for the standardisation of DAP reporting and for a greater range of age-specific diagnostic reference levels have been highlighted. For the first time, Australian dose values for paediatric cardiac catheterisation are presented. (authors)

  15. 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.

  16. Effect of a television digital noise reduction device on fluoroscopic image quality and dose rate

    International Nuclear Information System (INIS)

    Jaffe, C.C.; Orphanoudakis, S.C.; Ablow, R.C.

    1982-01-01

    In conventional fluoroscopy, the current, and therefore the dose rate, is usually determined by the level at which the radiologist visualizes a just tolerable amount of photon ''mottle'' on the video monitor. In this study, digital processing of the analogue video image reduced noise and generated a television image at half the usual exposure rate. The technique uses frame delay to compare an incoming frame with the preceding output frame. A first-order recursive filter implemented under a motion-detection scheme operates on the image of a point-by-point basis. This effective motion detection algorithm permits noise suppression without creating noticeable lag in moving structures. Eight radiologists evaluated images of vesicoureteral reflux in the pig for noise, contrast, resolution, and general image quality on a five-point preferential scale. They rated the digitally processed fluoroscopy images equivalent in diagnostic value to unprocessed images

  17. Intraoperative use of low-dose recombinant activated factor VII during thoracic aortic operations.

    Science.gov (United States)

    Andersen, Nicholas D; Bhattacharya, Syamal D; Williams, Judson B; Fosbol, Emil L; Lockhart, Evelyn L; Patel, Mayur B; Gaca, Jeffrey G; Welsby, Ian J; Hughes, G Chad

    2012-06-01

    Numerous studies have supported the effectiveness of recombinant activated factor VII (rFVIIa) for the control of bleeding after cardiac procedures; however safety concerns persist. Here we report the novel use of intraoperative low-dose rFVIIa in thoracic aortic operations, a strategy intended to improve safety by minimizing rFVIIa exposure. Between July 2005 and December 2010, 425 consecutive patients at a single referral center underwent thoracic aortic operations with cardiopulmonary bypass (CPB); 77 of these patients received intraoperative low-dose rFVIIa (≤60 μg/kg) for severe coagulopathy after CPB. Propensity matching produced a cohort of 88 patients (44 received intraoperative low-dose rFVIIa and 44 controls) for comparison. Matched patients receiving intraoperative low-dose rFVIIa got an initial median dose of 32 μg/kg (interquartile range [IQR], 16-43 μg/kg) rFVIIa given 51 minutes (42-67 minutes) after separation from CPB. Patients receiving intraoperative low-dose rFVIIa demonstrated improved postoperative coagulation measurements (partial thromboplastin time 28.6 versus 31.5 seconds; p=0.05; international normalized ratio, 0.8 versus 1.2; pproduct transfusions (2.5 versus 5.0 units; p=0.05) compared with control patients. No patient receiving intraoperative low-dose rFVIIa required postoperative rFVIIa administration or reexploration for bleeding. Rates of stroke, thromboembolism, myocardial infarction, and other adverse events were equivalent between groups. Intraoperative low-dose rFVIIa led to improved postoperative hemostasis with no apparent increase in adverse events. Intraoperative rFVIIa administration in appropriately selected patients may correct coagulopathy early in the course of refractory blood loss and lead to improved safety through the use of smaller rFVIIa doses. Appropriately powered randomized studies are necessary to confirm the safety and efficacy of this approach. Copyright © 2012 The Society of Thoracic Surgeons

  18. Dose optimisation for intraoperative cone-beam flat-detector CT in paediatric spinal surgery

    International Nuclear Information System (INIS)

    Petersen, Asger Greval; Eiskjaer, Soeren; Kaspersen, Jon

    2012-01-01

    During surgery for spinal deformities, accurate placement of pedicle screws may be guided by intraoperative cone-beam flat-detector CT. The purpose of this study was to identify appropriate paediatric imaging protocols aiming to reduce the radiation dose in line with the ALARA principle. Using O-arm registered (Medtronic, Inc.), three paediatric phantoms were employed to measure CTDI w doses with default and lowered exposure settings. Images from 126 scans were evaluated by two spinal surgeons and scores were compared (Kappa statistics). Effective doses were calculated. The recommended new low-dose 3-D spine protocols were then used in 15 children. The lowest acceptable exposure as judged by image quality for intraoperative use was 70 kVp/40 mAs, 70 kVp/80 mAs and 80 kVp/40 mAs for the 1-, 5- and 12-year-old-equivalent phantoms respectively (kappa = 0,70). Optimised dose settings reduced CTDI w doses 89-93%. The effective dose was 0.5 mSv (91-94,5% reduction). The optimised protocols were used clinically without problems. Radiation doses for intraoperative 3-D CT using a cone-beam flat-detector scanner could be reduced at least 89% compared to manufacturer settings and still be used to safely navigate pedicle screws. (orig.)

  19. 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

  20. 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.

  1. Assessment of intraoperative 3D imaging alternatives for IOERT dose estimation

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Vazquez, Veronica; Marinetto, Eugenio [Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid (Spain); Guerra, Pedro [Univ. Politecnica de Madrid (Spain). Dept. de Ingenieria Electronica; Centro de Investigacion Biomedica en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Zaragoza (Spain); Valdivieso-Casique, Manlio Fabio [GMV SA, Madrid (Spain); Calvo, Felipe Angel [Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid (Spain); Hospital General Univ. Gregorio Maranon, Madrid (Spain). Dept. de Oncologia; Univ. Complutense de Madrid (Spain). Facultad de Medicina; Alvarado-Vazquez, Eduardo [Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid (Spain); Hospital General Univ. Gregorio Maranon, Madrid (Spain). Servicio de Oncologia Radioterapica; Sole, Claudio Vicente [Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid (Spain); Instituto de Radiomedicina, Santiago (Chile). Service of Radiation Oncology; Vosburgh, Kirby Gannett [Harvard Medical School, Brigham and Women' s Hospital, Boston, MA (United States). Department of Radiology; Desco, Manuel; Pascau, Javier [Instituto de Investigacion Sanitaria Gregorio Maranon, Madrid (Spain); Univ. Carlos III de Madrid (Spain). Dept. de Bioingenieria e Ingenieria Aeroespacial; Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Madrid (Spain)

    2017-10-01

    Intraoperative electron radiation therapy (IOERT) involves irradiation of an unresected tumour or a post-resection tumour bed. The dose distribution is calculated from a preoperative computed tomography (CT) study acquired using a CT simulator. However, differences between the actual IOERT field and that calculated from the preoperative study arise as a result of patient position, surgical access, tumour resection and the IOERT set-up. Intraoperative CT imaging may then enable a more accurate estimation of dose distribution. In this study, we evaluated three kilovoltage (kV) CT scanners with the ability to acquire intraoperative images. Our findings indicate that current IOERT plans may be improved using data based on actual anatomical conditions during radiation. The systems studied were two portable systems (''O-arm'', a cone-beam CT [CBCT] system, and ''BodyTom'', a multislice CT [MSCT] system) and one CBCT integrated in a conventional linear accelerator (LINAC) (''TrueBeam''). TrueBeam and BodyTom showed good results, as the gamma pass rates of their dose distributions compared to the gold standard (dose distributions calculated from images acquired with a CT simulator) were above 97% in most cases. The O-arm yielded a lower percentage of voxels fulfilling gamma criteria owing to its reduced field of view (which left it prone to truncation artefacts). Our results show that the images acquired using a portable CT or even a LINAC with on-board kV CBCT could be used to estimate the dose of IOERT and improve the possibility to evaluate and register the treatment administered to the patient.

  2. Assessment of intraoperative 3D imaging alternatives for IOERT dose estimation

    International Nuclear Information System (INIS)

    Garcia-Vazquez, Veronica; Marinetto, Eugenio; Guerra, Pedro; Valdivieso-Casique, Manlio Fabio; Calvo, Felipe Angel

    2017-01-01

    Intraoperative electron radiation therapy (IOERT) involves irradiation of an unresected tumour or a post-resection tumour bed. The dose distribution is calculated from a preoperative computed tomography (CT) study acquired using a CT simulator. However, differences between the actual IOERT field and that calculated from the preoperative study arise as a result of patient position, surgical access, tumour resection and the IOERT set-up. Intraoperative CT imaging may then enable a more accurate estimation of dose distribution. In this study, we evaluated three kilovoltage (kV) CT scanners with the ability to acquire intraoperative images. Our findings indicate that current IOERT plans may be improved using data based on actual anatomical conditions during radiation. The systems studied were two portable systems (''O-arm'', a cone-beam CT [CBCT] system, and ''BodyTom'', a multislice CT [MSCT] system) and one CBCT integrated in a conventional linear accelerator (LINAC) (''TrueBeam''). TrueBeam and BodyTom showed good results, as the gamma pass rates of their dose distributions compared to the gold standard (dose distributions calculated from images acquired with a CT simulator) were above 97% in most cases. The O-arm yielded a lower percentage of voxels fulfilling gamma criteria owing to its reduced field of view (which left it prone to truncation artefacts). Our results show that the images acquired using a portable CT or even a LINAC with on-board kV CBCT could be used to estimate the dose of IOERT and improve the possibility to evaluate and register the treatment administered to the patient.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  4. Phase space determination from measured dose data for intraoperative electron radiation therapy.

    Science.gov (United States)

    Herranz, E; Herraiz, J L; Ibáñez, P; Pérez-Liva, M; Puebla, R; Cal-González, J; Guerra, P; Rodríguez, R; Illana, C; Udías, J M

    2015-01-07

    A procedure to characterize beams of a medical linear accelerator for their use in Monte Carlo (MC) dose calculations for intraoperative electron radiation therapy (IOERT) is presented. The procedure relies on dose measurements in homogeneous media as input, avoiding the need for detailed simulations of the accelerator head. An iterative algorithm (EM-ML) has been employed to extract the relevant details of the phase space (PHSP) of the particles coming from the accelerator, such as energy spectra, spatial distribution and angle of emission of particles. The algorithm can use pre-computed dose volumes in water and/or air, so that the machine-specific tuning with actual data can be performed in a few minutes. To test the procedure, MC simulations of a linear accelerator with typical IOERT applicators and energies, have been performed and taken as reference. A solution PHSP derived from the dose produced by the simulated accelerator has been compared to the reference PHSP. Further, dose delivered by the simulated accelerator for setups not included in the fit of the PHSP were compared to the ones derived from the solution PHSP. The results show that it is possible to derive from dose measurements PHSP accurate for IOERT MC dose estimations.

  5. Peripheral nerve and ureteralo tolerance to intraoperative radiation therapy; Clinical and dose-response analysis

    Energy Technology Data Exchange (ETDEWEB)

    Shaw, E.G.; Gunderson, L.L.; Martin, J.K.; Baers, R.W.; Nagorney, D.M.; Podratz, K.C. (Mayo Clinic, Rochester, MN (USA))

    1990-07-01

    Between April 1981 and July 1984, 51 received intraoperative radiation therapy (IORT) as a component of therapy for the management of primary of recurrent pelvic malignancies which were initially unresectable for cure. For these patients, curative surgical alternatives did not exist, or would have involved extensive procedures such as pelvic exenteration, distal sacrectomy, hemipelvectomy, or hemicorporectemy. The primary disease was colorectal in 38 patients. Treatment consisted of external beam radiation (range 3000 to 6890 cGy, median 5040 cGy), surgical debulking when feasible, and an intraoperative electron beam boost to the gross of microscopic residual desease (dose range 1000 to 2500 cGy, median 1750 cGy) utilizing 9-18 MeV electrons. The most common IORT associated toxicities were peripheral neurophaty and ureteral obstruction. None were life-threatening or fatal in severity. Of the 50 patients evaluable for neurotoxicity analysis, 16 (32%) developed peripheral neurophaty consisting of pain in 16 patients, numbness and tingling in 11, and weakness in 8. The pain, numbness and tingling resolved in about 40% of patients, while weakness resolved in only 1 of 8. Sixteen ureters were initially unobstructed by tumor at the time of IORT. Of these, 10 (63%) subsequently showed evidence of obstruction and hydronephrosis. The development of neurotoxicity was more common at IORT doses of 1500 cGy or more versus 1000 cGy. Ureteral obstruction with hydronephrosis occurred more frequently at IORT doses of 1250 cGy or more compared to 1000 cGy. There was no relationship between the likelihood of developing complications and the total external beam dose. The observed dependence of human nerve toxicity primarily on the IORT dose is consistent with data generated form animal experiments. (author). 21 refs.; 4 tabs.

  6. Characterization of a team intraoperative Radiation therapy and measurement of dose in skin with film radiochromic

    International Nuclear Information System (INIS)

    Onses Segarra, A.; Sancho Kolster, I.; Eraso Urien, A.; Pla Farnos, M. J.; Picon Olmos, C.

    2015-01-01

    This paper presents the results of the initial reference state of intraoperative radiotherapy equipment lntraBeam, for performing breast treatments are analyzed. To the initial reference team was established for the following dosimetric and geometric beam parameters: percentage depth dose, beam quality, isotropy, linearity and mechanical and geometric integrity for both the source RX as for different spherical applicators of the team. Based on these checks, a program of periodic quality control was established. One of the exclusion criteria for this treatment is that the tumor is less than l cm of the skin, yaque give doses received in this organ can be high. For this reason it is important to know exactly the absorbed dose in skin during these treatments. In this regard we have implemented a system for measuring the skin dose during treatment with Radiochromic film, placing 4 film segments in fixed positions of the skin around the surgical incision. It .ha obtained calibration curve of sterilized films and compared the results with a calibration beam megavoltage. The results of the skin dose measurements are compared with theoretical estimates given by the planning system equipment. The results indicate the need to measure individually the skin dose for these treatments. (Author)

  7. 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.

  8. Assessment of radiation dose due to fluoroscopic procedures in patients at some selected facilities in the Greater Accra Region, Ghana

    International Nuclear Information System (INIS)

    Gyasi, E.

    2013-07-01

    Radiation doses to 182 adults patients who underwent barium enema, barium meal, barium swallow, myelogram, hysterosalpingography and urethrogram examination collectively at facilities A and B were investigated. Radiation dose was measured using kerma-area-product (KAP) meter. From the KAP readings, patient's data and other relevant information from the control console, effective dose and selective organ doses were estimated using Monte Carlo program software (PCXMC version 1.5). Quality control tests performed on the two fluoroscopy machines were found to be within the acceptance criteria. Mean effective doses were found to be 8.45 ± 0.38mSv, 7.628 ± 0.42 mSv, 1.46 ± 0.13 mSv, 2.02 ± 0.16 mSv, 0.32 ± 0.03 mSv for barium enema, barium meal, barium swallow, myelogram and urethrogram examinations respectively at Facility A. At Facility B the mean effective dose were found to be 4.12 ± 0.15 mSv, 1.83 ± 0.10 mSv, 0.81 ± 0.04 mSv, 0.53 ± 0.036 mSv and 0.27 ± 0.01 mSv for barium enema, barium meal, barium swallow, myelogram, hysterosalpingography and urethrogram examination respectively. Thymus received the highest organ dose of 29.19± 2.07mGy during barium meal studies at Facility A of all the procedures in the two hospitals. Magnitude of organ doses was observed to to be in relation with the closeness to or in the direction of the primary beam of radiation. Organ and effective doses from Facility A were relatively higher than those from Facility B in comparison by a factor of a about 2 with the exception of the barium meal examination at Facility A which was by a factor of about 4. The measured KAP readings fro the two facilities were below the international accepted reference levels with the exception of barium meal examination at Facility A which recorded a higher value of 25.96 ± 1.83 Gy.cm 2 as compared to ICRP (2001) reference value of 25 Gy.cm 2 . Longer radiation beam on time, high number of radiographs taken per patient, wide exposure beam area on

  9. High-dose-rate intraoperative radiation therapy: the nuts and bolts of starting a program

    Science.gov (United States)

    Moningi, Shalini; Armour, Elwood P.; Terezakis, Stephanie A.; Efron, Jonathan E.; Gearhart, Susan L.; Bivalacqua, Trinity J.; Kumar, Rachit; Le, Yi; Kien Ng, Sook; Wolfgang, Christopher L.; Zellars, Richard C.; Ellsworth, Susannah G.; Ahuja, Nita

    2014-01-01

    High-dose-rate intraoperative radiation therapy (HDR-IORT) has historically provided effective local control (LC) for patients with unresectable and recurrent tumors. However, IORT is limited to only a few specialized institutions and it can be difficult to initiate an HDR-IORT program. Herein, we provide a brief overview on how to initiate and implement an HDR-IORT program for a selected group of patients with gastrointestinal and pelvic solid tumors using a multidisciplinary approach. Proper administration of HDR-IORT requires institutional support and a joint effort among physics staff, oncologists, surgeons, anesthesiologists, and nurses. In order to determine the true efficacy of IORT for various malignancies, collaboration among institutions with established IORT programs is needed. PMID:24790628

  10. Monte Carlo skin dose simulation in intraoperative radiotherapy of breast cancer using spherical applicators

    Science.gov (United States)

    Moradi, F.; Ung, N. M.; Khandaker, M. U.; Mahdiraji, G. A.; Saad, M.; Malik, R. Abdul; Bustam, A. Z.; Zaili, Z.; Bradley, D. A.

    2017-08-01

    The relatively new treatment modality electronic intraoperative radiotherapy (IORT) is gaining popularity, irradiation being obtained within a surgically produced cavity being delivered via a low-energy x-ray source and spherical applicators, primarily for early stage breast cancer. Due to the spatially dramatic dose-rate fall off with radial distance from the source and effects related to changes in the beam quality of the low keV photon spectra, dosimetric account of the Intrabeam system is rather complex. Skin dose monitoring in IORT is important due to the high dose prescription per treatment fraction. In this study, modeling of the x-ray source and related applicators were performed using the Monte Carlo N-Particle transport code. The dosimetric characteristics of the model were validated against measured data obtained using an ionization chamber and EBT3 film as dosimeters. By using a simulated breast phantom, absorbed doses to the skin for different combinations of applicator size (1.5-5 cm) and treatment depth (0.5-3 cm) were calculated. Simulation results showed overdosing of the skin (>30% of prescribed dose) at a treatment depth of 0.5 cm using applicator sizes larger than 1.5 cm. Skin doses were significantly increased with applicator size, insofar as delivering 12 Gy (60% of the prescribed dose) to skin for the largest sized applicator (5 cm diameter) and treatment depth of 0.5 cm. It is concluded that the recommended 0.5-1 cm distance between the skin and applicator surface does not guarantee skin safety and skin dose is generally more significant in cases with the larger applicators. Highlights: • Intrabeam x-ray source and spherical applicators were simulated and skin dose was calculated. • Skin dose for constant skin to applicator distance strongly depends on applicator size. • Use of larger applicators generally results in higher skin dose. • The recommended 0.5-1 cm skin to applicator distance does not guarantee skin

  11. Definitive intraoperative very high-dose radiotherapy for localized osteosarcoma in the extremities

    International Nuclear Information System (INIS)

    Oya, Natsuo; Kokubo, Masaki; Mizowaki, Takashi; Shibamoto, Yuta; Nagata, Yasushi; Sasai, Keisuke; Nishimura, Yasumasa; Tsuboyama, Tadao; Toguchida, Junya; Nakamura, Takashi; Hiraoka, Masahiro

    2001-01-01

    Purpose: To evaluate the outcome and adverse effects in patients with osteosarcoma treated with very high-dose definitive intraoperative radiotherapy (IORT), with the intention of saving the affected limb. Methods and Materials: Thirty-nine patients with osteosarcoma in their extremities were treated with definitive IORT. The irradiation field included the tumor plus an adequate wide margin and excluded the major vessels and nerves. Forty-five to 80 Gy of electrons or X-rays were delivered. The median follow-up of the surviving patients was 124 months. Results: The cause-specific and relapse-free 5-year survival rate was 50% and 43%, respectively. Distant metastasis developed in 23 patients; 19 died and 4 were alive for >10 years. Nine local recurrences were found 4-29 months after IORT in the affected limb. No radiation-induced skin reaction or nerve palsy was observed in the patients treated with X-rays. Experiments using phantoms also confirmed that the scatter dose was below the toxic level in the IORT setting with X-rays. Conclusions: Very high-dose definitive IORT combined with preventive nailing and chemotherapy appeared to be a promising quality-of-life-oriented alternative to treating patients with osteosarcomas in the extremities, although the problem of recurrences from the surrounding unirradiated soft tissue remains to be solved

  12. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    International Nuclear Information System (INIS)

    Paik, Nam Chull

    2016-01-01

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  13. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull, E-mail: pncspine@gmail.com [Arumdaun Wooldul Spine Hospital, Department of Radiology (Korea, Republic of)

    2016-07-15

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  14. Reference air kerma and kerma-area product as estimators of peak skin dose for fluoroscopically guided interventions

    International Nuclear Information System (INIS)

    Kwon, Deukwoo; Little, Mark P.; Miller, Donald L.

    2011-01-01

    Purpose: To determine more accurate regression formulas for estimating peak skin dose (PSD) from reference air kerma (RAK) or kerma-area product (KAP). Methods: After grouping of the data from 21 procedures into 13 clinically similar groups, assessments were made of optimal clustering using the Bayesian information criterion to obtain the optimal linear regressions of (log-transformed) PSD vs RAK, PSD vs KAP, and PSD vs RAK and KAP. Results: Three clusters of clinical groups were optimal in regression of PSD vs RAK, seven clusters of clinical groups were optimal in regression of PSD vs KAP, and six clusters of clinical groups were optimal in regression of PSD vs RAK and KAP. Prediction of PSD using both RAK and KAP is significantly better than prediction of PSD with either RAK or KAP alone. The regression of PSD vs RAK provided better predictions of PSD than the regression of PSD vs KAP. The partial-pooling (clustered) method yields smaller mean squared errors compared with the complete-pooling method.Conclusion: PSD distributions for interventional radiology procedures are log-normal. Estimates of PSD derived from RAK and KAP jointly are most accurate, followed closely by estimates derived from RAK alone. Estimates of PSD derived from KAP alone are the least accurate. Using a stochastic search approach, it is possible to cluster together certain dissimilar types of procedures to minimize the total error sum of squares.

  15. Eye lens dose correlations with personal dose equivalent and patient exposure in paediatric interventional cardiology performed with a fluoroscopic biplane system.

    Science.gov (United States)

    Alejo, L; Koren, C; Corredoira, E; Sánchez, F; Bayón, J; Serrada, A; Guibelalde, E

    2017-04-01

    To analyse the correlations between the eye lens dose estimates performed with dosimeters placed next to the eyes of paediatric interventional cardiologists working with a biplane system, the personal dose equivalent measured on the thorax and the patient dose. The eye lens dose was estimated in terms of H p (0.07) on a monthly basis, placing optically stimulated luminescence dosimeters (OSLDs) on goggles. The H p (0.07) personal dose equivalent was measured over aprons with whole-body OSLDs. Data on patient dose as recorded by the kerma-area product (P KA ) were collected using an automatic dose management system. The 2 paediatric cardiologists working in the facility were involved in the study, and 222 interventions in a 1-year period were evaluated. The ceiling-suspended screen was often disregarded during interventions. The annual eye lens doses estimated on goggles were 4.13±0.93 and 4.98±1.28mSv. Over the aprons, the doses obtained were 10.83±0.99 and 11.97±1.44mSv. The correlation between the goggles and the apron dose was R 2 =0.89, with a ratio of 0.38. The correlation with the patient dose was R 2 =0.40, with a ratio of 1.79μSvGy -1 cm -2 . The dose per procedure obtained over the aprons was 102±16μSv, and on goggles 40±9μSv. The eye lens dose normalized to P KA was 2.21±0.58μSvGy -1 cm -2 . Measurements of personal dose equivalent over the paediatric cardiologist's apron are useful to estimate eye lens dose levels if no radiation protection devices are typically used. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  16. 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

  17. Low-dose-rate intraoperative brachytherapy combined with external beam irradiation in the conservative treatment of soft tissue sarcoma

    International Nuclear Information System (INIS)

    Delannes, M.; Thomas, L.; Martel, P.; Bonnevialle, P.; Stoeckle, E.; Chevreau, Ch.; Bui, B.N.; Daly-Schveitzer, N.; Pigneux, J.; Kantor, G.

    2000-01-01

    Purpose: Conservative treatment of soft tissue sarcomas most often implies combination of surgical resection and irradiation. The aim of this study was to evaluate low-dose-rate intraoperative brachytherapy, delivered as a boost, in the local control of primary tumors, with special concern about treatment complications. Methods and Materials: Between 1986 and 1995, 112 patients underwent intraoperative implant. This report focuses on the group of 58 patients with primary sarcomas treated by combination of conservative surgery, intraoperative brachytherapy, and external irradiation. Most of the tumors were located in the lower limbs (46/58--79%). Median size of the tumor was 10 cm, most of the lesions being T2-T3 (51/58--88%), Grade 2 or 3 (48/58--83%). The mean brachytherapy dose was 20 Gy and external beam irradiation dose 45 Gy. In 36/58 cases, iridium wires had to be placed on contact with neurovascular structures. Results: With a median follow-up of 54 months, the 5-year actuarial survival was 64.9%, with a 5-year actuarial local control of 89%. Of the 6 patients with local relapse, 3 were salvaged. Acute side effects, essentially wound healing problems, occurred in 20/58 patients, late side effects in 16/58 patients (7 neuropathies G2 to G4). No amputation was required. The only significant factor correlated with early side effects was the location of the tumor in the lower limb (p = 0.003), and with late side effects the vicinity of the tumor with neurovascular structures (p = 0.009). Conclusion: Brachytherapy allows early delivery of a boost dose in a reduced volume of tissue, precisely mapped by the intraoperative procedure. Combined with external beam irradiation, it is a safe and efficient treatment technique leading to high local control rates and limited functional impairment

  18. High-dose rate intra-operative radiation therapy for local advanced and recurrent colorectal cancer

    International Nuclear Information System (INIS)

    Harrison, L.B.; Mychalczak, B.; Enker, W.; Anderson, L.; Cohen, A.E.; Minsky, B.

    1996-01-01

    In an effort to improve the local control for advanced and recurrent cancers of the rectum, we have integrated high-dose rate intra-operative radiation therapy (HDR-IORT) into the treatment program. Between 11/92 and 10/95, 47 patients (pts) were treated. There were 26 males and 21 females whose ages ranged from 30-80 (median = 62) years. There were 19 pts with primary unresectable rectal cancer, and 28 pts who were treated for recurrent rectal cancer. Histology was adenocarcinoma - 45 pts, squamous cancer - 2 pts. The range of follow-up is 1-34 months (median = 14 months). The majority of primary unresectable pts received pre-operative radiation therapy (4500-5040 cGy) with chemotherapy (5-FU with Leucovorin) 4-6 weeks later, they underwent resection + HDR-IORT (1200 cGy). For the 28 pts with recurrent cancer, the majority received surgery and HDR-IORT alone because they had received prior RT. For the pts with primary unresectable disease, actuarial 2-year local control was 77%, actuarial distant metastasis-free survival was 71%, disease free survival was 66%, and overall survival was 84%. For those pts with recurrent disease, actuarial 2-year local control rate was 65%, distant metastasis-free survival was 65%, disease free survival was 47%, and overall survival was 61%. Complications occurred in 36%. There were no cases where the anatomical distribution of disease, or technical limitations prevented the adequate delivery of HDR-IORT. We conclude that this technique was most versatile, and enabled all appropriate pts to receive IORT. The preliminary data in terms of local control are encouraging, even for the poor prognostic sub-group of pts with recurrent cancer

  19. Estimating the effective radiation dose imparted to patients by intraoperative cone-beam computed tomography in thoracolumbar spinal surgery.

    Science.gov (United States)

    Lange, Jeffrey; Karellas, Andrew; Street, John; Eck, Jason C; Lapinsky, Anthony; Connolly, Patrick J; Dipaola, Christian P

    2013-03-01

    Observational. To estimate the radiation dose imparted to patients during typical thoracolumbar spinal surgical scenarios. Minimally invasive techniques continue to become more common in spine surgery. Computer-assisted navigation systems coupled with intraoperative cone-beam computed tomography (CT) represent one such method used to aid in instrumented spinal procedures. Some studies indicate that cone-beam CT technology delivers a relatively low dose of radiation to patients compared with other x-ray-based imaging modalities. The goal of this study was to estimate the radiation exposure to the patient imparted during typical posterior thoracolumbar instrumented spinal procedures, using intraoperative cone-beam CT and to place these values in the context of standard CT doses. Cone-beam CT scans were obtained using Medtronic O-arm (Medtronic, Minneapolis, MN). Thermoluminescence dosimeters were placed in a linear array on a foam-plastic thoracolumbar spine model centered above the radiation source for O-arm presets of lumbar scans for small or large patients. In-air dosimeter measurements were converted to skin surface measurements, using published conversion factors. Dose-length product was calculated from these values. Effective dose was estimated using published effective dose to dose-length product conversion factors. Calculated dosages for many full-length procedures using the small-patient setting fell within the range of published effective doses of abdominal CT scans (1-31 mSv). Calculated dosages for many full-length procedures using the large-patient setting fell within the range of published effective doses of abdominal CT scans when the number of scans did not exceed 3. We have demonstrated that single cone-beam CT scans and most full-length posterior instrumented spinal procedures using O-arm in standard mode would likely impart a radiation dose within the range of those imparted by a single standard CT scan of the abdomen. Radiation dose increases

  20. An experimental attenuation plate to improve the dose distribution in intraoperative electron beam radiotherapy for breast cancer.

    Science.gov (United States)

    Oshima, T; Aoyama, Y; Shimozato, T; Sawaki, M; Imai, T; Ito, Y; Obata, Y; Tabushi, K

    2009-06-07

    Intraoperative electron beam radiotherapy (IOERT) is a technique in which a single-fraction high dose is intraoperatively delivered to subclinical tumour cells using an electron beam after breast-conserving surgery. In IOERT, an attenuation plate consisting of a pair of metal disks is commonly used to protect the normal tissues posterior to the breast. However, the dose in front of the plate is affected by backscatter, resulting in an unpredictable delivered dose to the tumour cells. In this study, an experimental attenuation plate, termed a shielding plate, was designed using Monte Carlo simulation, which significantly diminished the electron beam without introducing any backscatter radiation. The plate's performance was verified by measurements. It was made of two layers, a first layer (source side) of polymethyl methacrylate (PMMA) and a second layer of copper, which was selected from among other metals (aluminium, copper and lead) after testing for shielding capability and the range and magnitude of backscatter. The optimal thicknesses of the PMMA (0.71 cm) and copper (0.3 cm) layers were determined by changing their thicknesses during simulations. On the basis of these results, a shielding plate was prototyped and depth doses with and without the plate were measured by radiophotoluminescence glass dosimeters using a conventional stationary linear accelerator and a mobile linear accelerator dedicated for IOERT. The trial shielding plate functioned as intended, indicating its applicability in clinical practice.

  1. 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.

  2. Intraoperative high-dose-rate brachytherapy for the treatment of pediatric tumors: the Ohio State University experience

    International Nuclear Information System (INIS)

    Nag, Subir; Tippin, Douglas; Ruymann, Frederick B.

    2001-01-01

    Purpose: To determine whether intraoperative high-dose-rate brachytherapy (IO-HDRBT) can be used to decrease the dose of external beam radiotherapy (EBRT) in the treatment of children with soft-tissue sarcomas and, thereby, reduce morbidity without compromising local control. Methods and Materials: From March 1992 through April 1999, 13 pediatric patients were treated with IO-HDRBT, low-dose EBRT, chemotherapy, and radical surgery at 21 sites that were not amenable to intraoperative electron beam therapy. The IO-HDRBT dose at 5 mm depth was 10 to 12.5 Gy for close margins/microscopic disease at 14 sites and 12.5 to 15 Gy for gross disease at 7 sites. The treatment volumes ranged from 4 to 96 cm 3 (mean 27). The EBRT dose was limited to 27-30 Gy in most cases to minimize growth retardation and preserve normal organ function. Results: After a median follow-up of 47 months (range 12-97), 11 patients were alive and without evidence of disease (overall survival rate 85%, 4-year actuarial survival rate 77%). Of the 2 who died, 1 had Stage III pulmonary blastoma with a sacral recurrence; the other had Stage IV undifferentiated synovial sarcoma with a pulmonary recurrence. One local failure occurred in a patient with gross residual disease after incomplete resection for Stage IV pulmonary blastoma. The local control rate was 95%, and morbidity was observed in 3 patients (23%). One patient developed impaired orbital growth with mild ptosis. Another patient required orthopedic pinning of her femoral subcapital epiphysis and construction of a neobladder secondary to urethral obstruction. The third patient required reimplantation of her autotransplanted kidney secondary to chronic urinary tract infection and ureteral reflux. Conclusions: IO-HDRBT allowed for reduction in EBRT without compromising local control or disease-free survival in children with soft-tissue sarcomas. Tumor beds inaccessible to electron beam methods could be satisfactorily encompassed with IO

  3. 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

  4. 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

    Energy Technology Data Exchange (ETDEWEB)

    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

  5. 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

  6. SU-F-T-654: Pacemaker Dose Estimate Using Optically Stimulated Luminescent Dosimeter for Left Breast Intraoperative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Y; Goenka, A; Sharma, A; Wang, L; Cao, Y; Jamshidi, A [Northwell Health, Lake Success, NY (United States)

    2016-06-15

    Purpose: To assess and report the in vivo dose for a patient with a pacemaker being treated in left breast intraoperative radiation therapy (IORT). The ZEISS Intrabeam 50 kVp X-ray beam with a spherical applicator was used. Methods: The optically stimulated luminescent dosimeters (OSLDs) (Landauer nanoDots) were employed and calibrated under the conditions of the Intrabeam 50 kVp X-rays. The nanoDots were placed on the patient at approximately 15 cm away from the lumpectomy cavity both under and above a shield of lead equivalence 0.25 mm (RayShield X-Drape D-110) covering the pacemaker area during IORT with a 5 cm spherical applicator. Results: The skin surface dose near the pacemaker during the IORT with a prescription of 20 Gy was measured as 4.0±0.8 cGy. The dose behind the shield was 0.06±0.01 Gy, demonstrating more than 98% dose reduction. The in vivo skin surface doses during a typical breast IORT at a 4.5 cm spherical applicator surface were further measured at 5, 10, 15, and 20 cm away to be 159±11 cGy, 15±1 cGy, 6.6±0.5 cGy, and 1.8±0.1 cGy, respectively. A power law fit to the dose versus the distance z from the applicator surface yields the dose fall off at the skin surface following z^-2.5, which can be used to estimate skin doses in future cases. The comparison to an extrapolation of depth dose in water reveals an underestimate of far field dose using the manufactory provided data. Conclusion: The study suggests the appropriateness of OSLD as an in vivo skin dosimeter in IORT using the Intrabeam system in a wide dose range. The pacemaker dose measured during the left breast IORT was within a safe limit.

  7. The efficacy of low and high dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism.

    Science.gov (United States)

    Gencoglu, Esra Arzu; Aktas, Ayse

    2014-01-01

    The aim of this study was to compare the efficacy of low- and high-dose (99m)Tc-MIBI protocols for intraoperative identification of hyperplastic parathyroid glands via gamma probe in secondary hyperparathyroidism. This retrospective study was conducted using a prospective database of 59 patients who had undergone radioguided subtotal parathyroidectomy between 2004-2012. The patients were studied in 2 groups. Group 1 (n=31) received 37 MBq (99m)Tc-MIBI intravenously in the surgical room approximately 10 min before the beginning of the intervention and surgery was performed under gamma probe guidance. Group 2 (n=28) received 555 MBq (99m)Tc- MIBI intravenously 2h before surgery, which was also performed under gamma probe guidance. Intraoperative gamma probe findings, laboratory findings, and histopathological findings were evaluated together. Using acceptance of the histopathological findings as gold standard, sensitivity and specificity of intraoperative gamma probe for identifying hyperplastic parathyroid glands was 98% and 100%, respectively, in both groups. In the light of these findings, it is concluded that the low-dose (99m)Tc-MIBI protocol might be preferable for intraoperative identification of hyperplastic parathyroid glands in secondary hyperparathyroidism patients because it was observed to be as effective as the high-dose (99m)Tc-MIBI protocol. Furthermore, the low-dose protocol does not have the disadvantages that are associated with the high-dose protocol. Copyright © 2014 Elsevier España, S.L. and SEMNIM. All rights reserved.

  8. 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)

  9. 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

  10. High-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.

    Science.gov (United States)

    Inoue, Satoki; Kawaguchi, Masahiko; Sakamoto, Takanori; Kitaguchi, Katsuyasu; Furuya, Hitoshi; Sakaki, Toshisuke

    2002-07-01

    group were significantly faster and lower, respectively, than in the control group. Systemic vascular resistance in the AMR 15 group was smaller than in the control group throughout the study; on the other hand, only the value after the start of rewarming in the ReAMR group was smaller than in the control group. Amrinone at an infusion rate of 15 or 5 microg x kg(-1) x min(-1) with a reloading at the beginning of rewarming accelerated the rewarming rate of core temperature during deliberate mild hypothermia. This suggests that high-dose amrinone is required to accelerate rewarming from deliberate mild intraoperative hypothermia for neurosurgical procedures.

  11. Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers

    International Nuclear Information System (INIS)

    Gemignani, Mary L.; Alektiar, Kaled M.; Leitao, Mario; Mychalczak, Boris; Chi, Dennis; Venkatraman, Ennapadam; Barakat, Richard R.; Curtin, John P.

    2001-01-01

    Objective: To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT). Methods and Materials: Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy. Results: With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p<0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%). Conclusion: Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross

  12. Intraoperative radiation therapy in patients with bladder cancer. A review of techniques allowing improved tumor doses and providing high cure rates without loss of bladder function

    International Nuclear Information System (INIS)

    Shipley, W.U.; Kaufman, S.D.; Prout, G.R. Jr.

    1987-01-01

    Conventional external beam irradiation, using modern megavoltage techniques and doses that do not harm bladder function, will permanently eradicate local bladder cancer in 30% to 50% of patients, compared with 70% to 90% with cystectomy. In appropriately chosen patients, open surgery can safely provide excellent exposure for the selective delivery of more radiant energy directly to the tumor and less to the uninvolved portion of the bladder. Intraoperative radiation therapy, by either a removable radium or iridium implant or a large single dose of electrons, has been reported to be safe and can permanently cure the bladder of cancer and also preserve bladder function in more than 75% of patients with solitary tumors that invade into but not beyond the bladder muscle. With the increasing interest in and availability of intraoperative radiation therapy in the US, this curative and bladder-sparing treatment for operable patients with bladder cancer invading the trigone is appropriate for careful clinical trial. 13 references

  13. Treatment results by uneven fractionated irradiation, low-dose rate telecobalt therapy as a boost, and intraoperative irradiation for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Shogo; Takai, Yoshihiro; Nemoto, Kenji; Ogawa, Yoshihiro; Kakuto, Yoshihisa; Hoshi, Akihiko; Sakamoto, Kiyohiko; Kayama, Takamasa; Yoshimoto, Takashi (Tohoku Univ., Sendai (Japan). School of Medicine)

    1992-08-01

    The prognosis of malignant glioma is extremely poor. We applied conventionally fractionated irradiation combined with 1-(4-aminio-2-methyl-5-pyrimidinyl)methyl-3-(2-chloroethyl)-3-nitrosourea (ACNU), uneven fractionated irradiation with ACNU, low dose rate telecobalt therapy as a boost, and intraoperative irradiation against 110 malignant gliomas to investigate the efficacy of these methods as alternative treatments for malignant glioma. Although local tumor control by uneven fractionated irradiation was better than that by the other methods, no significant improvement was obtained in survival rates. As a result of multiple regression analysis, age and histology were major factors for survival rates, and the difference of treatment methods was not important. Both low-dose rate telecobalt therapy as a boost and intraoperative irradiation showed little advantage because of the high risk of brain necrosis associated with them. (author).

  14. Intraoperative digital angiography: Peripheral vascular applications

    International Nuclear Information System (INIS)

    Bell, K.; Reifsteck, J.E.; Binet, E.F.; Fleisher, H.J.

    1986-01-01

    Intraoperative digital angiography is the procedure of choice for the peripheral vascular surgeon who wishes to evaluate his results before terminating anesthesia. Two operating suites at the John L. McClellan Memorial Veterans Hospital are equipped with permanent ceiling-mounted Philips C-arm fluoroscopes and share an ADAC 4100 digital angiographic system. In the last 18 months, 40 peripheral vascular intraoperative digital angiographic procedures have been performed, in all but two cases using direct arterial puncture. In 65% of cases, the intraoperative study showed no significant abnormality. In 12.5%, minor abnormalities not requiring reoperation were seen. In 22.5% of cases, the intraoperative digital angiogram revealed a significant abnormality requiring immediate operative revision. None of the patients who underwent reoperation experienced postoperative sequelae. Intraoperative digital angiography is useful in identifying complications of peripheral vascular operations

  15. 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.

  16. Factors impacting short and long-term kidney graft survival: modification by single intra-operative -high-dose induction with ATG-Fresenius.

    Science.gov (United States)

    Kaden, Jürgen; May, Gottfried; Völp, Andreas; Wesslau, Claus

    2011-01-01

    A majority of recipients benefited from the intra-operative single high-dose induction (HDI) with ATG-Fresenius (ATG-F) still leaving a group of recipients who did not profit from this kind of induction. Therefore the aim of this retrospective analysis was 1st to identify the risk factors impacting short and long-term graft survival, and 2nd to assess the efficacy of this type of induction in kidney graft recipients with or without these risk factors. A total of 606 recipients receiving two different immunosuppressive treatment regimens (1st: Triple drug therapy [TDT, n=196] consisting mainly of steroids, azathioprine and cyclosporine; 2nd: TDT + 9 mg/kg ATG-F intra-operatively [HDI, n=410]) were included in this analysis and grouped according to their kidney graft survival time (short GST: ≤1 yr, n=100 and long GST: >5 yrs, n=506). The main risk factors associated with a shortened graft survival were pre-transplant sensitization, re-transplantation, rejections (in particular vascular or mixed ones) and the necessity of a long-term anti-rejection therapy. Adding ATG-F single high dose induction to TDT was more efficient in prolonging kidney graft survival than TDT alone not only in recipients without any risk factors (p<0.005) but also in recipients with at least one risk factor (p<0.021). Only in 4.6% of recipients having two or more risk factors this effect could not be demonstrated. The intra-operative single high-dose induction with ATG-F significantly improves the kidney graft survival in recipients with or without risk factors and can therefore be recommended.

  17. Intraoperative Low-Dose Ketamine Infusion Reduces Acute Postoperative Pain Following Total Knee Replacement Surgery: A Prospective, Randomized Double-Blind Placebo-Controlled Trial

    International Nuclear Information System (INIS)

    Pelin Cengiz, P.; Gokcinar, D.; Karabeyoglu, I.; Topcu, H.; Cicek, G. S.; Gogus, N.

    2014-01-01

    Objective: To evaluate the effect of intraoperative low-dose ketamine with general anesthesia on postoperative pain after total knee replacement surgery. Study Design: A randomized, double-blind comparative study. Place and Duration of Study: Ankara Numune Training and Research Hospital, Turkey, from January and June 2011. Methodology: Sixty adults undergoing total knee arthroplasty were enrolled in this study. The patients were randomly allocated into two groups of equal size to receive either racemic ketamine infusion (6.25 g/kg/minute) or the same volume of saline. A visual analogue scale (VAS) was used to measure each patient's level of pain at 1, 3, 6, 12, and 24 hours after surgery. Time to first analgesic request, postoperative morphine consumption and the incidence of side effects were also recorded. Results: Low-dose ketamine infusion prolonged the time to first analgesic request. It also reduced postoperative cumulative morphine consumption at 1, 3, 6, 12, and 24 hours postsurgery (p < 0.001). Postoperative VAS scores were also significantly lower in the ketamine group than placebo, at all observation times. Incidences of side effects were similar in both study groups. Conclusion: Intraoperative continuous low-dose ketamine infusion reduced pain and postoperative analgesic consumption without affecting the incidence of side effects. (author)

  18. Intraoperative low-dose ketamine infusion reduces acute postoperative pain following total knee replacement surgery: a prospective, randomized double-blind placebo-controlled trial.

    Science.gov (United States)

    Cengiz, Pelin; Gokcinar, Derya; Karabeyoglu, Isil; Topcu, Hulya; Cicek, Gizem Selen; Gogus, Nermin

    2014-05-01

    To evaluate the effect of intraoperative low-dose ketamine with general anesthesia on postoperative pain after total knee replacement surgery. A randomized, double-blind comparative study. Ankara Numune Training and Research Hospital, Turkey, from January and June 2011. Sixty adults undergoing total knee arthroplasty were enrolled in this study. The patients were randomly allocated into two groups of equal size to receive either racemic ketamine infusion (6 μg/kg/minute) or the same volume of saline. A visual analogue scale (VAS) was used to measure each patient's level of pain at 1, 3, 6, 12, and 24 hours after surgery. Time to first analgesic request, postoperative morphine consumption and the incidence of side effects were also recorded. Low-dose ketamine infusion prolonged the time to first analgesic request. It also reduced postoperative cumulative morphine consumption at 1, 3, 6, 12, and 24 hours postsurgery (p < 0.001). Postoperative VAS scores were also significantly lower in the ketamine group than placebo, at all observation times. Incidences of side effects were similar in both study groups. Intraoperative continuous low-dose ketamine infusion reduced pain and postoperative analgesic consumption without affecting the incidence of side effects.

  19. Improved long-term survival after intra-operative single high-dose ATG-Fresenius induction in renal transplantation: a single centre experience.

    Science.gov (United States)

    Kaden, Jürgen; May, Gottfried; Völp, Andreas; Wesslau, Claus

    2009-01-01

    In organ grafts donor-specific sensitization is initiated immediately after revascularization. Therefore, in 1990 we introduced the intra-operative single high-dose ATG-Fresenius (ATG-F) induction in addition to standard triple drug therapy (TDT) consisting of steroids, azathioprine and cyclosporin. A total of 778 first renal transplantations from deceased donors, performed between 1987 and 1998, were included in this evaluation. This retrospective analysis of clinic records and electronic databases presents data of all recipients of first kidney grafts who received two different ATG-F inductions (1(st) group: 9 mg/kg body weight as single high-dose intra-operatively, n=484; 2(nd) group: 3 mg/kg body weight on 7 or 8 consecutive days as multiple-dose starting also intra-operatively, n=78) and standard TDT alone (3(rd) group: TDT alone, n=216). The 10-year patient survival rates were 72.6+/-2.6% (TDT + ATG-F single high-dose), 79.5+/-5.1% (TDT + ATG-F multiple-dose) and 67.2+/-3.7%% (TDT alone; Kaplan-Meier estimates with standard errors; ATG-F vs TDT alone, p=0.001). The 10-year graft survival rates with censoring of patients that died with a functioning graft were 73.8+/-2.4%, 57.7+/-5.8% and 58.4+/-3.6% (Kaplan-Meier estimates with standard errors; 1(st) vs 2(nd )and 3(rd) group, respectively, p<0.001) and the 10-year graft survival rates with patient death counted as graft failure were 58.3+/-2.7%, 55.7+/-5.8% and 48.2+/-3.5% (Kaplan-Meier estimates with standard errors; ATG-F single high-dose vs TDT, p=0.023). In pre-sensitized recipients there were also significant differences in favour of ATG-F, more notably in the single high-dose ATG-F induction. A total of 69% of the patients in the two cohorts receiving ATG-F did not experience any transplant rejections compared to 56% in patients undergoing TDT alone (p=0.018). The incidence of infectious complications was comparable across all groups. According to evidence obtained from the routine documentation of 778

  20. Intraoperative electron beam radiation therapy: technique, dosimetry, and dose specification: report of task force 48 of the radiation therapy committee, American association of physicists in medicine

    International Nuclear Information System (INIS)

    Palta, Jatinder R.; Biggs, Peter J.; Hazle, John D.; Huq, M. Saiful; Dahl, Robert A.; Ochran, Timothy G.; Soen, Jerry; Dobelbower, Ralph R.; McCullough, Edwin C.

    1995-01-01

    Intraoperative radiation therapy (IORT) is a treatment modality whereby a large single dose of radiation is delivered to a surgically open, exposed cancer site. Typically, a beam of megavoltage electrons is directed at an exposed tumor or tumor bed through a specially designed applicator system. In the last few years, IORT facilities have proliferated around the world. The IORT technique and the applicator systems used at these facilities vary greatly in sophistication and design philosophy. The IORT beam characteristics vary for different designs of applicator systems. It is necessary to document the existing techniques of IORT, to detail the dosimetry data required for accurate delivery of the prescribed dose, and to have a uniform method of dose specification for cooperative clinical trials. The specific charge to the task group includes the following: (a) identify the multidisciplinary IORT team, (b) outline special considerations that must be addressed by an IORT program, (c) review currently available IORT techniques, (d) describe dosimetric measurements necessary for accurate delivery of prescribed dose, (e) describe dosimetric measurements necessary in documenting doses to the surrounding normal tissues, (f) recommend quality assurance procedures for IORT, (g) review methods of treatment documentation and verification, and (h) recommend methods of dose specification and recording for cooperative clinical trials

  1. Phase I study of intraoperative radiotherapy with photon radiosurgery system in children with recurrent brain tumors: Preliminary report of first dose level (10 Gy)

    International Nuclear Information System (INIS)

    Kalapurakal, John A.; Goldman, Stewart; Stellpflug, Wendy; Curran, John; Sathiaseelan, Vythialingam; Marymont, Maryanne H.; Tomita, Tadanori

    2006-01-01

    Purpose: To describe the preliminary results after intraoperative radiotherapy (IORT) with the photon radiosurgery system in children with recurrent brain tumors treated at the first dose level (10 Gy) of a Phase I protocol. Methods and Materials: A Phase I IORT dose escalation protocol was initiated at Children's Memorial Hospital to determine the maximal tolerated IORT dose in children with recurrent brain tumors. Results: Fourteen children have received IORT thus far. Eight had been previously irradiated. Thirteen children had ependymoma. The median follow-up was 16 months. Three patients (21%) developed radiation necrosis on follow-up MRI scans 6 to 12 months after IORT. They had not been previously irradiated and had received 10 Gy to a depth of 5 mm. One required surgery and the other two had resolution of their lesions without treatment. All 3 patients were asymptomatic at the last follow-up. No other late toxicity was observed at the last follow-up visit. Eight patients (57%) had tumor control within the surgical bed after IORT. Conclusion: Our findings have demonstrated the safety and feasibility of IORT to a dose of 10 Gy to 2 mm in children with previously irradiated brain tumors. IORT to a dose of 10 Gy at 5 mm was associated with a greater complication rate

  2. Intraoperative panoramic image using alignment grid, is it accurate?

    Science.gov (United States)

    Apivatthakakul, T; Duanghakrung, M; Luevitoonvechkit, S; Patumasutra, S

    2013-07-01

    Minimally invasive orthopedic trauma surgery relies heavily on intraoperative fluoroscopic images to evaluate the quality of fracture reduction and fixation. However, fluoroscopic images have a narrow field of view and often cannot visualize the entire long bone axis. To compare the coronal femoral alignment between conventional X-rays to that achieved with a new method of acquiring a panoramic intraoperative image. Twenty-four cadaveric femurs with simple diaphyseal fractures were fixed with an angulated broad DCP to create coronal plane malalignment. An intraoperative alignment grid was used to help stitch different fluoroscopic images together to produce a panoramic image. A conventional X-ray of the entire femur was then performed. The coronal plane angulation in the panoramic images was then compared to the conventional X-rays using a Wilcoxon signed rank test. The mean angle measured from the panoramic view was 173.9° (range 169.3°-178.0°) with median of 173.2°. The mean angle measured from the conventional X-ray was 173.4° (range 167.7°-178.7°) with a median angle of 173.5°. There was no significant difference between both methods of measurement (P = 0.48). Panoramic images produced by stitching fluoroscopic images together with help of an alignment grid demonstrated the same accuracy at evaluating the coronal plane alignment of femur fractures as conventional X-rays.

  3. Effect of single intraoperative dose of amiodarone in patients with rheumatic valvular heart disease and atrial fibrillation undergoing valve replacement surgery

    Directory of Open Access Journals (Sweden)

    Selvaraj Thiruvenkadam

    2009-01-01

    Full Text Available Maintenance of sinus rhythm (SR is superior to rate control in atrial fibrillation (AF. In order to achieve SR, we administered single-dose intravenous amiodarone intraoperatively and evaluated its effect on conversion of rheumatic AF to SR in patients undergoing valvular heart surgery. Patients were randomly assigned to amiodarone ( n = 42 or control ( n = 40 group in a double blind manner. The amiodarone group received amiodarone (3 mg/kg intravenously prior to the institution of cardiopulmonary bypass and the control group received the same volume of normal saline. In the amiodarone group, the initial rhythm after the release of aortic cross clamp was noted to be AF in 14.3% ( n = 6 and remained so in 9.5% ( n = 4 of patients till the end of surgery. In the control group, the rhythm soon after the release of aortic cross clamp was AF in 37.5% ( n = 15 ( p = 0.035 and remained so in 32.5% ( n = 13 of patients till the end of surgery ( p = 0.01. At the end of first post-operative day 21.4% ( n = 9 of patients in amiodarone group and 55% ( n = 22 of patients in control group were in AF ( p = 0.002. The requirement of cardioversion/defibrillation was 1.5 (±0.54 in amiodarone group and 2.26 (±0.73 in the control group ( p = 0.014, and the energy needed was 22.5 (±8.86 joules in the amiodarone group and 40.53 (±16.5 in the control group ( p = 0.008. A single intraoperative dose of intravenous amiodarone increased the conversion rate of AF to normal sinus rhythm, reduced the need and energy required for cardioversion/defibrillation and reduced the recurrence of AF within one day.

  4. Intraoperative electrocorticography

    Directory of Open Access Journals (Sweden)

    Gabriela Alcaraz

    2017-01-01

    Full Text Available Intraoperative electrocorticography (ECoG is the recording of electrophysiological activity from electrodes placed directly on the exposed surface of brain, during surgery for epilepsy and tumor resection. The ECoG is helpful in defining the seizure onset and spread within the cortical surface and delineation of the interface between epileptogenic zones and functional cortex substance of the brain. Intraoperative ECoG is an invasive procedure, it is performed during surgery mostly commonly during awake craniotomy but at times during general anaesthesia. As most anesthetic agents will affect ECoG, they should be minimized or stopped prior to any recording. Activation of intraoperative epileptiform activity may also be required if there are no spontaneous discharges. The appropriate management of the anesthetic during the time of ECoG is critical for its success. There are limitations and some controversies to all the uses of intraoperative ECoG, thus each center will set their own indications, criteria, and protocols.

  5. A quality improvement project to reduce the intraoperative use of single-dose fentanyl vials across multiple patients in a pediatric institution.

    Science.gov (United States)

    Buck, David; Subramanyam, Rajeev; Varughese, Anna

    2016-01-01

    The use of a single-dose vial across multiple patients presents a risk to sterility and is against CDC guidelines. We initiated a quality improvement (QI) project to reduce the intraoperative use of single-dose vials of fentanyl across multiple patients at Cincinnati Children's Hospital Medical Center (CCHMC). The initial step of the improvement project was the development of a Key Driver Diagram. The diagram has the SMART aim of the project, key drivers inherent to the process we are trying to improve, and specific interventions targeting the key drivers. The number of patients each week receiving an IV dose of fentanyl, from a vial previously accessed for another patient was tracked in a high turnover operating room (OR). The improvement model used was based on the concept of building Plan-Do-Study-Act (PDSA) cycles. Tests of change included provider education, provision of an increased number of fentanyl vials, alternate wasting processes, and provision of single-use fentanyl syringes by the pharmacy. Prior to initiation of this project, it was common for a single fentanyl vial to be accessed for multiple patients. Our data showed an average percentage of failures of just over 50%. During the end of the project, after 7 months, the mean percentage failures had dropped to 5%. Preparation of 20 mcg single-use fentanyl syringes by pharmacy, combined with education of providers on appropriate use, was successful in reducing failures to below our goal of 25%. Appropriately sized fentanyl syringes prepared by pharmacy, education on correct use of single-dose vials, and reminders in the OR, reduced the percentage of patients receiving a dose of fentanyl from a vial previously accessed for another patient in a high-volume otolaryngology room. © 2015 John Wiley & Sons Ltd.

  6. Intraoperative engineering of osteogenic grafts combining freshly harvested, human adipose-derived cells and physiological doses of bone morphogenetic protein-2

    Directory of Open Access Journals (Sweden)

    A Mehrkens

    2012-09-01

    Full Text Available Engineered osteogenic constructs for bone repair typically involve complex and costly processes for cell expansion. Adipose tissue includes mesenchymal precursors in large amounts, in principle allowing for an intraoperative production of osteogenic grafts and their immediate implantation. However, stromal vascular fraction (SVF cells from adipose tissue were reported to require a molecular trigger to differentiate into functional osteoblasts. The present study tested whether physiological doses of recombinant human BMP-2 (rhBMP-2 could induce freshly harvested human SVF cells to generate ectopic bone tissue. Enzymatically dissociated SVF cells from 7 healthy donors (1 x 106 or 4 x 106 were immediately embedded in a fibrin gel with or without 250 ng rhBMP-2, mixed with porous silicated calcium-phosphate granules (Actifuse®, Apatech (final construct size: 0.1 cm3 and implanted ectopically for eight weeks in nude mice. In the presence of rhBMP-2, SVF cells not only supported but directly contributed to the formation of bone ossicles, which were not observed in control cell-free, rhBMP-2 loaded implants. In vitro analysis indicated that rhBMP-2 did not involve an increase in the percentage of SVF cells recruited to the osteogenic lineage, but rather induced a stimulation of the osteoblastic differentiation of the committed progenitors. These findings confirm the feasibility of generating fully osteogenic grafts using an easily accessible autologous cell source and low amounts of rhBMP-2, in a timing compatible with an intraoperative schedule. The study warrants further investigation at an orthotopic site of implantation, where the delivery of rhBMP-2 could be bypassed thanks to the properties of the local milieu.

  7. Effect of a single intraoperative high-dose ATG-Fresenius on delayed graft function in donation after cardiac-death donor renal allograft recipients: a randomized study.

    Science.gov (United States)

    van den Hoogen, Martijn W F; Kho, Marcia M L; Abrahams, Alferso C; van Zuilen, Arjan D; Sanders, Jan-Stephan; van Dijk, Marja; Hilbrands, Luuk B; Weimar, Willem; Hoitsma, Andries J

    2013-04-01

    Reducing the incidence of delayed graft function after transplant with donation after cardiac death donor renal allografts would facilitate managing recipients during their first weeks after a transplant. To reduce this incidence, in most studies, induction therapy with depleting anti-T-lymphocyte antibodies is coupled with a reduction of the dosage of the calcineurin inhibitor. The separate effect of anti-T-cell therapy on the incidence and duration of delayed graft function is therefore difficult to assess. We performed a randomized study to evaluate the effect of a single intraoperative high-dose of anti-T-lymphocyte immunoglobulin (ATG)-Fresenius (9 mg/kg body weight) on the incidence of delayed graft function. Eligible adult recipients of a first donation after cardiac death donor renal allograft were randomly assigned to ATG-Fresenius or no induction therapy. Maintenance immunosuppression consisted of tacrolimus, in an unadjusted dose, mycophenolate mofetil, and steroids. The study was prematurely terminated because of a lower-than-anticipated inclusion rate. Baseline characteristics were comparable in the ATG-Fresenius group (n=28) and the control group (n=24). Twenty-two patients in the ATG-Fresenius group (79%) had delayed graft function, compared with 13 in the control group (54%; P = .06). Allograft and patient survival were comparable in both groups. Serious adverse events occurred more frequently in the ATG-Fresenius group than they did in the control group (57% vs 29%; P Fresenius in donation after cardiac death donor renal allograft recipients, followed by triple immunosuppression with an unadjusted tacrolimus dose, seems ineffective to reduce the incidence of delayed graft function. Moreover, this was associated with a higher rate of serious adverse events (EudraCT-number, 2007-000210-36.).

  8. 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.

  9. 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.

  10. 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.

  11. A Novel Form of Breast Intraoperative Radiation Therapy With CT-Guided High-Dose-Rate Brachytherapy: Results of a Prospective Phase 1 Clinical Trial

    International Nuclear Information System (INIS)

    Showalter, Shayna L.; Petroni, Gina; Trifiletti, Daniel M.; Libby, Bruce; Schroen, Anneke T.; Brenin, David R.; Dalal, Parchayi; Smolkin, Mark; Reardon, Kelli A.; Showalter, Timothy N.

    2016-01-01

    Purpose: Existing intraoperative radiation therapy (IORT) techniques are criticized for the lack of image guided treatment planning and energy deposition with, at times, poor resultant dosimetry and low radiation dose. We pioneered a novel method of IORT that incorporates customized, computed tomography (CT)-based treatment planning and high-dose-rate (HDR) brachytherapy to overcome these drawbacks: CT-HDR-IORT. Methods and Materials: A phase 1 study was conducted to demonstrate the feasibility and safety of CT-HDR-IORT. Eligibility criteria included age ≥50 years, invasive or in situ breast cancer, tumor size <3 cm, and N0 disease. Patients were eligible before or within 30 days of breast-conserving surgery (BCS). BCS was performed, and a multilumen balloon catheter was placed. CT images were obtained, a customized HDR brachytherapy plan was created, and a dose of 12.5 Gy was delivered to 1-cm depth from the balloon surface. The catheter was removed, and the skin was closed. The primary endpoints were feasibility and acute toxicity. Feasibility was defined as IORT treatment interval (time from CT acquisition until IORT completion) ≤90 minutes. The secondary endpoints included dosimetry, cosmetic outcome, quality of life, and late toxicity. Results: Twenty-eight patients were enrolled. The 6-month follow-up assessments were completed by 93% of enrollees. The median IORT treatment interval was 67.2 minutes (range, 50-108 minutes). The treatment met feasibility criteria in 26 women (93%). The dosimetric goals were met in 22 patients (79%). There were no Radiation Therapy Oncology Group grade 3+ toxicities; 6 patients (21%) experienced grade 2 events. Most patients (93%) had good/excellent cosmetic outcomes at the last follow-up visit. Conclusions: CT-HDR-IORT is feasible and safe. This promising approach for a conformal, image-based, higher-dose breast IORT is being evaluated in a phase 2 trial.

  12. A Novel Form of Breast Intraoperative Radiation Therapy With CT-Guided High-Dose-Rate Brachytherapy: Results of a Prospective Phase 1 Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Showalter, Shayna L., E-mail: snl2t@virginia.edu [Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Petroni, Gina [Division of Translation Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Trifiletti, Daniel M.; Libby, Bruce [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Schroen, Anneke T.; Brenin, David R. [Division of Surgical Oncology, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Dalal, Parchayi [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Smolkin, Mark [Division of Translation Research and Applied Statistics, Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia (United States); Reardon, Kelli A.; Showalter, Timothy N. [Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, Virginia (United States)

    2016-09-01

    Purpose: Existing intraoperative radiation therapy (IORT) techniques are criticized for the lack of image guided treatment planning and energy deposition with, at times, poor resultant dosimetry and low radiation dose. We pioneered a novel method of IORT that incorporates customized, computed tomography (CT)-based treatment planning and high-dose-rate (HDR) brachytherapy to overcome these drawbacks: CT-HDR-IORT. Methods and Materials: A phase 1 study was conducted to demonstrate the feasibility and safety of CT-HDR-IORT. Eligibility criteria included age ≥50 years, invasive or in situ breast cancer, tumor size <3 cm, and N0 disease. Patients were eligible before or within 30 days of breast-conserving surgery (BCS). BCS was performed, and a multilumen balloon catheter was placed. CT images were obtained, a customized HDR brachytherapy plan was created, and a dose of 12.5 Gy was delivered to 1-cm depth from the balloon surface. The catheter was removed, and the skin was closed. The primary endpoints were feasibility and acute toxicity. Feasibility was defined as IORT treatment interval (time from CT acquisition until IORT completion) ≤90 minutes. The secondary endpoints included dosimetry, cosmetic outcome, quality of life, and late toxicity. Results: Twenty-eight patients were enrolled. The 6-month follow-up assessments were completed by 93% of enrollees. The median IORT treatment interval was 67.2 minutes (range, 50-108 minutes). The treatment met feasibility criteria in 26 women (93%). The dosimetric goals were met in 22 patients (79%). There were no Radiation Therapy Oncology Group grade 3+ toxicities; 6 patients (21%) experienced grade 2 events. Most patients (93%) had good/excellent cosmetic outcomes at the last follow-up visit. Conclusions: CT-HDR-IORT is feasible and safe. This promising approach for a conformal, image-based, higher-dose breast IORT is being evaluated in a phase 2 trial.

  13. Intraoperative CT in the assessment of posterior wall acetabular fracture stability.

    Science.gov (United States)

    Cunningham, Brian; Jackson, Kelly; Ortega, Gil

    2014-04-01

    Posterior wall acetabular fractures that involve 10% to 40% of the posterior wall may or may not require an open reduction and internal fixation. Dynamic stress examination of the acetabular fracture under fluoroscopy has been used as an intraoperative method to assess joint stability. The aim of this study was to demonstrate the value of intraoperative ISO computed tomography (CT) examination using the Siemens ISO-C imaging system (Siemens Corp, Malvern, Pennsylvania) in the assessment of posterior wall acetabular fracture stability during stress examination under anesthesia. In 5 posterior wall acetabular fractures, standard fluoroscopic images (including anteroposterior pelvis and Judet radiographs) with dynamic stress examinations were compared with the ISO-C CT imaging system to assess posterior wall fracture stability during stress examination. After review of standard intraoperative fluoroscopic images under dynamic stress examination, all 5 cases appeared to demonstrate posterior wall stability; however, when the intraoperative images from the ISO-C CT imaging system demonstrated that 1 case showed fracture instability of the posterior wall segment during stress examination, open reduction and internal fixation was performed. The use of intraoperative ISO CT imaging has shown an initial improvement in the surgeon's ability to assess the intraoperative stability of posterior wall acetabular fractures during stress examination when compared with standard fluoroscopic images. Copyright 2014, SLACK Incorporated.

  14. High dose rate intraoperative radiation therapy (HDR-IORT) as part of the management strategy for locally advanced primary and recurrent rectal cancer

    International Nuclear Information System (INIS)

    Harrison, Louis B.; Minsky, Bruce D.; Enker, Warren E.; Mychalczak, Borys; Guillem, Jose; Paty, Philip B.; Anderson, Lowell; White, Carol; Cohen, Alfred M.

    1998-01-01

    Purpose: Primary unresectable and locally advanced recurrent rectal cancer presents a significant clinical challenge. Local failure rates are high in both situations. Under such circumstances, there is a significant need to safely deliver tumoricidal doses of radiation in an attempt to improve local control. For this reason, we have incorporated a new approach utilizing high dose rate intraoperative radiation therapy (HDR-IORT). Methods and Materials: Between 11/92-12/96, a total of 112 patients were explored, of which 68 patients were treated with HDR-IORT, and 66 are evaluable. The majority of the 44 patients were excluded for unresectable disease or for distant metastases which eluded preoperative imaging. There were 22 patients with primary unresectable disease, and 46 patients who presented with recurrent disease. The histology was adenocarcinoma in 64 patients, and squamous cell carcinoma in four patients. In general, the patients with primary unresectable disease received preoperative chemotherapy with 5-fluorouracil (5-FU) and leucovorin, and external beam irradiation to 4500-5040 cGy, followed by surgical resection and HDR-IORT (1000-2000 cGy). In general , the patients with recurrent disease were treated with surgical resection and HDR-IORT (1000-2000 cGy) alone. All surgical procedures were done in a dedicated operating room in the brachytherapy suite, so that HDR-IORT could be delivered using the Harrison-Anderson-Mick (HAM) applicator. The median follow-up is 17.5 months (1-48 mo). Results: In primary cases, the actuarial 2-year local control is 81%. For patients with negative margins, the local control was 92% vs. 38% for those with positive margins (p = 0.002). The 2-year actuarial disease-free survival was 69%; 77% for patients with negative margins vs. 38% for patients with positive margins (p = 0.03). For patients with recurrent disease, the 2-year actuarial local control rate was 63%. For patients with negative margins, it was 82%, while it was

  15. 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.)

  16. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. 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.

  19. 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...

  20. Phase II trial of combined surgical resection, high dose rate intraoperative radiation therapy, and external beam radiotherapy for malignant pleural mesothelioma

    International Nuclear Information System (INIS)

    Raben, A.; Rusch, V.; Mychalczak, B.; Ginsberg, R.; Burt, M.; Bains, M.; Francois, Damien; Harrison, L.B.

    1997-01-01

    Purpose: To determine the feasibility of combining extrapleural pneumonectomy (EPP) or pleurectomy / decortication (PD), high dose rate intraoperative radiation therapy (HDR-IORT) and postoperative external beam radiation hemithoracic radiation (EBHRT) to treat malignant pleural mesothelioma (MPM). Materials and Methods: From 3/94 through 9/94, 15 patients (pts) were enrolled on this trial. This included 3 females and 12 males with a median age of 59 (Range: 45-75). Eligibility criteria included biopsy proven MPM, no evidence of T4 or N3 disease by exam/CT/MRI, no evidence of metastatic disease, no previous treatment, and a Karnofsky performance status of ≥ 80%. Pts with pulmonary function tests permitting EPP, underwent EPP and HDR-IORT (N=7). The rest underwent PD/HDR-IORT (N=4). An intraoperative dose of 15 Gy was prescribed to a depth of 5 mm in tissue to the ipsilateral mediastinum, diaphragm, and chest wall. Postoperatively, 54 Gy of EBHRT was prescribed to the hemithorax, surgical scar and surgical drain site. The median surgical procedure time, median IORT time and median overall operating time was 554 minutes, 240 minutes, and 649 minutes respectively. The median dose of EBHRT was 50.4 Gy (Range 50-54 Gy). The median follow-up time is 8 months (Range: 3.5 to 28 months). Four of 15 pts had unresectable disease at the time of surgery and were taken off study. Results are presented in crude and actuarial analysis. Results: A complete resection of all visible gross disease was accomplished in 10 pts. One pt had a single focus of gross residual disease (less than 5 mm in size) left behind in the chest wall. The overall complication rate was 54%. Treatment related mortality occurred in 2 pts (18%) at 1 and 7 months respectively. This was attributed to ARDS in 1 pt (EPP/HDR-IORT) and radiation pneumonitis combined with a tracheoesophageal fistula in 1 pt (PD/HDR-IORT). Of the 6 remaining pts undergoing EPP/HDR-IORT, 2 pts developed a postoperative empyema with

  1. 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.

  2. Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy.

    Science.gov (United States)

    Sarmento, Sandra; Costa, Filipa; Pereira, Alexandre; Lencart, Joana; Dias, Anabela; Cunha, Luís; Sousa, Olga; Silva, José Pedro; Santos, Lúcio

    2015-01-09

    Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT. CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber. Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR (192)Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT. The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR (192)Ir brachytherapy.

  3. Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Sarmento, Sandra; Costa, Filipa; Pereira, Alexandre; Lencart, Joana; Dias, Anabela; Cunha, Luís; Sousa, Olga; Silva, José Pedro; Santos, Lúcio

    2015-01-01

    Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT. CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber. Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR 192 Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT. The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR 192 Ir brachytherapy

  4. 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.

  5. 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.)

  6. [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.

  7. A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT and intraoperative radiation therapy (IORT in patients with retroperitoneal soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Roeder Falk

    2012-07-01

    Full Text Available Abstract Background Local control rates in patients with retroperitoneal soft tissue sarcoma (RSTS remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative radiation therapy (RT has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated radiation therapy (IMRT are considered. Methods/design The trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant dose-escalated IMRT (50–56 Gy followed by surgery and IORT (10–12 Gy in patients with at least marginally resectable RSTS. The primary objective is the local control rate after five years. Secondary endpoints are progression-free and overall survival, acute and late toxicity, surgical resectability and patterns of failure. The aim of accrual is 37 patients in the per-protocol population. Discussion The present study evaluates combined neoadjuvant dose-escalated IMRT followed by surgery and IORT concerning its value for improved local control without markedly increased toxicity. Trial registration NCT01566123

  8. A Clinical phase I/II trial to investigate preoperative dose-escalated intensity-modulated radiation therapy (IMRT) and intraoperative radiation therapy (IORT) in patients with retroperitoneal soft tissue sarcoma

    International Nuclear Information System (INIS)

    Roeder, Falk; Hensley, Frank W; Buechler, Markus W; Debus, Juergen; Koch, Moritz; Weitz, Juergen; Bischof, Marc; Schulz-Ertner, Daniela; Nikoghosyan, Anna V; Huber, Peter E; Edler, Lutz; Habl, Gregor; Krempien, Robert; Oertel, Susanne; Saleh-Ebrahimi, Ladan

    2012-01-01

    Local control rates in patients with retroperitoneal soft tissue sarcoma (RSTS) remain disappointing even after gross total resection, mainly because wide margins are not achievable in the majority of patients. In contrast to extremity sarcoma, postoperative radiation therapy (RT) has shown limited efficacy due to its limitations in achievable dose and coverage. Although Intraoperative Radiation Therapy (IORT) has been introduced in some centers to overcome the dose limitations and resulted in increased outcome, local failure rates are still high even if considerable treatment related toxicity is accepted. As postoperative administration of RT has some general disadvantages, neoadjuvant approaches could offer benefits in terms of dose escalation, target coverage and reduction of toxicity, especially if highly conformal techniques like intensity-modulated radiation therapy (IMRT) are considered. The trial is a prospective, one armed, single center phase I/II study investigating a combination of neoadjuvant dose-escalated IMRT (50–56 Gy) followed by surgery and IORT (10–12 Gy) in patients with at least marginally resectable RSTS. The primary objective is the local control rate after five years. Secondary endpoints are progression-free and overall survival, acute and late toxicity, surgical resectability and patterns of failure. The aim of accrual is 37 patients in the per-protocol population. The present study evaluates combined neoadjuvant dose-escalated IMRT followed by surgery and IORT concerning its value for improved local control without markedly increased toxicity. NCT01566123

  9. Analysis of radiation risk to patients from intra-operative use of the mobile X-ray system (C-arm

    Directory of Open Access Journals (Sweden)

    Yang-Sub Lee

    2015-01-01

    Full Text Available Background: The aim of this study was to investigate clinical applications of mobile C-arms and consequent radiation risk, to increase medical attention on radiation protection, and to provide basic data for safe radiation use in the operating room. Materials and Methods: In this study, a total of 374 surgical operations, conducted using a portable fluoroscopic X-ray system from January to March of 2013, were analyzed. Dose summaries produced by the General Electric C-arm and data elements in digital imaging and communications in the medicine header of Ziehm C-arm, fluoroscopy time were used to obtain dose-area product (DAP and effective dose. Corresponding mean and maximum values were calculated, and the resulting data on the frequency of application, fluoroscopy time, DAP, and effective dose were compared and analyzed in terms of surgical specialty and operation types. Results: Orthopedic surgery was the most frequent with 165 cases (44.1%. The highest DAP value and effective dose were found in liver transplant among surgical specialty fields, with mean values of 2.90 ± 3.76 mGy∙m 2 and 58 ± 75.2 mSv, respectively (P = 0.0001. The highest DAP value and effective dose were observed in intra-operative mesenteric portography among types of surgery, showing mean values of 2.90 ± 3.81 mGy∙m 2 and 58.03 ± 76.24 mSv, respectively (P = 0.0001. Conclusion: Because DAP varies significantly across surgical specialties and types of operation, aggressive efforts to understand the effects of radiation dose is critical for radiation protection from intra-operative use of mobile C-arms.

  10. Fluoroscopically-guided foam sclerotherapy with sodium morrhuate for the treatment of lower extremity varices

    International Nuclear Information System (INIS)

    Wang Haiting; Jiang Zhongpu; Zhou Yi

    2011-01-01

    Objective: To evaluate fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate in treating lower extremity varices. Methods: A total of 30 cases (39 diseased lower limbs) with lower extremity varices were enrolled in this study. Under fluoroscopic guidance foam sclerotherapy with injection of domestic sodium morrhuate was carried out in all patients. The obstructed condition of the great saphenous vein was observed during the following three months. Results: The technical success was achieved in all 39 patients. The mean dose of foam sclerosant used for each diseased limb was 5.9 ml (3.4-8.2 ml). Disappearance of blood flow reflux in lower extremity vein immediately after the treatment was seen in 35 patients (90%). Three months after the therapy, vascular sonography showed that the great saphenous vein was obstructed, and no serious complications occurred. Conclusion: For the treatment of lower extremity varices, fluoroscopically-guided foam sclerotherapy with injection of domestic sodium morrhuate is safe and effective with satisfactory results. This technique is a newly-developed micro-invasive therapy for lower extremity varices. (authors)

  11. Effect of Intraoperative Three-Dimensional Imaging During the Reduction and Fixation of Displaced Calcaneal Fractures on Articular Congruence and Implant Fixation

    DEFF Research Database (Denmark)

    Eckardt, Henrik; Lind, Marianne

    2015-01-01

    BACKGROUND: Operative treatment of displaced calcaneal fractures should restore joint congruence, but conventional fluoroscopy is unable to fully visualize the subtalar joint. We questioned whether intraoperative 3-dimensional (3D) imaging would aid in the reduction of calcaneal fractures......, resulting in improved articular congruence and implant positioning. METHOD: Sixty-two displaced calcaneal fractures were operated on using standard fluoroscopic views. When the surgeon had achieved a satisfactory reduction, an intraoperative 3D scan was conducted, malreductions or implant imperfections were...

  12. 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)

  13. Intraoperative radiation therapy

    International Nuclear Information System (INIS)

    Dobelbower Junior, R.R.

    1987-01-01

    A briefly history of intraoperative radiotherapy is presented. The equipment used is described and the treatment with superficial X-ray beams, orthovoltage X-ray beams and megavoltage electron beams are discussed. The effect on normal tissues and the clinical use of intraoperative radiotherapy in several Kind of cancer is studied. (M.A.C.) [pt

  14. 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

  15. Intraoperative radiotherapy for cancer of the pancreas

    International Nuclear Information System (INIS)

    Manabe, Tadao; Nagai, Toshihiro; Tobe, Takayoshi; Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

    1985-01-01

    Seven patients treated by intraoperative radiotherapy for cancer of the pancreas were evaluated. Three patients undergoing pancreaticoduodenectomy for cancer of the head of the pancreas received a dose of 2,500--3,000 rad (6--10 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 2,520 rad (10 MeV lineac X-ray). One patient developed radiation pancreatitis and died 0.8 month after surgery. Autopsy revealed the degeneration of cancer cells in the involved superior mesenteric artery. One died of hepatic metastasis 8.5 months after surgery, however, recurrence was not found in the irradiation field. The other patient who had external beam irradiation combined with intraoperative radiotherapy is alive 7.5 months after surgery. Four patients with unresectable cancer of the body of the pancreas received a dose of 2,500--3,000 rad (13--18 MeV Betatron) intraoperatively with or without external beam irradiation at a dose of 1,500--5,520 rad (10 MeV lineac X-ray). One patient died of peritonitis carcinomatosa 3.0 months after surgery. One patient died of DIC 0.6 month after surgery. Two patients are alive 1.0 and 6.5 months after surgery. In these patients with intraoperative radiotherapy for unresectable cancer of the pancreas, remarkable effects on relief of pain and shrinkage of tumor were obtained. Further pursuit of intraoperative and external beam radiotherapies in combination with pancreatectomy should be indicated in an attempt to prolong survival of patient with cancer of the pancreas. (author)

  16. 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

  17. [Intraoperative multidimensional visualization].

    Science.gov (United States)

    Sperling, J; Kauffels, A; Grade, M; Alves, F; Kühn, P; Ghadimi, B M

    2016-12-01

    Modern intraoperative techniques of visualization are increasingly being applied in general and visceral surgery. The combination of diverse techniques provides the possibility of multidimensional intraoperative visualization of specific anatomical structures. Thus, it is possible to differentiate between normal tissue and tumor tissue and therefore exactly define tumor margins. The aim of intraoperative visualization of tissue that is to be resected and tissue that should be spared is to lead to a rational balance between oncological and functional results. Moreover, these techniques help to analyze the physiology and integrity of tissues. Using these methods surgeons are able to analyze tissue perfusion and oxygenation. However, to date it is not clear to what extent these imaging techniques are relevant in the clinical routine. The present manuscript reviews the relevant modern visualization techniques focusing on intraoperative computed tomography and magnetic resonance imaging as well as augmented reality, fluorescence imaging and optoacoustic imaging.

  18. Tolerance of bile duct to intraoperative irradiation

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Tepper, J.; Travis, E.L.

    1982-01-01

    In order to determine the effects of intraoperative radiation therapy of the bile duct and surrounding tissues, seven adult dogs were subjected to laparotomy and intraoperative irradiation with 11 MeV electrons. Two animals were treated at each dose level of 2000, 3000, and 4500 rads. A single dog which received a laparotomy and sham irradiation served as a control. The irradiation field consisted of a 5 cm diameter circle encompassing the extrahepatic bile duct, portal vein, hepatic artery, and lateral duodenal wall. The animals were followed clinically for mor than 18 months after treatment, and autopsies were performed on dogs that died to assess radiation-induced complications or tissue damage. All dogs developed fibrosis and mural thickening of the common duct, which appeared by 6 weeks following irradiation and which was dose-related, being mild at low doses and more severe at high doses. Hepatic changes were seen as early as 6 weeks after irradiation, consisting of periportal inflammation and fibrosis. The hepatic changes appeared earliest at the highest doses. Frank biliary cirrhosis eventually developed at all dose levels. Duodenal fibrosis appeared in the irradiation portal, being most severe at the highest doses and in some animals resulting in duodenal obstruction. No changes were observed in irradiated portions of portal vein and hepatic artery at any dose level. It was concluded that intraoperative radiation therapy delivered to the region of the common duct leads to ductal fibrosis, partial biliary obstruction with secondary hepatic changes, and duodenal fibrosis if bowel wall is included in the field. Clinical use of intraoperative radiation therapy to the bile duct in humans may require routine use of biliary and duodenal bypass to prevent obstructive complications

  19. 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)

  20. 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...

  1. 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...

  2. Intraoperative radiotherapy - Current status

    International Nuclear Information System (INIS)

    Gunderson, Leonard L.; Willett, Christopher G.; Harrison, Louis B.

    1997-01-01

    Purpose/Objective: Intraoperative irradiation (IORT) in its broadest sense refers to the delivery of irradiation at the time of an operation. This refresher course will discuss the use of both electrons (IOERT) and high dose rate brachytherapy (IOHDR) in conjunction with surgical exploration and resection ± external irradiation/chemotherapy. Both IORT methods have evolved with similar philosophies as an attempt to achieve higher effective doses of irradiation while dose limiting structures are surgically displaced. The rationale for each is supported by excellent local control ± survival results achieved with brachytherapy alone or as a boost to external irradiation in organ preservation efforts in traditional sites (head and neck, breast, gynecologic) wherein a boost dose could be delivered to smaller volumes than could usually be accomplished with external irradiation alone. IOERT has been a tool in modern radiotherapy in Japan since the 1960's and in the U.S. since the mid 1970's. Results from randomized and nonrandomized trials will be presented in the refresher course with major emphasis on GI sites (gastric, pancreas, colorectal) since the data is more mature. While the largest clinical experience with IOERT (± external irradiation/chemotherapy, maximal resection) has been with gastrointestinal cancers in adults, moderate experience has also been obtained with locally advanced retroperitoneal sarcomas and recurrent genitourinary and gynecologic cancers. With primary colorectal cancers that are unresectable for cure or for locally recurrent colorectal cancers, both local control and long-term survival appear to be improved with the aggressive combinations including IOERT when compared to results achieved with conventional treatment. When residual disease exists after resection of gastric cancers, IOERT ± external radiation has achieved optimistic survival results in trials in Japan, the U.S., Spain and China. With locally unresectable pancreatic cancer, an

  3. Experimental and clinical studies with intraoperative radiotherapy

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Kinsella, T.; Tepper, J.; Travis, E.L.; Rosenberg, S.A.; Glatstein, E.

    1983-01-01

    Studies of normal tissue tolerance to intraoperative radiotherapy were done upon 65 dogs subjected to laparotomy and 11 million electron volt electron irradiation in doses ranging from zero to 5,000 rads. Results of studies indicated that intact aorta and vena cava tolerate up to 5,000 rads without loss of structural integrity. Ureteral fibrosis and stenosis develop at doses of 3,000 rads or more. Arterial anastomoses heal after doses of 4,500 rads, but fibrosis can lead to occlusion. Intestinal suture lines heal after doses of 4,500 rads. Bile duct fibrosis and stenosis develop at doses of 2,000 rads or more. Biliary-enteric anastomoses fail to heal at any dose level. A clinical trial of intraoperative radiotherapy combined with radical surgery was performed upon 20 patients with advanced malignant tumors which were considered unlikely to be cured by conventional therapies and which included carcinomas of the stomach, carcinomas of the pancreas, carcinomas involving the hilus of the liver, retroperitoneal sarcomas and osteosarcomas of the pelvis. All patients underwent resection of gross tumor, followed by intraoperative irradiation of the tumor bed and regional nodal basins. Some patients received additional postoperative external beam radiotherapy. Treatment mortality for combined operation and radiotherapy occurred in four of 20 patients. Postoperative complications occurred in four of the 16 surviving patients. Local tumor control was achieved in 11 of the 16 surviving patients, with an over-all median follow-up period of 18 months. The clinical trial suggested that intraoperative radiotherapy is a feasible adjunct to resection in locally advanced tumors, that the resulting mortality and morbidity is similar to that expected from operation alone and that local tumor control may be improved

  4. 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.)

  5. 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

  6. 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

  7. Intraoperative cranial nerve monitoring.

    Science.gov (United States)

    Harper, C Michel

    2004-03-01

    The purpose of intraoperative monitoring is to preserve function and prevent injury to the nervous system at a time when clinical examination is not possible. Cranial nerves are delicate structures and are susceptible to damage by mechanical trauma or ischemia during intracranial and extracranial surgery. A number of reliable electrodiagnostic techniques, including nerve conduction studies, electromyography, and the recording of evoked potentials have been adapted to the study of cranial nerve function during surgery. A growing body of evidence supports the utility of intraoperative monitoring of cranial nerve nerves during selected surgical procedures.

  8. 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

  9. Comparison of postoperative analgesic efficacy of intraoperative single-dose intravenous administration of dexketoprofen trometamol and diclofenac sodium in laparoscopic cholecystectomy.

    Science.gov (United States)

    Anıl, Ali; Kaya, Fatma Nur; Yavaşcaoğlu, Belgin; Mercanoğlu Efe, Esra; Türker, Gürkan; Demirci, Abdurrahman

    2016-08-01

    The aim of this study is to compare the effects of intravenous single-dose dexketoprofen trometamol and diclofenac sodium 30 minutes before the end of the surgery on relief of postoperative pain in patients undergoing laparoscopic cholecystectomy. A randomized fashion. Sixty (American Society of Anesthesiologist class I-II) patients undergoing laparoscopic cholecystectomy were divided into 2 groups Patients in group DT received 50 mg dexketoprofen trometamol, whereas patients in group DS received 75 mg diclofenac sodium, intravenously 30 minutes before the end of surgery. Postoperative pain intensity, morphine consumption with patient-controlled analgesia, time to first analgesic requirement, complications, rescue analgesic (intravenous tenoxicam 20 mg) requirement, and duration of hospital stay were recorded. Postoperative pain visual analog scale scores were similar in the follow-up periods (P > .05). Patient-controlled analgesia morphine consumption was significantly less in group DT compared with group DS in all postoperative follow-up periods (2 and 4 hours: P dexketoprofen trometamol 30 minutes before the end of surgery provided effective analgesia with reduced consumption of opioids and requirement for rescue analgesic compared with diclofenac sodium in patients undergoing laparoscopic cholecystectomy. For this reason, we believe that, as a part of multimodal analgesia, dexketoprofen trometamol provides more effective analgesia than diclofenac sodium in patients undergoing laparoscopic cholecystectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. 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.)

  11. Intraoperative ultrasound in neurosurgery

    International Nuclear Information System (INIS)

    Velasco, J.; Manzanares, R.; Fernandez, L.; Hernando, A.; Ramos, M. del Mar; Garcia, R.

    1996-01-01

    The present work is a review of the major indications for intraoperative ultrasound in the field of neurosurgery, stressing the exploratory method and describing what we consider to be the most illustrative cases. We attempt to provide a thorough view of this constantly developing technique which, despite its great practical usefulness, may be being underemployed. (Author) 47 refs

  12. Intraoperative radiotherapy for pancreatic carcinoma

    International Nuclear Information System (INIS)

    Nishimura, Akira; Iida, Koyo; Sato, Shigehiro; Sakata, Suo

    1986-01-01

    Twenty-eight patients with pancreatic carcinoma, 23 (82 %) of whom had Stage III or IV, received intraoperative radiotherapy (IOR) with curative or non-curative surgery. Electron beams (10 to 18 MeV) with doses of 20 to 40 Gy were delivered to the tumor. Eight of 26 patients with unresectable tumor had postoperative external irradiation of 10.5 to 50 Gy. Abdominal and back pain relief was achieved after IOR in 12 (71 %) and in 6 (60 %) of the 26 patients, respectively. Appetite was promoted in 11 patients. In the case of unresectable carcinoma, survival time tended to prolong in the 8 patients receiving both IOR and postoperative external irradiation. One patient developed perforation of the colon probably caused by IOR. (Namekawa, K.)

  13. Phase II trial of combined surgical resection, intraoperative high dose rate brachytherapy (IORT), and external beam radiation therapy (EBRT) for malignant pleural mesothelioma (MPM)

    International Nuclear Information System (INIS)

    Raben, A.; Rusch, V.; Mychalczak, B.; Schupak, K.; Ginsburg, R.; Burt, M.; Bains, M.; Harrison, L.B.

    1996-01-01

    The purpose of this study was to determine the feasibility of combining extrapleural pneumonectomy (EPP) or pleurectomy/decortication (PD), IORT and postoperative EBRT to treat MPM. From (3(94)) through (9(94)), 16 patients (pts) were enrolled on this trial; 2 females and 14 males with a median age of 59 (range: 45 - 75). Eligibility criteria included biopsy proven MPM, no evidence of T4 or N3 disease by exam/CT scan, no evidence of metastatic disease, no previous treatment, and a Karnofsky performance status of ≥ 80%. Pts with pulmonary function tests permitting EPP, underwent EPP and IORT (15 Gy prescribed to a depth of 5 mm in tissue to the mediastinum, diaphragm and chestwall) with postoperative EBRT (54 Gy to entire hemithorax, surgical scar and surgical drain site). Pts ineligible for EPP due to marginal pulmonary function underwent PD and IORT (15 Gy to mediastinum, diaphragm and chestwall), with EBRT (54 Gy to entire hemithorax with customized lung blocking). The median surgical procedure time, median IORT time and median overall operating time was 554 minutes, 240 minutes and 649 minutes respectively. The median dose of EBRT was 50.4 Gy (range 50-54 Gy). The median follow-up time is 8 months (range: 3 - 17 months). Four of 16 pts had unresectable disease at the time of surgery and were taken off study. Eight pts underwent EPP/IORT and 4 patients underwent PD/IORT. A complete resection of all gross disease was obtained in 11pts. One pt had a single focus of gross residual disease (less than 5 mm in size) left behind. The overall actuarial local control at 1 year for resected patients is 66%. The crude local control rate and distant control rate for pts undergoing EPP was 75% and 50% respectively. The crude local control rate and distant control rate for PD pts was 50% and 75%. The overall distant metastasis rate at 1 year was 42%. The overall complication rate was 58% ((7(12))). Of the 8 pts undergoing EPP and IORT, 1 patient developed postoperative acute

  14. A non-docking intraoperative electron beam applicator system

    International Nuclear Information System (INIS)

    Palta, J.R.; Suntharalingam, N.

    1989-01-01

    A non-docking intraoperative radiation therapy electron beam applicator system for a linear accelerator has been designed to minimize the mechanical, electrical, and tumor visualization problems associated with a docking system. A number of technical innovations have been used in the design of this system. These include: (a) a new intraoperative radiation therapy cone design that gives a better dose uniformity in the treatment volume at all depths; (b) a collimation system which reduces the leakage radiation dose to tissues outside the intraoperative radiation therapy cone; (c) a non-docking system with a translational accuracy of 2 mm and a rotational accuracy of 0.5 degrees; and (d) a rigid clamping system for the cones. A comprehensive set of dosimetric characteristics of the intraoperative radiation therapy applicator system is presented

  15. 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)

  16. 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.

  17. 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

  18. 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

  19. Intraoperative radiation therapy for glioblastoma multiforme

    International Nuclear Information System (INIS)

    Matsutani, Masao; Tanaka, Yoshiaki; Matsuda, Tadayoshi

    1986-01-01

    Intraoperative radiation therapy (IOR) is quite applicable for radioresistant malignant gliomas, because of precise demarcations of the treatment volume under direct vision, minimum damage to surrounding normal tissues, and a high target absorbed dose of 1500 to 2000 rad. Fifteen patients with glioblatoma were treated with IOR, and the 2-year survival rate was 61.1 %. The result apparently indicate that areas adjacent to the margin of almost complete removal should be irradated with a sufficient dose to sterilize the remaining malignant remnants, and IOR is one of the logical treatment modalities for local control of malignant gliomas. (author)

  20. Intraoperative Radiotherapy for Breast Cancer

    Directory of Open Access Journals (Sweden)

    Eleanor E. R. Harris

    2017-12-01

    Full Text Available Intraoperative radiotherapy (IORT for early stage breast cancer is a technique for partial breast irradiation. There are several technologies in clinical use to perform breast IORT. Regardless of technique, IORT generally refers to the delivery of a single dose of radiation to the periphery of the tumor bed in the immediate intraoperative time frame, although some protocols have performed IORT as a second procedure. There are two large prospective randomized trials establishing the safety and efficacy of breast IORT in early stage breast cancer patients with sufficient follow-up time on thousands of women. The advantages of IORT for partial breast irradiation include: direct visualization of the target tissue ensuring treatment of the high-risk tissue and eliminating the risk of marginal miss; the use of a single dose coordinated with the necessary surgical excision thereby reducing omission of radiation and the selection of mastectomy for women without access to a radiotherapy facility or unable to undergo several weeks of daily radiation; favorable toxicity profiles; patient convenience and cost savings; radiobiological and tumor microenvironment conditions which lead to enhanced tumor control. The main disadvantage of IORT is the lack of final pathologic information on the tumor size, histology, margins, and nodal status. When unexpected findings on final pathology such as positive margins or positive sentinel nodes predict a higher risk of local or regional recurrence, additional whole breast radiation may be indicated, thereby reducing some of the convenience and low-toxicity advantages of sole IORT. However, IORT as a tumor bed boost has also been studied and appears to be safe with acceptable toxicity. IORT has potential efficacy advantages related to overall survival related to reduced cardiopulmonary radiation doses. It may also be very useful in specific situations, such as prior to oncoplastic reconstruction to improve accuracy of

  1. Tolerance of retroperitoneal structures to intraoperative radiation

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Tepper, J.; Travis, E.L.; Terrill, R.

    1982-01-01

    In conjunction with the clinical development of intraoperative radiotherapy, a study was undertaken in dogs to define the tolerance of normal anatomic structures in the retroperitoneum to radiation delivered during operation. Twenty adult dogs were subjected to laparotomy and intraoperative 11 MeV electron irradiation in single doses ranging from 0.to 5000 rad. Animals were followed regularly with clinical observation, blood count, serum chemistries, pyelography, and angiography. Animals were sacrificed and autopsied at regular intervals up to 12 months following treatment to assess radiation-induced complications or tissue damage. Irradiation field in all dogs consisted of a 4 X 15 cm rectangle extending in the retroperitoneum from the level of the renal vessels to the bifurcation of aorta and vena cava. The field included aorta, vena cava, inferior portion of left kidney, and distal portion of left ureter. No complications or histologic changes occurred in any animal given doses of 2000 rad, with a follow-up in excess of 18 months. A dose of 3000 rad was well tolerated, except for left ureteral occlusion in one animal. Mild vascular fibrosis was present inthe aorta and vena cava, and significant ureteral fibrosis developed by six months after doses of 4000 or 5000 rad. All animals that received 5000 rad died of radiation-related complications, including ureteral obstruction and rectal perforation. It was concluded that major vessels tolerate intraoperative irradiation well up to and including 3000 rad and that no clinically significant vascular problems develop after 4000 and 5000 rad, although some fibrosis does occur. The ureter and kidney appear to be the most radiosensitive structures inthe retroperitoneum, showing progressive changes at 300 rad or greater and showing the potential for serious complications after doses of 4000 rad or more

  2. Study on intraoperative radiotherapy of brain tumors

    International Nuclear Information System (INIS)

    Uozumi, Akimasa

    1990-01-01

    Effects of a single large dose radiation on the brain of dogs were investigated for the purpose of determining the optimal dose and radiation field in intraoperative radiotherapy. The right parietal lobe of dogs (three groups, four dogs in each) were radiated at the dose of 30, 40 and 50 Gy respectively at the depth of 1.5 cm by 11 Nev electron beam with field size of 2 cm. CT and histopathological study were performed 2, 6, 12 and 24 months after radiation. L-hemiparesis developed 14 months after radiation in the 30 Gy group and 8 months in the 40 Gy group, 6 months in the 50 Gy group. All animals in the 40 Gy and 50 Gy groups died before 15 months of radiation. CT showed delayed radiation necrosis in all groups. Brain swelling and ventricular displacement in the radiated hemisphere and contralateral ventricular dilatation were depicted on plain CT. Diffuse heterogeneous contrast enhancement (CE) was observed on CE-CT. CT revealed disappearance of radiation necrosis in the 30 Gy group 24 months of radiation, suggesting that radiation necrosis may be dependent on the term after radiation. Histological findings of radiation necrosis were similar in all animals, and the vascular change preceding the parechymal necrosis was not observed. This supports the theory that the vascular alternation dose not play a major role in the production of radiation necrosis. The necrotic area grossly reflected the isodose curve and was observed in the radiation field with 15 to 20 Gy at the depth of 3 to 4.5 cm. Thus, the intraoperative radiotherapy should be planned on the basis of two such factors as electron beam energy and the field size, and the area out of the target should not be radiated at the dose of more than 15 Gy. The author believes that the information would contribute to safer and more effective application of intraoperative radiotherapy on malignant brain tumors. (J.P.N.) 63 refs

  3. Role of fluoroscopic guided self expandable metallic stents in the management of malignant esophageal strictures

    Directory of Open Access Journals (Sweden)

    Mohamed Shaker

    2016-09-01

    Conclusion: Fluoroscopic guided esophageal stenting is a highly effective and safe method for palliating dysphagia in patients with obstructing esophageal cancer with significant clinical improvement.

  4. 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

  5. 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

  6. 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.

  7. Intraoperative HDR brachytherapy for rectal cancer using a flexible intraoperative template: standard plans versus individual planning

    International Nuclear Information System (INIS)

    Kolkman-Deurloo, Inger-Karine K.; Nuyttens, Joost J.; Hanssens, Patrick E.J.; Levendag, Peter C.

    2004-01-01

    HDR intraoperative brachytherapy (IOBT) is applied to locally advanced rectal tumors using a 5 mm thick flexible intraoperative template (FIT). To reduce the procedure time, treatment planning is performed using standard plans that neglect the curvature of the FIT. We have calculated the individual treatment plan, based on the real geometry of the FIT, and the dose at clips placed during surgery. A mean treatment dose of 9.55±0.21 Gy was found for the individual plan, compared to the prescribed 10 Gy (P<0.0001). The mean central dose was 10.03±0.10 Gy in the standard plan and 9.20±0.32 Gy in the individual plan (P<0.0001). The mean dose at the corners of the FIT was 10.3 Gy in the standard plan and ranged between 10.3 and 10.5 Gy in the individual plan. In 63% of the clips, the dose was larger than 15.0 Gy, which is equivalent to a gap between the FIT and the target smaller than 5 mm. In 18% of the clips, the dose was smaller than 13.0 Gy indicating that locally the gap was larger than 5 mm. Clinical practice will have to prove if these small dose deviations influence the clinical outcome

  8. 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)

  9. [Intraoperative floppy iris syndrome].

    Science.gov (United States)

    Mazal, Z

    2007-04-01

    In the year 2005, Chang and Cambell described unusual reaction of the iris during the cataract surgery in patients treated with tamsulosine. This was named as IFIS, an acronym for the Intraoperative Floppy Iris Syndrome. In its advanced stage, the syndrome is characterized by insufficient mydfiasis before the surgery, narrowing of the pupil during the surgery, its impossible dilatation during the surgery by means of stretching, unusual elasticity of the pupilar margin, surging and fluttering iris with tendency to prolapse. The same manifestations we observed in our patients and we confirm the direct connection with tamsulosine hydrochloride treatment. Tamsulosine is the antagonist of alpha 1A adrenergic receptors whose are present, except in the smooth musculature of the prostate gland and the urinary bladder, in the iris dilator as well. At the same time we observed this syndrome rarely in some patients not using tamsulosine. In most cases, these patients were treated with antipsychotic drugs.

  10. Radiation dose in vertebroplasty

    International Nuclear Information System (INIS)

    Mehdizade, A.; Lovblad, K.O.; Wilhelm, K.E.; Somon, T.; Wetzel, S.G.; Kelekis, A.D.; Yilmaz, H.; Abdo, G.; Martin, J.B.; Viera, J.M.; Ruefenacht, D.A.

    2004-01-01

    We wished to measure the absorbed radiation dose during fluoroscopically controlled vertebroplasty and to assess the possibility of deterministic radiation effects to the operator. The dose was measured in 11 consecutive procedures using thermoluminescent ring dosimeters on the hand of the operator and electronic dosimeters inside and outside of the operator's lead apron. We found doses of 0.022-3.256 mGy outside and 0.01-0.47 mGy inside the lead apron. Doses on the hand were higher, 0.5-8.5 mGy. This preliminary study indicates greater exposure to the operator's hands than expected from traditional apron measurements. (orig.)

  11. Use of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement

    International Nuclear Information System (INIS)

    Bae, Jae-Ik; Shin, Ji Hoon; Song, Ho-Young; Yoon, Chang Jin; Nam, Deok Ho; Choi, Won-Chan; Lim, Jin-Oh

    2005-01-01

    Our purpose was to assess the safety and usefulness of guiding sheaths in peroral fluoroscopic gastroduodenal stent placement. Two types of guiding sheath were made from straight polytetrafluoroethylene tubes. Type A was 80 cm in length, 4 mm in outer diameter and 3 mm in inner diameter. Type B was 70 cm in length, 6 mm in outer diameter and 5 mm in inner diameter. The type A sheath was used in 18 patients in whom a catheter-guide wire combination failed to pass through a stricture. The type B sheath was used in 22 patients in whom a stent delivery system failed to pass through the stricture due to loop formation within the gastric lumen. The overall success rate for guiding a catheter-guide wire through a stricture after using the type A sheath was 89%. The overall success rate for passing a stent delivery system through a stricture after using the type B sheath was 100%. All procedures were tolerated by the patients without any significant complications. The guiding sheaths were safe and useful in peroral fluoroscopic gastroduodenal stent placement. (orig.)

  12. 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.)

  13. 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)

  14. Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelm, Kai E; Hofer, Ulrich; Textor, Hans J [Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Boeker, Thorsten [Department of Ophthalmology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany); Strunk, Holger; Schild, Hans H [Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, D-53127 Bonn (Germany)

    2000-01-15

    Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results.

  15. Nonsurgical Fluoroscopically Guided Dacryocystoplasty of Common Canalicular Obstructions

    International Nuclear Information System (INIS)

    Wilhelm, Kai E.; Hofer, Ulrich; Textor, Hans J.; Boeker, Thorsten; Strunk, Holger; Schild, Hans H.

    2000-01-01

    Purpose: To assess dacryocystoplasty in the treatment of epiphora due to obstructions of the common canaliculus.Methods: Twenty patients with severe epiphora due to partial (n = 16) or complete (n = 4) obstruction of the common canaliculus underwent fluoroscopically guided dacryocystoplasty. In all cases of incomplete obstruction balloon dilation was performed. Stent implantation was attempted in cases with complete obstruction. Dacryocystography and clinical follow-up was performed at intervals of 1 week, and 3, 6, 12, and 18 months after the procedure. The mean follow-up was 6 months (range 3-18 months).Results: Balloon dilation was technically successfully performed in all patients with incomplete obstructions (n = 16). In three of four patients with complete obstruction stent implantation was performed successfully. Subsequent to failure of stent implantation in one of these patients balloon dilation was performed instead. The long-term primary patency rate in patients with incomplete obstructions was 88% (n = 14/16). In three of four cases with complete obstruction long-term patency was achieved during follow-up. Severe complications, infections, or punctal splitting were not observed.Conclusion: Fluoroscopically guided balloon dacryocystoplasty is a feasible nonsurgical therapy in canalicular obstructions with good clinical results that may be used as an alternative to surgical procedures. In patients with complete obstructions stent placement is possible but further investigations are needed to assess the procedural and long-term results

  16. 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.

  17. Intraoperative radiotherapy for locally advanced refractory cancer

    Energy Technology Data Exchange (ETDEWEB)

    Abe, Mitsuyuki; Takahashi, Masaji; Ono, Koji; Dodo, Yoshihiro; Hiraoka, Masahiro [Kyoto Univ. (Japan). Faculty of Medicine

    1983-05-01

    Clinical results of intraoperative radiotherapy (IOR) in carcinoma of the stomach and prostate, and malignant soft tissue tumors are reported. The 5-year survival rate was found to be increased by IOR in stages II-IV gastric cancer. From the analysis of the clinical results of prostatic cancer, a single dose of 3,500 rad was considered to be a potential curative dose for the tumor less than 3 cm in diameter. The local recurrence rate of patients with malignant soft tissue tumors who received a single dose ranging from 3,000 to 4,500 rad was 5.9 and the 5-year survival rate was 64.6 %.

  18. 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

  19. 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.

  20. 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.

  1. Intraoperative glucose management in children < 1 year or < 10 kg ...

    African Journals Online (AJOL)

    The intraoperative management of intravenous dextrose administration and blood glucose monitoring was at the discretion of the attending anaesthetists. Data collected included patient demographics, period of starvation, dose of dextrose administered and blood glucose measurements taken. Results: Nine infants had at ...

  2. 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

  3. Targeted intraoperative radiotherapy in oncology

    CERN Document Server

    Keshtgar, Mohammed; Wenz, Frederik

    2014-01-01

    Targeted intraoperative radiotherapy is a major advance in the management of cancer patients. With an emphasis on practical aspects, this book offers an ideal introduction to this innovative  technology for clinicians.

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

    Energy Technology Data Exchange (ETDEWEB)

    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

  5. 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

  6. Effects of intraoperative irradiation (IORT) and intraoperative hyperthermia (IOHT) on canine sciatic nerve : Histopathological and morphometric studies

    NARCIS (Netherlands)

    Vujaskovic, Z; Powers, BE; Paardekoper, G; Gillette, SM; Gillette, EL; Colacchio, TA

    1999-01-01

    Purpose/Objective: Peripheral neuropathies have emerged as the major dose-limiting complication reported after intraoperative radiation therapy (IORT). The combination of IORT with hyperthermia may further increase the risk of peripheral nerve injury. The objective of this study was to evaluate

  7. 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.

  8. 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

  9. Fluoroscopically guided percutaneous jejunostomy: outcomes in 25 consecutive patients

    International Nuclear Information System (INIS)

    Yang, Z.Q.; Shin, J.H.; Song, H.-Y.; Kwon, J.H.; Kim, J.-W.; Kim, K.R.; Kim, J.-H.

    2007-01-01

    Aim: To assess the feasibility and safety of fluoroscopically guided percutaneous jejunostomy. Material and methods: Between May 1999 and August 2006 percutaneous jejunostomy was attempted in 25 patients. A 5 F vascular catheter (n = 20) or a 7.5 F multifunctional coil catheter (n = 5) was used to insufflate the jejunum. The distended jejunum was punctured using a 17 G needle (n = 19) or a 21 G Chiba needle (n = 6) with the inserted catheter as a target. A 12 or 14 F loop feeding tube was inserted after serial dilations. The technical success, complications, 30-day mortality, and in-dwelling period of the feeding tube placement were evaluated. Results: The technical success rate was 92% (23/25). Technical failures (n = 2) resulted from the inability to insufflate the jejunum secondary to failure to pass the catheter through a malignant stricture at the oesophagojejunostomy site and thus subsequent puncture of the undistended jejunum failed, or failure to introduce the Neff catheter into the jejunum. Pericatheter leakage with pneumoperitoneum was a complication in three patients (12%) and was treated conservatively. The 30-day mortality was 13% (3/23); however, there was no evidence that these deaths were attributed to the procedure. Except for four patients who were lost to follow-up and two failed cases, 15 of the 19 jejunostomy catheters were removed because of patient death (n = 12) or completion of treatment (n = 3), with a mean and median in-dwelling period of 231 and 87 days, respectively. Conclusions: Fluoroscopically guided percutaneous jejunostomy is a feasible procedure with a high technical success and a low complication rate. In addition to a 17 G needle, a 21 G needle can safely be used to puncture the jejunum

  10. 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.

  11. Intraoperative haloperidol does not improve quality of recovery and postoperative analgesia

    Directory of Open Access Journals (Sweden)

    Amin Ebneshahidi

    2013-01-01

    Conclusion: Intraoperative small-dose IV haloperidol is effective against post-operative nausea and vomiting with no significant effect on overall QoR. It may also attenuate the analgesic effects of morphine PCA.

  12. Intra-operative radiation treatment of cancers

    International Nuclear Information System (INIS)

    Dubois, J.B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1986-01-01

    Intra-operative radiation treatment (I.O.R.T.) is concerning the treatment either of an unresectable tumor or of tumor bed after complete excision of a primary tumor and its first draining lymph nodes. We describe X-ray and electrons techniques and we discuss the delivered doses according to experimental and clinical data. According to the residual disease (macroscopic or microscopic), to the healthy tissues in the target volume, and the histological type, single doses from 20 Gy to 40 Gy can be delivered. Our preliminary results are reported: 25 patients with resectable tumors of the cardia, the stomach and the pancreas, 5 patients with pelvic recurrences of colon and rectum carcinomas. Therapeutic results of the I.O.R.T. providing from the literature are discussed. The I.O.R.T. indications are defined as palliative (unresectable tumors) and curative (irradiation of tumor bed after complete excision of the tumor) [fr

  13. 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.

  14. 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.)

  15. 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.)

  16. 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 (

  17. Role of fluoroscopic guided self expandable metallic stents in the management of malignant esophageal strictures

    OpenAIRE

    Mohamed Shaker; Ahmed Deif; Amr Abdelaal

    2016-01-01

    Objectives: To evaluate the role of fluoroscopic guided self expanding metallic stents in the management of dysphagia caused by malignant esophageal strictures. Materials and methods: During the period between April 2010 and October 2012, 31 patients with malignant esophageal strictures were subjected to fluoroscopic guided self expanding metallic stent application. The study included 22 males and 9 females ranging in age between 22 and 75 years old with mean age of 56.8 years. Lesions wer...

  18. Intraoperative transfusion practices in Europe

    DEFF Research Database (Denmark)

    Meier, J; Filipescu, D; Kozek-Langenecker, S

    2016-01-01

    BACKGROUND: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (p......RBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. METHODS: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month...... period in 2013. RESULTS: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone...

  19. Intraoperative irradiation in advanced cervical cancer

    International Nuclear Information System (INIS)

    Delgado, G.; Goldson, A.L.; Ashayeri, E.; Petrilli, E.S.

    1987-01-01

    Conventional treatment of cervical cancer, such as radical hysterectomy with lymphadenectomy or pelvic exenteration, is limited to the pelvis. Standard radio-therapeutic treatment is a combination of external-beam radiotherapy to the pelvis and intracavitary applications. However, there is a group of patients for whom external radiotherapy alone has limitations. This group consists primarily of patients with large pelvic lymph nodes containing metastatic cancer, metastatically involved paraaortic lymph nodes outside the usual pelvic radiation field, or large central tumors with parametrial involvement. In patients with cancer of the cervix, the incidence of metastasis to paraaortic lymph nodes is high. Attempts to treat paraaortic nodes with external radiotherapy have resulted in high complication rates because the treatment field includes the highly sensitive gastrointestinal tract. External radiation therapy after retroperitoneal exploration of lymph nodes does not seem to improve survival. In an attempt to circumvent the morbidity and mortality associated with conventional external-beam irradiation, the authors initiated a pilot study of intraoperative electron-beam irradiation of the paraaortic nodes and of the large metastatic lymph nodes in the pelvis. The intraoperative boost was followed by conventional fractionated external-beam irradiation. The theoretical advantages of this procedure include a higher radiation tumor dose without a concomitant increase in treatment morbidity and mortality

  20. Intraoperative electron beam radiation therapy (IOEBRT) for carcinoma of the exocrine pancreas

    International Nuclear Information System (INIS)

    Dobelbower, R.R. Jr.; Konski, A.A.; Merrick, H.W. III; Bronn, D.G.; Schifeling, D.; Kamen, C.

    1991-01-01

    The abdominal cavities of 50 patients were explored in a specially constructed intraoperative radiotherapy operating amphitheater at the Medical College of Ohio. Twenty-six patients were treated with intraoperative and postoperative precision high dose external beam therapy, 12 with intraoperative irradiation but no external beam therapy, and 12 with palliative surgery alone. All but two patients completed the postoperative external beam radiation therapy as initially prescribed. The median survival time for patients treated with palliative surgery alone was 4 months, and that for patients treated with intraoperative radiotherapy without external beam therapy was 3.5 months. Patients undergoing intraoperative irradiation and external beam radiation therapy had a median survival time of 10.5 months. Four patients died within 30 days of surgery and two patients died of gastrointestinal hemorrhage 5 months posttreatment

  1. Intraoperative ultrasound in colorectal surgery.

    Science.gov (United States)

    Greif, Franklin; Aranovich, David; Hananel, Nissim; Knizhnik, Mikhail; Belenky, Alexander

    2009-09-01

    To assess the accuracy of intraoperative ultrasound (IOUS) as a localizing technique for colorectal resections, and its impact on surgical management. Twenty-five patients (15 men and 10 women; mean age, 74.4 years) with early cancers (p T1), or polyps, not amenable to endoscopic removal were selected. IOUS was used as a sole method of intraoperative localization. Its performance was evaluated through review of preoperative colonoscopy reports, intraoperative findings, histopathology reports, and clinical follow-up. The lesions were situated in the cecum (n = 5), ascending colon (n = 3), transverse colon (n = 4), descending colon (n = 7), and rectum (n = 6). IOUS technique allowed correct localization in 24 of 25 patients, visualization of the bowel wall, and its penetration by malignant tumors. In rectal lesions, IOUS showed clearly the tumor and its margin, which facilitated performance sphincter-sparing procedure. In patients with small polyps and early cancers of colon and rectum, IOUS may be effectively used as a sole method of intraoperative localization and provide additional information that may alter decision making with regard to surgical technique. (c) 2009 Wiley Periodicals, Inc.

  2. 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

  3. The ultrastructure of tumor cells in patients with rectal cancer after pre-operative irradiation and intra-operative cryotherapy

    International Nuclear Information System (INIS)

    Vyinnik, Yu.O.; Kotenko, O.Je.; Nevzorov, V.P.; Chyibyisov, L.P.

    2000-01-01

    Electronic microscopy of the tumor cells was performed to confirm the efficacy of combined pre-operative gamma-therapy and intraoperative cryotherapy (CT). Pre-operative irradiation at the dose of 20 Gy accompanied by intra-operative cryotherapy caused the changes in the ultrastructure, the depth and degree of which allow to consider them destructive and irreversible

  4. 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

  5. Intraoperative real-time planned conformal prostate brachytherapy: Post-implantation dosimetric outcome and clinical implications

    International Nuclear Information System (INIS)

    Zelefsky, Michael J.; Yamada, Yoshiya; Cohen, Gil'ad N.; Sharma, Neha; Shippy, Alison M.; Fridman, David; Zaider, Marco

    2007-01-01

    Purpose: To report the dosimetric outcome of patients with clinically localized prostate cancer treated with I-125 permanent implantation using an intraoperative real-time conformal planning technique. Methods and materials: Five hundred and sixty-two patients with prostate cancer were treated with I-125 permanent interstitial implantation using a transrectal ultrasound-guided approach. Real-time intraoperative treatment planning software that incorporates inverse planning optimization was used. Dose-volume constraints for this inverse-planning system included: prostate V100 ≥95%, maximal urethral dose ≤120%, and average rectal dose 3 of the rectum was exposed to the prescription dose, the incidence of late grade 2 toxicity rectal toxicity was 9% compared to 4% for smaller volumes of the rectum exposed to similar doses (p = 0.003). No dosimetric parameter in these patients with tight dose confines for the urethra influenced acute or late urinary toxicity. Conclusion: Real-time intraoperative planning was associated with a 90% consistency of achieving the planned intraoperative dose constraints for target coverage and maintaining planned urethral and rectal constraints in a high percentage of implants. Rectal volumes of ≥2.5 cm 3 exposed to the prescription doses were associated with an increased incidence of grade 2 rectal bleeding. Further enhancements in imaging guidance for optimal seed deposition are needed to guarantee optimal dose distribution for all patients. Whether such improvements lead to further reduction in acute and late morbidities associated with therapy requires further study

  6. 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

  7. 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

  8. Intraoperative Sentinel Lymph Node Evaluation

    DEFF Research Database (Denmark)

    Shaw, Richard; Christensen, Anders; Java, Kapil

    2016-01-01

    BACKGROUND: Intraoperative analysis of sentinel lymph nodes would enhance the care of early-stage oral squamous cell carcinoma (OSCC). We determined the frequency and extent of cytokeratin 19 (CK19) expression in OSCC primary tumours and surrounding tissues to explore the feasibility of a "clinic......-ready" intraoperative diagnostic test (one step nucleic acid amplification-OSNA, sysmex). METHODS: Two cohorts were assembled: cohort 1, OSCC with stage and site that closely match cases suitable for sentinel lymph node biopsy (SLNB); cohort 2, HNSCC with sufficient fresh tumour tissue available for the OSNA assay (>50......% of tumours. Discordance between different techniques indicated that OSNA was more sensitive than qRT-PCR or RNA-ISH, which in turn were more sensitive than IHC. OSNA results showed CK19 expression in 80% of primary cases, so if used for diagnosis of lymph node metastasis would lead to a false-negative result...

  9. Radiation doses in interventional neuroradiology

    International Nuclear Information System (INIS)

    Theodorakou, C.; Butler, P.; Horrocks, J.A.

    2001-01-01

    Patient radiation doses during interventional radiology (IR) procedures may reach the thresholds for radiation-induced skin and eye lens injuries. This study investigates the radiation doses received by patients undergoing cerebral embolization. Measurements were conducted using thermoluminescent dosimeters. Radiotherapy verification films were used in order to visualise the radiation field. For each procedure the fluoroscopic and digital dose-area product, the fluoroscopic time, the total number of acquired images and entrance-skin dose calculated by the angiographic unit were recorded. In this paper, the skin, eye and thyroid glands doses on a sample of patients are presented. From a preliminary study of 13 patients having undergone cerebral embolization, it was deduced that six of them have received a dose above 1 Gy. Detailed dose data from patients undergoing IR procedures will be collected in the future with the aim of developing a model to allow estimation of the dose prior to the procedure as well as to look at techniques of dose reduction. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

    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.)

  11. 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)

  12. 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)

  13. 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)

  14. Intraoperative radiotherapy in combined treatment of sinonasal malignant tumors

    Science.gov (United States)

    Novikov, V. A.; Gribova, O. V.; Vasiljev, R. V.; Choynzonov, E. L.; Shtin, V. I.; Shiianova, A. A.; Surkova, P. V.; Starceva, Zh. A.; Shilova, O. G.

    2017-09-01

    Obvious advantage of IORT (intraoperative radiotherapy) is that the radiation source is delivered directly to the bed of the tumor during surgery, thus avoiding the negative impact on the skin, subcutaneous tissue and reducing the risk of fibrosis. Sinonasal tumors—a convenient object for intraoperative radiotherapy application (surface location, relatively small size tumors, good operational access). The surface location and comparatively small size of neoplasms, good operational access provide an efficient and accurate transfer of the electron beam to the postoperative cavity to increase the irradiation dose in the areas of the most probable recurrence, which makes the tumors of this localization a convenient object for the use of the intraoperative radiation therapy. The treatment was conducted using a mobile compact betatron (MIB-6E), 10-12 Gy single dose. IORT session extends surgery period by 30 min. There were no pathological clinical and laboratory reactions on IORT in the early postoperative period. Carrying out the procedure is possible in various standard operating rooms. It does not require special security measures for the patients and the staff. IORT with the help of electron beam allows avoiding post-radiation reactions and achieving a 5-year—disease-free survival of 66% of the patients. IORT session is possible through a minimal incision during organ preservation surgeries. Evident economic feasibility provides the prospects of applying IORT in the clinical practice.

  15. 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.)

  16. Automatic brightness control algorithms and their effect on fluoroscopic imaging

    International Nuclear Information System (INIS)

    Quinn, P.W.; Gagne, R.M.

    1989-01-01

    This paper reports a computer model used to investigate the effect on dose and image quality of three automatic brightness control (ABC) algorithms used in the imaging of barium during general-purpose fluoroscopy. A model incorporating all aspects of image formation - i.e., x- ray production, phantom attenuation, and energy absorption in the CSI phosphor - was driven according to each ABC algorithm as a function of patient thickness. The energy absorbed in the phosphor was kept constant, while the changes in exposure, integral dose, organ dose, and contrast were monitored

  17. 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.

  18. 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...

  19. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Takada, Mitsuaki; Hirata, Toshifumi; Funakoshi, Takashi; Doi, Hidetaka; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1989-04-01

    Intraoperative radiation therapy (IOR) is an ideal means of exterminating residual tumor after surgical resection. In this study, the clinical results of IOR using a Scanditronix Microtron MM-22 were evaluated in 14 patients with malignant glioma, five of whom had recurrent tumors. Between July, 1985 and October, 1986, 11 patients with glioblastoma multiforme (GB) were irradiated 18 times (mean, 1.6 times/case), and three with astrocytoma (Kernohan grade III) underwent IOR once each. The target-absorbed dose at 1 to 2 cm deeper than the tumor resection surface was 15 to 50 Gy. During irradiation, a cotton bolus was placed in the dead space after over 91% of the tumor had been resected. As a rule, external irradiation therapy was also given postoperatively at a dose of 30 to 52 Gy. One patient died of pneumonia and disseminated intravascular coagulation syndrome 1 month postoperatively. The 1- and 2-year survival rates of the ramaining 13 patients were 84.6% and 61.5%, respectively; among the 10 with GB, they were 80% and 50%. Generally, the smaller the tumor size, the better the results. There were no adverse effects, despite the dose 15 to 50 Gy applied temporally to the tumor bed. IOR was especially effective against small, localized tumors, but was not always beneficial in cases of large tumors, particularly those with a contralateral focus. The improved survival rate in this series demonstrates that IOR is significantly effective in the 'induction of remission' following surgical excision of malignant gliomas. (author).

  20. Minimalism through intraoperative functional mapping.

    Science.gov (United States)

    Berger, M S

    1996-01-01

    Intraoperative stimulation mapping may be used to avoid unnecessary risk to functional regions subserving language and sensori-motor pathways. Based on the data presented here, language localization is variable in the entire population, with only certainty existing for the inferior frontal region responsible for motor speech. Anatomical landmarks such as the anterior temporal tip for temporal lobe language sites and the posterior aspect of the lateral sphenoid wing for the frontal lobe language zones are unreliable in avoiding postoperative aphasias. Thus, individual mapping to identify essential language sites has the greatest likelihood of avoiding permanent deficits in naming, reading, and motor speech. In a similar approach, motor and sensory pathways from the cortex and underlying white matter may be reliably stimulated and mapped in both awake and asleep patients. Although these techniques require an additional operative time and equipment nominally priced, the result is often gratifying, as postoperative morbidity has been greatly reduced in the process of incorporating these surgical strategies. The patients quality of life is improved in terms of seizure control, with or without antiepileptic drugs. This avoids having to perform a second costly operative procedure, which is routinely done when extraoperative stimulation and recording is done via subdural grids. In addition, an aggressive tumor resection at the initial operation lengthens the time to tumor recurrence and often obviates the need for a subsequent reoperation. Thus, intraoperative functional mapping may be best alluded to as a surgical technique that results in "minimalism in the long term".

  1. Fluoroscopic radiation exposure: are we protecting ourselves adequately?

    Science.gov (United States)

    Hoffler, C Edward; Ilyas, Asif M

    2015-05-06

    While traditional intraoperative fluoroscopy protection relies on thyroid shields and aprons, recent data suggest that the surgeon's eyes and hands receive more exposure than previously appreciated. Using a distal radial fracture surgery model, we examined (1) radiation exposure to the eyes, thyroid, chest, groin, and hands of a surgeon mannequin; (2) the degree to which shielding equipment can decrease exposure; and (3) how exposure varies with fluoroscopy unit size. An anthropomorphic model was fit with radiation-attenuating glasses, a thyroid shield, an apron, and gloves. "Exposed" thermoluminescent dosimeters overlaid the protective equipment at the eyes, thyroid, chest, groin, and index finger while "shielded" dosimeters were placed beneath the protective equipment. Fluoroscopy position and settings were standardized. The mini-c-arm milliampere-seconds were fixed based on the selection of the kilovolt peak (kVp). Three mini and three standard c-arms scanned a model of the patient's wrist continuously for fifteen minutes each. Ten dosimeter exposures were recorded for each c-arm. Hand exposure averaged 31 μSv/min (range, 22 to 48 μSv/min), which was 13.0 times higher than the other recorded exposures. Eye exposure averaged 4 μSv/min, 2.2 times higher than the mean thyroid, chest, and groin exposure. Gloves reduced hand exposure by 69.4%. Glasses decreased eye exposure by 65.6%. There was no significant difference in exposure between mini and standard fluoroscopy. Surgeons' hands receive the most radiation exposure during distal radial plate fixation under fluoroscopy. There was a small but insignificant difference in mean exposure between standard fluoroscopy and mini-fluoroscopy, but some standard units resulted in lower exposure than some mini-units. On the basis of these findings, we recommend routine protective equipment to mitigate exposure to surgeons' hands and eyes, in addition to the thyroid, chest, and groin, during fluoroscopy procedures

  2. INTRAOPERATIVE PREDONATION CONTRIBUTES TO BLOOD SAVING

    NARCIS (Netherlands)

    SCHONBERGER, JPAM; BREDEE, JJ; TJIAN, D; EVERTS, PAM; WILDEVUUR, CRH

    1993-01-01

    The merits of reinfusing prebypass-removed autologous blood (intraoperative predonation) to salvage blood and improve postoperative hemostasis are still debated, specifically for patients at a higher risk for bleeding. To evaluate the effect of intraoperative predonation on the platelet count, blood

  3. Intraoperative radiotherapy in breast cancer: literature review

    International Nuclear Information System (INIS)

    Alfaro Hidalgo, Sabrina A.

    2013-01-01

    A literature review was performed on intraoperative radiotherapy of breast cancer. The strength and attractiveness is established of techniques of partial irradiation in the treatment of breast cancer. The benefit is originated to restrict the area immediate of radiotherapy to the tumor bed or quadrant index and identifying the benefit of being applied during the radiotherapy while surgical lumpectomy. The impact of local recurrence has been established using intraoperative radiotherapy. The advantages of intraoperative radiotherapy was compared in the management of the conservative surgery in early stages of breast cancer with external radiotherapy. Different methods of intraoperative radiotherapy have been compared and individual impact on local recurrence ranges. Intraoperative radiotherapy has had many advantages: radiobiological, technical, clinical, psychological and economical in the handling of conservative surgery in early stages of breast cancer, compared with external radiotherapy [es

  4. Evaluation of Patient Radiation Dose during Orthopedic Surgery

    International Nuclear Information System (INIS)

    Osman, H; Elzaki, A.; Sam, A.K.; Sulieman, A.

    2013-01-01

    The number of orthopedic procedures requiring the use of the fluoroscopic guidance has increased over the recent years. Consequently the patient exposed to un avoidable radiation doses. The aim of the current study was to evaluate patient radiation dose during these procedures.37 patients under went dynamic hip screw (DHS) and dynamic cannulated screw (DCS) were evaluated using calibrated Thermolumincent Dosimeters (TLDs), under carm fluoroscopic machines ,in three centers in Khartoum-Sudan. The mean Entrance Skin Dose (ESD) was 7.9 m Gy per procedure. The bone marrow and gonad organ exposed to significant doses. No correlation was found between ESD and Body Mass Index (BMI), or patient weight. Well correlation was found between kilo voltage applied and ESD. Orthopedic surgeries delivered lower radiation dose to patients than cardiac catheterization or hysterosalpingraphy (HSG) procedures. More study should be implemented to follow radiation dose before surgery and after surgery

  5. Intraoperative radiation therapy for malignant glioma

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Noboru; Yamada, Hiromu; Andoh, Takashi; Hirata, Toshifumi; Nishimura, Yasuaki; Miwa, Yoshiaki; Shimizu, Kotoyuki; Yanagawa, Shigeo [Gifu Univ. (Japan). Faculty of Medicine

    1991-11-01

    Intraoperative radiation therapy (IORT) was used as part of the initial therapy for malignant glioma in 32 of 73 patients with histologically verified anaplastic astrocytoma (grade III astrocytoma) and glioblastoma multiforme. The initial treatment for all cases was subtotal or total tumor resection combined with external irradiation and chemotherapy. IORT was performed 1 week after tumor resection, with doses of 10-50 Gy (mean 26.7 Gy) in one session. Fourteen of 32 cases had IORT two times because of tumor recurrence. The IORT patients had survival rates at 24 and 36 months after initial treatment of 57.1 and 33.5% (median survival 26.2 months). The other 41 patients had 23.6 and 13.1% survivals (median survival 20.7 months), which were significantly lower (p<0.01). Tumor recurrence within the original lesion site was suspected because of clinical condition, computed tomography, and magnetic resonance imaging studies in 65.6% of the IORT group (21 cases) 12 months after initial treatment. Twenty cases of death in the IORT group, including five autopsy cases, demonstrated regional tumor recurrence with a high incidence of intraventricular tumor invasion. The authors consider IORT is beneficial for selected malignant glioma patients, including tumor recurrence, because of prolonged survival. (author).

  6. Effects of intraoperative irradiation and intraoperative hyperthermia on canine sciatic nerve: neurologic and electrophysiologic study

    International Nuclear Information System (INIS)

    Vujaskovic, Zeljko; Gillette, Sharon M.; Powers, Barbara E.; Stukel, Therese A.; LaRue, Susan M.; Gillette, Edward L.; Borak, Thomas B.; Scott, Robert J.; Weiss, Julia; Colacchio, Thomas A.

    1996-01-01

    Purpose: Late radiation injury to peripheral nerve may be the limiting factor in the clinical application of intraoperative radiation therapy (IORT). The combination of IORT with intraoperative hyperthermia (IOHT) raises specific concerns regarding the effects on certain normal tissues such as peripheral nerve, which might be included in the treatment field. The objective of this study was to compare the effect of IORT alone to the effect of IORT combined with IOHT on peripheral nerve in normal beagle dogs. Methods and Materials: Young adult beagle dogs were randomized into five groups of three to five dogs each to receive IORT doses of 16, 20, 24, 28, or 32 Gy to 5 cm of surgically exposed right sciatic nerve using 6 MeV electrons and six groups of four to five dogs each received IORT doses of 0, 12, 16, 20, 24, or 28 Gy simultaneously with 44 deg. C of IOHT for 60 min. IOHT was performed using a water circulating hyperthermia device with a multichannel thermometry system on the surgically exposed sciatic nerve. Neurologic and electrophysiologic examinations were done before and monthly after treatment for 24 months. Electrophysiologic studies included electromyographic (EMG) examinations of motor function, as well as motor nerve conduction velocities studies. Results: Two years after treatment, the effective dose for 50% complication (ED 50 ) for limb paresis in dogs exposed to IORT only was 22 Gy. The ED 50 for paresis in dogs exposed to IORT combined with IOHT was 15 Gy. The thermal enhancement ratio (TER) was 1.5. Electrophysiologic studies showed more prominent changes such as EMG abnormalities, decrease in conduction velocity and amplitude of the action potential, and complete conduction block in dogs that received the combination of IORT and IOHT. The latency to development of peripheral neuropathies was shorter for dogs exposed to the combined treatment. Conclusion: The probability of developing peripheral neuropathies in a large animal model was higher

  7. Practicality of intraoperative teamwork assessments.

    Science.gov (United States)

    Phitayakorn, Roy; Minehart, Rebecca; Pian-Smith, May C M; Hemingway, Maureen W; Milosh-Zinkus, Tanya; Oriol-Morway, Danika; Petrusa, Emil

    2014-07-01

    High-quality teamwork among operating room (OR) professionals is a key to efficient and safe practice. Quantification of teamwork facilitates feedback, assessment, and improvement. Several valid and reliable instruments are available for assessing separate OR disciplines and teams. We sought to determine the most feasible approach for routine documentation of teamwork in in-situ OR simulations. We compared rater agreement, hypothetical training costs, and feasibility ratings from five clinicians and two nonclinicians with instruments for assessment of separate OR groups and teams. Five teams of anesthesia or surgery residents and OR nurses (RN) or surgical technicians were videotaped in simulations of an epigastric hernia repair where the patient develops malignant hyperthermia. Two anesthesiologists, one OR clinical RN specialist, one educational psychologist, one simulation specialist, and one general surgeon discussed and then independently completed Anesthesiologists' Non-Technical Skills, Non-Technical Skills for Surgeons, Scrub Practitioners' List of Intraoperative Non-Technical Skills, and Observational Teamwork Assessment for Surgery forms to rate nontechnical performance of anesthesiologists, surgeons, nurses, technicians, and the whole team. Intraclass correlations of agreement ranged from 0.17-0.85. Clinicians' agreements were not different from nonclinicians'. Published rater training was 4 h for Anesthesiologists' Non-Technical Skills and Scrub Practitioners' List of Intraoperative Non-Technical Skills, 2.5 h for Non-Technical Skills for Surgeons, and 15.5 h for Observational Teamwork Assessment for Surgery. Estimated costs to train one rater to use all instruments ranged from $442 for a simulation specialist to $6006 for a general surgeon. Additional training is needed to achieve higher levels of agreement; however, costs may be prohibitive. The most cost-effective model for real-time OR teamwork assessment may be to use a simulation technician

  8. Premedication with oral Dextromethorphan reduces intra-operative Morphine requirement

    Directory of Open Access Journals (Sweden)

    R Talakoub

    2005-09-01

    Full Text Available Background: Intra-operative pain has adverse effects on hemodynamic parameters. Due to complications of opioids for pain relief, using non-opioids medication is preferred. The purpose of this study was to investigate the effect of oral dextrometorphan premedication on intra-operative Morphine requirement. Methods: After approval of the Ethics committee and informed consent, 40 adult patients who stand in American Society of Anesthesiologists Physical Status I and II, under general anesthesia for elective laparatomy were selected and classified in two equal groups randomly. In group A, oral dextromethorphan (60mg was administered at 10 PM and 6 AM preoperatively. In group B, placebo (dextrose was administered. After induction of general anesthesia and before skin incision, intravenous morphine (0.01 mg/kg was administered. During surgery, when systolic blood pressure or heart rate was increased more than 20% of the preoperative baseline, 0.01 mg/kg morphine was administered. At the end of surgery, the totally prescribed morphine (mg/kg and maximal increase in systolic, diastolic, mean arterial blood pressure and heart rate relative to the baseline values were calculated and statistically compared with student’s t-test. Results: The mean dose of administered morphine during surgery was significantly less in group A than group B (P<0.0001. Also, Maximal increase in systolic, diastolic and mean arterial blood pressure was significantly less in group A (p<0.003, p<0.004, p<0.0001, respectively. There was no significant difference in maximal heart rate increase between two groups (p<0.114. Conclusion: Oral dextromethorphan premedication may decrease intra-operative morphine requirement and reduce maximal increase in systolic and mean arterial blood pressure during surgery. Key words: Dextromethorphan, Morphine, Intra-operative, Premedication Hemodynamic

  9. Intraoperative radiation in the canine para-aortic abdomen

    International Nuclear Information System (INIS)

    Hoopes, P.J.; Gillette, E.L.

    1984-01-01

    Twenty adult beagle dogs received intraoperatively delivered 6 MeV electrons to the para-aortic abdomen and bladder. The dogs were equally divided into 4 dose groups receiving 22 Gy, 30 Gy, 38.5 Gy and 47 Gy. The 5 cm x 8 cm radiation field included a variable portion of the left kidney, the left ureter, the abdominal aorta and vena cava, the base of the bladder and the left sciatic and femoral nerves. The lesions observed were fibroelastic proliferation of the aortic intima, severe renal atrophy and fibrosis, ureteral stenosis, bladder fibrosis and demyelinating peripheral neuropathies. Histologic, morphometric and dose response analyses are compared with responses of dogs receiving more conventional fractionated doses to a total of 60 Gy, 70 Gy or 80 Gy x-ray in 6 weeks

  10. Clinical experience with intraoperative radiotherapy for locally advanced colorectal cancer

    International Nuclear Information System (INIS)

    Shibamoto, Yuta; Takahashi, Masaharu; Abe, Mitsuyuki

    1988-01-01

    Intraoperative radiotherapy (IORT) was performed on 20 patients with colorectal cancer. IORT with a single dose of 20 to 40 Gy was delivered to the residual tumor, tumor bed, and/or lymphnode regions. Although most of the patients had advanced lesions, local control was achieved in 67 % of the patients when IORT was combined with tumor resection, and 4 patients survived more than 5 years. There were no serious complications, except for contracture or atrophy of the psoas muscle seen in 2 patients. IORT combined with external beam radiotherapy should be a useful adjuvant therapy to surgery for locally advanced colorectal cancer. (author)

  11. Intraoperative Ultrasound for Peripheral Nerve Applications.

    Science.gov (United States)

    Willsey, Matthew; Wilson, Thomas J; Henning, Phillip Troy; Yang, Lynda J-S

    2017-10-01

    Offering real-time, high-resolution images via intraoperative ultrasound is advantageous for a variety of peripheral nerve applications. To highlight the advantages of ultrasound, its extraoperative uses are reviewed. The current intraoperative uses, including nerve localization, real-time evaluation of peripheral nerve tumors, and implantation of leads for peripheral nerve stimulation, are reviewed. Although intraoperative peripheral nerve localization has been performed previously using guide wires and surgical dyes, the authors' approach using ultrasound-guided instrument clamps helps guide surgical dissection to the target nerve, which could lead to more timely operations and shorter incisions. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Intraoperative radiotherapy for adenocarcinoma of the pancreas

    International Nuclear Information System (INIS)

    Yasue, Mitsunori; Yasui, Kenzo; Morimoto, Takeshi; Miyaishi, Seiichi; Morita, Kozo

    1986-01-01

    Thirty-six patients were given intraoperative radiotherapy for adenocarcinoma of the pancreas between April 1980 and March 1986. Twenty-six of those with well-advanced cancer underwent palliative intraoperative radiotherapy of their main primary lesions (1,500 to 3,000 rads). Fourteen of the 19 patients in this group who had intractable back pain before surgery achieved relief within one week after treatment. Of the remaining 10 patients who underwent pancreatectomy and received adjuvant intraoperative radiotherapy (2,000 to 3,000 rads), two remain clinically free of disease five years and six months and four years and six months after palliative distal pancreatectomy. (author)

  13. 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.)

  14. Intraoperative and external beam radiotherapy for pancreatic carcinoma; Intraoperative und perkutane Radiotherapie des Pankreaskarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Eble, M.J. [Abt. Klinische Radiologie, Radiologische Universitaetsklinik Heidelberg (Germany); Maurer, U. [Klinikum der Stadt Mannheim (Germany). Inst. fuer Radiologie

    1996-05-01

    Therapeutic strategies in the treatment of pancreatic carcinoma are based on the high number of non-resectable cancers, the high relative radioresistance and the high distant metastases rate. Even in curatively resected carcinomas, a locally effective treatment modality is needed because of the risk of microscopical residual disease in the peripancreatic tissue. The efficacy of radiotherapy is dose dependent. Based on an analysis of published data a dose of more than 50 Gy is recommended, resulting in a high morbidity rate with external beam radiotherapy alone. The use of intraoperative radiotherapy allows locally restricted dose escalation without increased perioperative morbidity. In adjuvant and in primary treatment, local tumor control was improved (70-90%). With palliative intent, pain relief was obtained rapidly in over 60% of patients and led to improved patient performance. As a result of the high distant metastases rate, even in curatively resected carcinomas, the overall prognosis could not be significantly improved. Further dose escalation is limited by the increasing incidence of upper gastrointestinal bleeding (20-30%). (orig.) [Deutsch] Therapiestrategien beim Pankreaskarzinom werden bestimmt durch den hohen Anteil primaer nicht resektabler Karzinome, der hohen relativen Strahlenresistenz und der hohen Fernmetastasierungsrate. Selbst kurativ resezierte Karzinome erfordern durch ihre hohe lokale Tumorzellpersistenz eine lokal effektive adjuvante Behandlungsmassnahme. Die Effektivitaet einer Radiotherapie ist dosisabhaengig. Aus der Analyse publizierter Daten wird eine Dosis von >50 Gy, welche bei der alleinigen perkutanen Bestrahlung mit einer hohen Morbiditaet verbunden ist, empfohlen. Mit der intraoperativen Radiotherapie ist eine lokal begrenzte Dosiseskalation ohne erhoehte perioperative Morbiditaet moeglich. Sowohl in der adjuvanten als auch in der primaeren Behandlung kann die lokale Tumorkontrolle deutlich verbessert werden (70-90%). Unter

  15. 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)

  16. 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.)

  17. Effects of Intraoperative Fluid Management on Postoperative Outcomes : A Hospital Registry Study

    NARCIS (Netherlands)

    Shin, Christina H; Long, Dustin R; McLean, Duncan; Grabitz, Stephanie D; Ladha, Karim; Timm, Fanny P; Thevathasan, Tharusan; Pieretti, Alberto; Ferrone, Cristina; Hoeft, Andreas; Scheeren, Thomas W L; Thompson, Boyd Taylor; Kurth, Tobias; Eikermann, Matthias

    2017-01-01

    OBJECTIVE: Evaluate the dose-response relationship between intraoperative fluid administration and postoperative outcomes in a large cohort of surgical patients. BACKGROUND: Healthy humans may live in a state of fluid responsiveness without the need for fluid supplementation. Goal-directed protocols

  18. Repeated sugammadex reversal of muscle relaxation during lumbar spine surgery with intraoperative neurophysiological multimodal monitoring.

    Science.gov (United States)

    Errando, C L; Blanco, T; Díaz-Cambronero, Ó

    2016-11-01

    Intraoperative neurophysiological monitoring during spine surgery is usually acomplished avoiding muscle relaxants. A case of intraoperative sugammadex partial reversal of the neuromuscular blockade allowing adequate monitoring during spine surgery is presented. A 38 year-old man was scheduled for discectomy and vertebral arthrodesis throughout anterior and posterior approaches. Anesthesia consisted of total intravenous anesthesia plus rocuronium. Intraoperatively monitoring was needed, and the muscle relaxant reverted twice with low dose sugammadex in order to obtain adequate responses. The doses of sugammadex used were conservatively selected (0.1mg/kg boluses increases, total dose needed 0.4mg/kg). Both motor evoqued potentials, and electromyographic responses were deemed adequate by the neurophysiologist. If muscle relaxation was needed in the context described, this approach could be useful to prevent neurological sequelae. This is the first study using very low dose sugammadex to reverse rocuronium intraoperatively and to re-establish the neuromuscular blockade. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer

    DEFF Research Database (Denmark)

    Vaidya, Jayant S; Wenz, Frederik; Bulsara, Max

    2014-01-01

    The TARGIT-A trial compared risk-adapted radiotherapy using single-dose targeted intraoperative radiotherapy (TARGIT) versus fractionated external beam radiotherapy (EBRT) for breast cancer. We report 5-year results for local recurrence and the first analysis of overall survival....

  20. Clinical toxicity of peripheral nerve to intraoperative radiotherapy in a canine model

    International Nuclear Information System (INIS)

    Johnstone, Peter A. S.; DeLuca, Anne Marie; Bacher, John D.; Hampshire, Victoria A.; Terrill, Richard E.; Anderson, William J.; Kinsella, Timothy J.; Sindelar, William F.

    1995-01-01

    Purpose: The clinical late effects of intraoperative radiotherapy (IORT) on peripheral nerve were investigated in a foxhound model. Methods and Materials: Between 1982 and 1987, 40 animals underwent laparotomy with intraoperative radiotherapy of doses from 0-75 Gy administered to the right lumbosacral plexus. Subsequently, all animals were monitored closely and sacrificed to assess clinical effects to peripheral nerve. This analysis reports final clinical results of all animals, with follow-up to 5 years. Results: All animals treated with ≥ 25 Gy developed ipsilateral neuropathy. An inverse relationship was noted between intraoperative radiotherapy dose and time to neuropathy, with an effective dose for 50% paralysis (ED 50 ) of 17.2 Gy. One of the animals treated with 15 Gy IORT developed paralysis, after a much longer latency than the other animals. Conclusions: Doses of 15 Gy delivered intraoperatively may be accompanied by peripheral neuropathy with long-term follow-up. This threshold is less than that reported with shorter follow-up. The value of ED 50 determined here is in keeping with data from other animal trials, and from clinical trials in humans

  1. 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.

  2. 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

  3. 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.

  4. 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.

  5. Intraoperative neurophysiological monitoring for the anaesthetist

    African Journals Online (AJOL)

    2012-11-15

    Nov 15, 2012 ... ... nerve tracts, and by understanding how anaesthetic agents affect the various ... of the physiologically sensitive nervous system and different ... Keywords: evoked potentials, intraoperative monitoring, brain mapping. Abstract.

  6. 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.

  7. A case of lumbar pain after intraoperative radiotherapy

    International Nuclear Information System (INIS)

    Shimizu, Wakako; Ogino, Takashi; Murakami, Koji; Nawano, Shigeru; Moriyama, Noriyuki; Ryu, Munemasa; Kawano, Nariaki

    1996-01-01

    We report a case of abnormal magnetic resonance imaging (MRI) findings after intraoperative radiotherapy. A 53-year-old woman with cancer of the papilla of Vater was treated with pancreatoduodenectomy and 20 Gy of intraoperative radiotherapy by electron beam to the tumor bed. Three months later the patient complained of lumbar pain. A change of signal intensity on MRI was detected in the anterior half of the vertebral body within the irradiated field. The signal was of high intensity but was not enhanced by Gd-DTPA on T1-weighted images, was isointense on T2-weighted images and of low intensity with the fat-suppression method. The radiation dose to the lumbar spine and the surrounding soft tissue was calculated to be 16 Gy. Histologic changes in bone after irradiation may include depletion of bone marrow cells and fat degeneration. The MRI findings were compatible with these changes. The radiation dose that can be tolerated by soft tissue is lower than that tolerated by bone. Therefore, late radiation injury of the soft tissue might have been the cause of the patient's lumbar pain. (author)

  8. Experimental study on intraoperative irradiation for pancreatic cancer

    International Nuclear Information System (INIS)

    Ito, Masanao; Asanuma, Yoshihiro; Shibata, Satoshi; Saitoh, Takashi; Koyama, Kenji; Watarai, Jiroh; Masuda, Hirotake

    1993-01-01

    For the treatment of pancreatic head cancer, pancreatoduodenectomy is followed by the intraoperative radiation therapy (IORT). The present dose adopted ranged 20 to 30 Gy; however, the dose is believed to be insufficient for local control of adenocarcinoma cells. In this study, high dose IORT was performed using rabbit, so histological and nutritional changes were evaluated. Rabbits were divided into three groups: 30 Gy, 50 Gy, and 80 Gy. The radiation was performed with electron focusing the base of cranial mesenteric artery (SMA in human). The rabbits were sacrificed at intervals ranging from immediately to 4 years after irradiation. The earliest evidence of histological changes was the loss of endothelium, although it was repaired within 1 week. Fragmentation and reduplication of internal elastic lamina were observed after 1 week; however, the degree was not dose dependent. Damages of the media was observed in 50 and 80 Gy groups. That is, focal degeneration of smooth muscle cell was demonstrated in 50 Gy group and medial necrosis in 80 Gy group. Degeneration of ganglion cells was observed and its severity was dose-dependent. In 80 Gy group, diarrhea occurred more frequently compared with the other groups and body weight loss could not recover within 4 weeks. It is concluded that, since necrosis of aortic media and marked degeneration of ganglion cells are inevitable in 80 Gy group, IORT dose should be increased within 50 Gy. (author)

  9. 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

  10. Safty and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors

    International Nuclear Information System (INIS)

    Zhai Yirui; Feng Qinfu; Li Minghui

    2010-01-01

    Objective: To investigate the safety and acute toxicities of intraoperative electron radiotherapy for patients with abdominal tumors. Methods: From May 2008 to August 2009, 52 patients with abdominal tumors were treated with intraoperative electron radiotherapy, including 14 patients with breast cancer,19 with pancreatic cancer, 3 with cervical cancer, 4 with ovarian cancer, 6 with sarcoma, and 6 with other tumors. Fifteen patients were with recurrent tumors. The intraoperative radiotherapy was performed using Mobetron mobile electron accelerator, with total dose of 9 - 18 Gy. In all, 29, 4 and 19 patients received complete resection, palliative resection and surgical exploration, respectively. The complications during the operations and within 6 months after operations were graded according to Common Terminology Criteria for Adverse Events v3.0 (CTC 3.0). Results: The median duration of surgery was 190 minutes. Intraoperative complications were observed in 5 patients, including 3 with hemorrhage, 1 with hypotension,and 1 with hypoxaemia, all of which were treated conservatively. The median hospitalization time and time to take out stitches was 12 and 13 days, respectively. And the in-hospital mortality was 4% (2/52). Twenty-four patients suffered post-operative adverse events, including 3 postoperative infections. With a median follow-up time of 183 days, 20% of patients suffered from grade 3 to 5 adverse events, with hematological toxicities being the most common complication, followed by bellyache. Grade 1 and 2 toxicities which were definitely associated with intraoperative radiotherapy was 28% and 4%, respectively. None of grade 3 to 5 complications were proved to be caused by intraoperative radiotherapy. Conclusions: Intraoperative electron radiotherapy is well tolerable and could be widely used for patients with abdominal tumors, with a little longer time to take out stitches but without more morbidities and toxicities compared surgery alone. (authors)

  11. Monte Carlo based simulation of LIAC intraoperative radiotherapy accelerator along with beam shaper applicator

    Directory of Open Access Journals (Sweden)

    N Heidarloo

    2017-08-01

    Full Text Available Intraoperative electron radiotherapy is one of the radiotherapy methods that delivers a high single fraction of radiation dose to the patient in one session during the surgery. Beam shaper applicator is one of the applicators that is recently employed with this radiotherapy method. This applicator has a considerable application in treatment of large tumors. In this study, the dosimetric characteristics of the electron beam produced by LIAC intraoperative radiotherapy accelerator in conjunction with this applicator have been evaluated through Monte Carlo simulation by MCNP code. The results showed that the electron beam produced by the beam shaper applicator would have the desirable dosimetric characteristics, so that the mentioned applicator can be considered for clinical purposes. Furthermore, the good agreement between the results of simulation and practical dosimetry, confirms the applicability of Monte Carlo method in determining the dosimetric parameters of electron beam  intraoperative radiotherapy

  12. Effects of intraoperative irradiation (IORT) and intraoperative hyperthermia (IOHT) on canine sciatic nerve: histopathological and morphometric studies

    International Nuclear Information System (INIS)

    Vujaskovic, Zeljko; Powers, Barbara E.; Paardekoper, Gabriel; Gillette, Sharon M.; Gillette, Edward L.; Colacchio, Thomas A.

    1999-01-01

    Purpose/Objective: Peripheral neuropathies have emerged as the major dose-limiting complication reported after intraoperative radiation therapy (IORT). The combination of IORT with hyperthermia may further increase the risk of peripheral nerve injury. The objective of this study was to evaluate histopathological and histomorphometric changes in the sciatic nerve of dogs, after IORT with or without hyperthermia treatment. Methods and Materials: Young adult beagle dogs were randomized into five groups of 3-5 dogs each to receive IORT doses of 16, 20, 24, 28, or 32 Gy. Six groups of 4-5 dogs each received IORT doses of 12, 16, 20, 24, or 28 Gy simultaneously with 44 deg. C of intraoperative hyperthermia (IOHT) for 60 min. One group of dogs acted as hyperthermia-alone controls. Two years after the treatment, dogs were euthanized, and histopathological and morphometric analyses were performed. Results: Qualitative histological analysis showed prominant changes such as focal necrosis, mineralization, fibrosis, and severe fiber loss in dogs which received combined treatment. Histomorphometric results showed a significantly higher decrease in axon and myelin and small blood vessels, with a corresponding increase in connective tissue in dogs receiving IORT plus hyperthermia treatment. The effective dose for 50% of nerve fiber loss (ED 50 ) in dogs exposed to IORT only was 25.3 Gy. The ED 50 for nerve fiber loss in dogs exposed to IORT combined with IOHT was 14.8 Gy. The thermal enhancement ratio (TER) was 1.7. Conclusion: The probability of developing peripheral neuropathies in a large animal model is higher when IORT is combined with IOHT, when compared to IORT application alone. To minimize the risk of peripheral neuropathy, clinical treatment protocols for the combination of IORT and hyperthermia should not assume a thermal enhancement ratio (TER) to be lower than 1.5

  13. [Selective intraoperative cholangiography in laparoscopic cholecystectomy].

    Science.gov (United States)

    Pickuth, D; Leutloff, U

    1995-01-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.

  14. Trends in Intraoperative Testing During Cochlear Implantation.

    Science.gov (United States)

    Page, Joshua Cody; Cox, Matthew D; Hollowoa, Blake; Bonilla-Velez, Juliana; Trinidade, Aaron; Dornhoffer, John L

    2018-03-01

    No consensus guidelines exist regarding intraoperative testing during cochlear implantation and wide variation in practice habits exists. The objective of this observational study was to survey otologists/neurotologists to understand practice habits and overall opinion of usefulness of intraoperative testing. Cross-sectional survey. A web-based survey was sent to 194 practicing Otologists/Neurotologists. Questions included practice setting and experience, habits with respect to electrodes used, intraoperative testing modalities used, overall opinion of intraoperative testing, and practice habits in various scenarios. Thirty-nine of 194 (20%) completed the survey. For routine patients, ECAPs and EIs were most commonly used together (38%) while 33% do not perform testing at all. Eighty-nine percent note that testing "rarely" or "never" changes management. Fifty-one percent marked the most important reason for testing is the reassurance provided to the family and/or the surgeon. Intraoperative testing habits and opinions regarding testing during cochlear implantation vary widely among otologic surgeons. The majority of surgeons use testing but many think there is minimal benefit and that surgical decision-making is rarely impacted. The importance of testing may change as electrodes continue to evolve.

  15. Intraoperative HDR implant boost for breast cancer (preliminary results)

    International Nuclear Information System (INIS)

    Rodriguez, I.; Torre, M. de la; Gonzalez, E.; Bourel, V.

    1996-01-01

    Introduction: In spite of the fact that it is been discussed whether or not a boost is necessary for all conservative treated breast cancer patients, it is a generalized radiotherapy practice. Since september 1993 we developed a breast conservative protocol for early stage breast cancer (T1-T2) with intraoperative HDR implant boost. Side effects, cosmetic results and recurrence rates are reviewed. Method and Material: From September 1993 we treated 55 patients with intraoperative HDR implant boost to the lumpectomy site for clinical T1 or T2 invasive breast cancer, followed by external megavoltage radiotherapy to the entire breast. We used the Nucletron microselectron HDR remote afterloading system with flexible implant tubes. The geometric distribution of the tubes was performed according to the 'Paris' configuration. Each implant was evaluated by calculating the dose-volume natural histograms. The HDR fractionation schedule consists of three fractions of 4.5Gy each given at least 48 hs apart, and starting between 48-72hs from surgical procedure. The external radiotherapy to the entire breast started one week after the completion of brachytherapy, using conventional fractionation of 5 fractions per week, 1,8Gy per fraction up to 45-50Gy. Results: So far there is not any local recurrence, but medium follow up is only 18 months. We did not observe any acute damage and the cosmetic outcome was 60% excellent, 30% good and 10% acceptable. Two patients developed localized fibrosis, in both the implant involved the submamary fold. Conclusion: The intraoperative implant is the most accurate way to localize the lumpectomy site, to define the target volume, decrease the total treatment time and avoid a second anesthetic procedure without delaying the inpatient time or the initial wound healing process

  16. Medical imaging using ionizing radiation: Optimization of dose and image quality in fluoroscopy

    International Nuclear Information System (INIS)

    Jones, A. Kyle; Balter, Stephen; Rauch, Phillip; Wagner, Louis K.

    2014-01-01

    The 2012 Summer School of the American Association of Physicists in Medicine (AAPM) focused on optimization of the use of ionizing radiation in medical imaging. Day 2 of the Summer School was devoted to fluoroscopy and interventional radiology and featured seven lectures. These lectures have been distilled into a single review paper covering equipment specification and siting, equipment acceptance testing and quality control, fluoroscope configuration, radiation effects, dose estimation and measurement, and principles of flat panel computed tomography. This review focuses on modern fluoroscopic equipment and is comprised in large part of information not found in textbooks on the subject. While this review does discuss technical aspects of modern fluoroscopic equipment, it focuses mainly on the clinical use and support of such equipment, from initial installation through estimation of patient dose and management of radiation effects. This review will be of interest to those learning about fluoroscopy, to those wishing to update their knowledge of modern fluoroscopic equipment, to those wishing to deepen their knowledge of particular topics, such as flat panel computed tomography, and to those who support fluoroscopic equipment in the clinic

  17. 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

  18. 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

    Retrospective review. To report our early clinical experience using C-arm cone beam computed tomography (C-arm CBCT) with fluoroscopic overlay for needle guidance during vertebroplasty. C-arm CBCT is advanced three-dimensional (3-D) imaging technology that is currently available on state-of-the-art flat panel based angiography systems. The imaging information provided by C-arm CBCT allows for the acquisition and reconstruction of "CT-like" images in flat panel based angiography/interventional suites. As part of the evolution of this technology, enhancements allowing the overlay of cross-sectional imaging information can now be integrated with real time fluoroscopy. We report our early clinical experience with C-arm CBCT with fluoroscopic overlay for needle guidance during vertebroplasty. This is a retrospective review of 10 consecutive oncology patients who underwent vertebroplasty of 13 vertebral levels using C-arm CBCT with fluoroscopic overlay for needle guidance from November 2007 to December 2008. Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral) and complications were recorded. Technical success with the overlay technology was assessed based on accuracy which consisted of 4 measured parameters: distance from target to needle tip, distance from planned path to needle tip, distance from midline to needle tip, and distance from the anterior 1/3 of the vertebral body to needle tip. Success within each parameter required that the distance between the needle tip and parameter being evaluated be no more than 5 mm on multiplanar CBCT or fluoroscopy. Imaging data for 12 vertebral levels was available for review. All vertebral levels were treated using unilateral access and 9 levels were treated with an extrapedicular approach. Technical success rates were 92% for both distance from planned path and distance from midline to final needle tip, 100% when distance from needle tip to the anterior 1

  19. 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

  20. 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

  1. Improvement of limb salvage procedure using intraoperative radiotherapy for osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Hirano, Toru; Iwasaki, Katsuo; Kamishiro,; Toshiyuki,; Hayashi, Yasuyuki [Nagasaki Univ. (Japan). School of Medicine

    1992-10-01

    Clinical outcome of limb salvage procedure combined with intraoperative irradiation was investigated in 6 patients with osteosarcoma in the distal part of femur (n=4) and proximal part of tibia (n=2). They ranged in age from 12 to 54 years, with a mean of 22.5. First, a lesion was separated from the surrounding soft tissue with curatively wide margin. Osteotomy was performed at the portion of diaphysis. After irradiation field was setted up by lifting the lesion, and was exposed to doses ranging from 60 Gy to 85 Gy of intraoperative irradiation, soft tissue and fragile tumor tissue, excluding joint capsule and ligament, were removed as soon as possible. Finally, bone was jointed by means of inner fixation or bone grafting. They had a median follow-up of one year and four months after surgery. Although superficial wound infection and delayed wound adhesion were encountered as postoperative complications in one and two patients, respectively, these were all healed. None of the patients had local recurrence. The ability of salvaged limb was excellent in one, good in 3, and fair in 2 patients. Because both of the two patients with sarcoma in the proximal part of tibia had excellent and good limb ability, this procedure was considered useful especially for sarcoma in the proximal part of tibia. (N.K.).

  2. Improvement of limb salvage procedure using intraoperative radiotherapy for osteosarcoma

    International Nuclear Information System (INIS)

    Hirano, Toru; Iwasaki, Katsuo; Kamishiro; Toshiyuki; Hayashi, Yasuyuki

    1992-01-01

    Clinical outcome of limb salvage procedure combined with intraoperative irradiation was investigated in 6 patients with osteosarcoma in the distal part of femur (n=4) and proximal part of tibia (n=2). They ranged in age from 12 to 54 years, with a mean of 22.5. First, a lesion was separated from the surrounding soft tissue with curatively wide margin. Osteotomy was performed at the portion of diaphysis. After irradiation field was setted up by lifting the lesion, and was exposed to doses ranging from 60 Gy to 85 Gy of intraoperative irradiation, soft tissue and fragile tumor tissue, excluding joint capsule and ligament, were removed as soon as possible. Finally, bone was jointed by means of inner fixation or bone grafting. They had a median follow-up of one year and four months after surgery. Although superficial wound infection and delayed wound adhesion were encountered as postoperative complications in one and two patients, respectively, these were all healed. None of the patients had local recurrence. The ability of salvaged limb was excellent in one, good in 3, and fair in 2 patients. Because both of the two patients with sarcoma in the proximal part of tibia had excellent and good limb ability, this procedure was considered useful especially for sarcoma in the proximal part of tibia. (N.K.)

  3. Short-term outcome of fluoroscopic-guided steroid injection therapy of lumber facet cyst-induced radicular pain

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Mi Ri; Kwon, Jong Won; Lee, Jong Seo; Kim, Eu Sang [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-04-15

    To determine the short-term effect of fluoroscopic-guided steroid injection therapy of lumbar facet cyst-induced radicular pain. Seventeen patients with radiculopathy due to lumbar synovial cysts, who were treated with fluoroscopically guided injection, were retrospectively evaluated. All plain radiographic images and MR images before the therapy were reviewed. Five patients underwent only the facet joint injection, whereas twelve patients underwent the facet joint injection with perineural injection therapy. The clinical course of pain was evaluated on the first follow-up after therapy. Effective pain relief was achieved in 11 (64.7%) of the 17 patients. Among 12 patients who underwent facet joint injection with perineural injection, 9 patients (75%) had an effective pain relief. Of 5 patients, 2 (40%) patients only took the facet joint injection and had an effective pain relief. Fluoroscopic-guided steroid injection therapy shows a good short-term effect in patients with symptomatic lumbar facet joint synovial cysts.

  4. 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.

  5. Response of canine esophagus to intraoperative electron beam radiotherapy

    International Nuclear Information System (INIS)

    Sindelar, W.F.; Hoekstra, H.J.; Kinsella, T.J.; Barnes, M.; DeLuca, A.M.; Tochner, Z.; Pass, H.I.; Kranda, K.C.; Terrill, R.E.

    1988-01-01

    Tolerance of esophagus to intraoperative radiotherapy (IORT) was investigated in dogs. Thirteen adult foxhounds were subjected to right thoractomy, mobilization of the intrathoracic esophagus, and IORT to a 6 cm full-thickness esophageal segment using 9 MeV electrons at doses of 0, 2,000, or 3,000 cGy. Dogs were followed clinically and were evaluated at regular intervals after treatment with fiberoptic esophagoscopy, barium swallows, and postmortem histologic evaluations. One sham-irradiated control dog showed no abnormalities during follow-up of 24 months. Seven dogs receiving 2,000 cGy IORT showed transient mild dysphagia and mild esophagitis, but no clinically or pathologically significant complications. Five dogs receiving 3,000 cGy demonstrated severe ulcerative esophagitis within 6 weeks of treatment which progressed to chronic ulcerative esophagitis with stricture formation by 9 months following IORT. One 3,000 cGy dog died at 13 months from an esophageal perforation. On the basis of a pilot experience using 13 experimental animals, it was concluded that intact canine esophagus tolerates IORT well to doses of 2,000 cGy, but doses of 3,000 cGy pose serious and potentially lethal risks. The clinical application of IORT to the treatment of human intrathoracic neoplasms requiring esophageal irradiation should be approached with caution, particularly at doses exceeding 2,000 cGy

  6. 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%

  7. 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

  8. Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments

    International Nuclear Information System (INIS)

    Schmitz-Rode, T.; Guenther, R.W.; Neulen, J.

    2004-01-01

    Purpose: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. Materials and Methods: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. Results: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88%). The resulting fertility rate was 30% (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. (orig.)

  9. Tolerance of canine portal vein anastomosis to intraoperative X-irradiation

    International Nuclear Information System (INIS)

    Ohara, K.; Takeshima, T.

    1987-01-01

    Tolerance of surgical portal vein anatomosis to intraoperative radiation therapy (IORT) was studied in dogs after single doses of zero, 10, 20 and 40 Gy (290 kVp X-rays). Portal venography was performed prior to IORT and before sacrificing. The dogs were sacrificed 3 and 12 months respectively after irradiation. Portal venography revealed no radiation induced anastomotic stenosis. Autopys disclosed macroscopic periportal fibrosis in all dogs, independent of radiation dose and observation periods. Microscopically, the three tunicas of the vein did not show any pathological changes after any dose level. (orig.)

  10. Intra-operative radiotherapy in oncology

    International Nuclear Information System (INIS)

    Gerard, J.P.; Braillon, G.; Sentenac, I.; Calvo, F.; Dubois, J.B.; Saint-Aubert, B.; Guillemin, C.; Roussel, A.

    1991-01-01

    This article is about a treatment used more and more frequently in the world, for some neoplasms: Intra-operative radiotherapy under electron beams. The main neoplasms concerned by this treatment are the stomach, pancreas, rectum, bladder, uterus cervix neoplasms and peritoneal sarcoma [fr

  11. Intraoperative neurophysiological monitoring for the anaesthetist ...

    African Journals Online (AJOL)

    Intraoperative neurophysiological monitoring (IONM) has become the gold standard for the monitoring of functional nervous tissue and mapping of eloquent brain tissue during neurosurgical procedures. The multimodal use of somatosensory-evoked potentials and motor-evoked potentials ensures adequate monitoring of ...

  12. Intraoperative and recovery room outcome | Edomwonyi | East ...

    African Journals Online (AJOL)

    Objectives: To identify and quantitate anaesthesia related complications in the intraoperative period and in the post anaesthesia recovery room. Design: A prospective study. Setting: University of Benin Teaching Hospital; a University - affiliated tertiary centre. Subjects: Patients scheduled for elective and emergency surgery ...

  13. Upper gastrointestinal tract injuries by intraoperative radiotherapy for pancreatic cancer

    Energy Technology Data Exchange (ETDEWEB)

    Tabata, I; Isawa, T; Satomi, T; Tazima, T [Tokyo Metropolitan Komagome Hospital (Japan)

    1981-08-01

    Twenty-one patients with unresectable carcinoma of the pancreas were treated by intraoperative irradiation with a large electron dose of 1500 - 3000 rads and upper gastrointestinal complications were encountered in five cases. All of those five cases were for carcinoma of the pancreatic head, and were seen for gastrointestinal tract injuries of the duodenum as follows, gastric ulcer in 2 cases, ulcer of the 1st duodenal portion in one case and ulcer with severe stenosis of the 2nd or 3rd duodenal portion in one case, respectively. Endoscopic features of these postirradiation gastrointestinal ulcers were characterized by deep, punched-out ulcers with grayish bases and sharp margins. Clinically these ulcers and stenosis were very difficult to treat, so by-pass operations were performed in two cases, resulting in prolonged survival.

  14. INTRAOPERATIVE PHOTODYNAMIC THERAPY FOR METASTATIC PERITONEAL TUMORS

    Directory of Open Access Journals (Sweden)

    E. A. Suleimanov

    2016-01-01

    Full Text Available This review is devoted to the cytoreductive treatment of malignant tumors of the abdominal organs. The actuality of the issue is determined both by increase of the incidence of abdominal cancer in Russia and in majority of developed countries and by high rate diagnosis on late stages of disease. The methods of treatment of peritoneal carcinomatosis, based on possible effects on the secondary peritoneal tumors after surgical cytoreduction to reduce the risk of local recurrence and disease progression are described. These methods of additional intraoperative specific antitumor action include intraoperative radiation therapy, hyperthermic intraperitoneal chemotherapy, intraoperative photodynamic therapy characterized by differences in difficulty of performance, mechanisms of effect on tumor and healthy tissues, efficiency. Benefits, opportunities and possibilities of application of intraoperative photodynamic therapy (IOPDT for secondary peritoneal tumors are described in details, the results of a number of domestic and foreign clinical studies are shown, the successful application of intraoperative photodynamic therapy in clinical oncology, which allows reducing the risk of secondary tumor lesions of the peritoneum significantly, is demonstrated. Photodynamic therapy – a method with high efficiency and almost no side effects and complications, based on the ability of photosensitizer to accumulate selectively and retain in the high proliferative tissues. The advantages of this type of treatment of patients with peritoneal carcinomatosis are a selective effect on the peritoneal carcinomatosis and on visually detected tumor tissue, high efficiency in patients with malignant tumors of the abdominal cavity and pelvis combined with surgical cytoreduction, minimal effect on normal organs and tissues of the patient, well tolerated procedure.

  15. [MINIMALLY INVASIVE SURGERY FOR DIRECT REPAIR OF LUMBAR SPONDYLOLYSIS BY UTILIZING INTRAOPERATIVE NAVIGATION AND MICROENDOSCOPIC TECHNIQUES].

    Science.gov (United States)

    Zhu, Xiaolong; Wang, Jian; Zhou, Yue; Zhang, Zhengfeng; Li, Changqing; Zheng, Wenjie

    2015-10-01

    To analyze the effectiveness of direct screw repair for lumbar spondylolysis by using intraoperative O-arm based navigation and microendoscopic techniques. Between February 2012 and May 2014, 11 consecutive patients with lumbar spondylolysis were treated with Buck's procedure by the aid of intraoperative O-arm based navigation and minimally invasive approach. The debridement and autograft of pars interarticularis defects was performed under microendoscopy. There were 7 males and 4 females, with an average age of 28.4 years (range, 19 - 47 years) and an average disease duration of 10.5 months (range, 8-23 months); no nerve symptoms or signs of lower limb was observed. The radiological examinations showed single level bilateral lumbar spondylolysis without obvious disc degeneration, lumbar instability, or spondylolisthesis. Isthmic injury located at L4 in 2 cases and at L5 in 9 cases. Of 11 patients, 7 were rated as grade 2 disc degeneration, and 4 as grade 3 disc degeneration according to the modified Pfirrmann classification system. The operation time, intraoperative blood loss, and complications were recorded. The fluoroscopic examinations were performed to assess defect repair and screw position. Visual analogue scale (VAS) score was used to evaluate the improvement of low back pain. The average operation time was 147.6 minutes (range, 126-183 minutes). The average blood loss was 54.9 mL (range, 40-85 mL). Primary healing of incision was obtained. There was no complication of nerve root injury, dural tear, or infection. Three patients had pain at donor site postoperatively, and pain disappeared within 3 weeks. The average follow-up duration was 15.7 months (range, 10-23 months). VAS score of low back pain was significantly decreased from preoperative 7.1 ± 2.3 to 1.8 ± 0.4 at last follow-up (t = 13.42, P = 0.01). Of 22 isthmic bone grafting, bilateral isthmic bony fusion was achieved in 7 patients and unilateral isthmic bony fusion in 3 patients at 6-10 months

  16. Tolerance of canine anastomoses to intraoperative radiation therapy

    International Nuclear Information System (INIS)

    Tepper, J.E.; Sindelar, W.; Travis, E.L.; Terrill, R.; Padikal, T.

    1983-01-01

    Radiation has been given intraoperatively to various abdominal structures in dogs, using a fixed horizontal 11 MeV electron beam at the Armed Forces Radiobiologic Research Institute. Animals were irradiated with single doses of 2000, 3000 and 4500 rad to a field which extended from the bifurcation of the aorta to the rib cage. All animals were irradiated during laparotomy under general anesthesia. Because the clinical use of intraoperative radiotherapy in cancer treatment will occasionally require irradiation of anastomosed large vessels and blind loops of bowel, the tolerance of aortic anastomoses and the suture lines of blind loops of jejunum to irradiation were studied. Responses in these experiments were scored at times up to one year after irradiation. In separate experiments both aortic and intestinal anastomoses were performed on each animal for evaluation of short term response. The dogs with aortic anastomoses showed adequate healing at all doses with no evidence of suture line weakening. On long-term follow-up one animal (2000 rad) had stenosis at the anastomosis and one animal (4500 rad) developed an arteriovenous fistula. Three of the animals that had an intestinal blind loop irradiated subsequently developed intussusception, with the irradiated loop acting as the lead point. One week after irradiation, bursting pressure of an intestinal blind loop was normal at 3000 rad, but markedly decreased at 4500 rad. No late complications were noted after the irradiation of the intestinal anastomosis. No late complicatons were observed after irradiation of intestinal anastomoses, but one needs to be cautious with regards to possible late stenosis at the site of an irradiated vascular anastomosis

  17. Debate: Pro intraoperative radiation therapy in breast cancer; Debat: pour la radiotherapie peroperatoire dans le cancer du sein

    Energy Technology Data Exchange (ETDEWEB)

    Dubois, J.B.; Lemanski, C.; Azria, D. [Departement de radiotherapie, CRLC Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France); Gutowski, M.; Rouanet, P.; Saint-Aubert, B. [Departement de chirurgie, CRLC Val-d' Aurelle-Paul-Lamarque, 208, rue des Apothicaires, 34298 Montpellier cedex 5 (France)

    2011-10-15

    The use of intraoperative radiation therapy in breast cancer patients started about 20 years ago. Several retrospective and prospective studies have been published. Intraoperative radiation therapy was initially given as a boost to the tumour bed, followed by whole-breast irradiation. These studies have demonstrated the feasibility of the technique, with local control rates and cosmetic results similar to those obtained with standard treatments. Accelerated partial breast irradiation yields local recurrence rates as low as those observed after whole-breast irradiation. Intraoperative radiation therapy as a single irradiation modality with a unique dose has been investigated in recent prospective studies showing satisfactory local results. Intraoperative radiation therapy can be proposed either as a boost or as a unique treatment in selected cases (tumour size, nodal and hormonal status, patient's age). Intraoperative radiation therapy can be delivered by orthovoltage (50 kV) X-rays from mobile generators, or by electrons from linear accelerators, mobile or fixed, dedicated or not to intraoperative radiation therapy. (authors)

  18. Intraoperative near-infrared fluorescent imaging during robotic operations.

    Science.gov (United States)

    Macedo, Antonio Luiz de Vasconcellos; Schraibman, Vladimir

    2016-01-01

    The intraoperative identification of certain anatomical structures because they are small or visually occult may be challenging. The development of minimally invasive surgery brought additional difficulties to identify these structures due to the lack of complete tactile sensitivity. A number of different forms of intraoperative mapping have been tried. Recently, the near-infrared fluorescence imaging technology with indocyanine green has been added to robotic platforms. In addition, this technology has been tested in several types of operations, and has advantages such as safety, low cost and good results. Disadvantages are linked to contrast distribution in certain clinical scenarios. The intraoperative near-infrared fluorescent imaging is new and promising addition to robotic surgery. Several reports show the utility of this technology in several different procedures. The ideal dose, time and site for dye injection are not well defined. No high quality evidence-based comparative studies and long-term follow-up outcomes have been published so far. Initial results, however, are good and safe. RESUMO A identificação intraoperatória de certas estruturas anatômicas, por seu tamanho ou por elas serem ocultas à visão, pode ser desafiadora. O desenvolvimento da cirurgia minimamente invasiva trouxe dificuldades adicionais, pela falta da sensibilidade tátil completa. Diversas formas de detecção intraoperatória destas estruturas têm sido tentadas. Recentemente, a tecnologia de fluorescência infravermelha com verde de indocianina foi associada às plataformas robóticas. Além disso, essa tecnologia tem sido testada em uma variedade de cirurgias, e suas vantagens parecem estar ligadas a baixo custo, segurança e bons resultados. As desvantagens estão associadas à má distribuição do contraste em determinados cenários. A imagem intraoperatória por fluorescência infravermelha é uma nova e promissora adição à cirurgia robótica. Diversas séries mostram

  19. 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

  20. 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.

  1. Intraoperative high-field magnetic resonance imaging, multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas.

    Science.gov (United States)

    Li, Fang-Ye; Chen, Xiao-Lei; Xu, Bai-Nan

    2016-09-01

    To determine the beneficial effects of intraoperative high-field magnetic resonance imaging (MRI), multimodal neuronavigation, and intraoperative electrophysiological monitoring-guided surgery for treating supratentorial cavernomas. Twelve patients with 13 supratentorial cavernomas were prospectively enrolled and operated while using a 1.5 T intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. All cavernomas were deeply located in subcortical areas or involved critical areas. Intraoperative high-field MRIs were obtained for the intraoperative "visualization" of surrounding eloquent structures, "brain shift" corrections, and navigational plan updates. All cavernomas were successfully resected with guidance from intraoperative MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative "brain shift" severely deterred locating of the lesions; however, intraoperative MRI facilitated precise locating of these lesions. During long-term (>3 months) follow-up, some or all presenting signs and symptoms improved or resolved in 4 cases, but were unchanged in 7 patients. Intraoperative high-field MRI, multimodal neuronavigation, and intraoperative electrophysiological monitoring are helpful in surgeries for the treatment of small deeply seated subcortical cavernomas.

  2. An analysis of intraoperative versus post-operative dosimetry with CT, CT-MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants

    International Nuclear Information System (INIS)

    Acher, Peter; Puttagunta, Srikanth; Rhode, Kawal; Morris, Stephen; Kinsella, Janette; Gaya, Andrew; Dasgupta, Prokar; Deehan, Charles; Beaney, Ronald; Popert, Rick; Keevil, Stephen

    2010-01-01

    Background and purpose: To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants. Materials and methods: Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose-volume histograms were calculated from CT, XMR and CT-MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90. Results: Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT-MR fusion assessments were: 11 Gy (-22, 45), 18 Gy (-13, 49) and 20 Gy (-17, 58) for Observer 1; and 15 Gy (-34, 63), 13 Gy (-29, 55) and 14 Gy (-27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities. Conclusion: This is the first study to report Bland-Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume.

  3. Eye lens exposure to medical staff performing electrophysiology procedures: dose assessment and correlation to patient dose

    International Nuclear Information System (INIS)

    Ciraj-Bjelac, Olivera; Bozovic, Predrag; Arandjic, Danijela; Antic, Vojislav; Selakovic, Jovana; Pavlovic, Sinisa

    2016-01-01

    The purpose of this study was to assess the patient exposure and staff eye dose levels during implantation procedures for all types of pacemaker therapy devices performed under fluoroscopic guidance and to investigate potential correlation between patients and staff dose levels. The mean eye dose during pacemaker/defibrillator implementation was 12 μSv for the first operator, 8.7 μSv for the second operator/nurse and 0.50 μSv for radiographer. Corresponding values for cardiac re-synchronisation therapy procedures were 30, 26 and 2.0 μSv, respectively. Significant (p < 0.01) correlation between the eye dose and the kerma-area product was found for the first operator and radiographers, but not for other staff categories. The study revealed eye dose per procedure and eye dose normalised to patient dose indices for different staff categories and provided an input for radiation protection in electrophysiology procedures. (authors)

  4. Alteration of the threshold stimulus for intraoperative brain mapping via use of antiepileptic medications

    Directory of Open Access Journals (Sweden)

    John W. Amburgy, MD

    2015-03-01

    Full Text Available Intraoperative seizures during awake craniotomy with cortical and subcortical mapping are a common occurrence. Patients are routinely treated preoperatively with anti-convulsive medications to reduce seizure occurrence. Historically these drugs have not been believed to significantly affect awake craniotomy procedures. We report a patient undergoing intraoperative mapping with differential response and seizure occurrence based upon antiepileptic drug usage. A 43 year old female presented with history of seizures, right sided hemiparesis, electrical sensations, and difficulty with language function. She was determined to have a mass lesion involving the left frontal and temporal lobes and subsequently elected to undergo resection by awake craniotomy with intraoperative mapping. A first attempt at lesion resection was performed after a missed dose of anti-convulsant medication (levetiracetam and was subsequently aborted because of repeated seizure activity. The threshold for seizure generation (1.75 mA was observed to be significantly lower than expected. Therapy was begun with both levetiracetam and phenytoin prior to a second attempted resection one week later. Thresholds for cortical motor response in the second operation were significantly higher than expected (> 9.0 mA, and no intraoperative seizure activity was observed. To our knowledge this is the first quantitative example of antiepileptic drugs affecting the current required for intraoperative mapping. This case highlights the potential for higher current requirements in patients preoperatively treated with high doses of antiepileptic drugs, as well as the importance of confirming adequate dosage of antiepileptic drugs in patients at an increased risk of seizure generation.

  5. Intraoperative ketorolac and bleeding after laparoscopic Roux-en-Y gastric by-pass surgery

    DEFF Research Database (Denmark)

    Klein, M; Støckel, Marianne; Rosenberg, J

    2012-01-01

    The unspecific non-steroidal anti-inflammatory drug (NSAID) ketorolac is used during surgery as a single dose regimen to reduce immediate postoperative pain. Many studies have shown an increased risk of bleeding in patients treated with NSAIDs. We wanted to investigate whether intraoperative...... ketorolac administered at the end of surgery resulted in increased bleeding assessed by reduction in haemoglobin and need for blood transfusion....

  6. Television system for verification and documentation of treatment fields during intraoperative radiation therapy

    International Nuclear Information System (INIS)

    Fraass, B.A.; Harrington, F.S.; Kinsella, T.J.; Sindelar, W.F.

    1983-01-01

    Intraoperative radiation therapy (IORT) involves direct treatment of tumors or tumor beds with large single doses of radiation. The verification of the area to be treated before irradiation and the documentation of the treated area are critical for IORT, just as for other types of radiation therapy. A television system which allows the target area to be directly imaged immediately before irradiation has been developed. Verification and documentation of treatment fields has made the IORT television system indispensable

  7. Fluoroscopic-guided covered metallic stent placement for gastric outlet obstruction and post-operative gastroenterostomy anastomotic stricture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Han, Young Min; Kim, Chong Soo; Lee, Sang Young; Lee, Soo Teik; Yang, Doo Hyun

    2001-07-01

    AIM: To evaluate the feasibility and safety of fluoroscopic-guided covered metallic stent placements in providing palliative care for patients with inoperable malignant gastric outlet obstruction. MATERIALS AND METHODS: Under fluoroscopic guidance, placement of self-expandable, covered stents was attempted in 20 patients with inoperable or recurrent gastric cancer (age range 36-79 years). All patients had inoperable gastric outlet obstruction, 13 with native anatomy and seven with post-operative anatomy (gastrointestinal anastomotic sites). All patients had intolerance to oral alimentation and/or vomiting after ingestion. Success was defined both technically and clinically. RESULTS: The placement of the stent was technically successful in 18 patients and failed in two patients (technical success: 90%). The cause of the technical failures was an inability to negotiate the guide wire through the obstruction sites in spite of the use of both fluoroscopic and endoscopic guidance. After stent placement, 15 patients were able to ingest at least liquids and had a markedly decreased incidence of vomiting (clinical success: 75%). During the mean follow-up of 6 weeks, there have been no stent reocclusion and no life-threatening complications except migration of two stents in one patient. CONCLUSION: Fluoroscopically guided covered metallic stent placement appears to be valuable for the palliative treatment of malignant obstruction of gastric outlet and post-operative gastrointestinal anastomoses. Lee, J.M. et al. (2001)

  8. 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)

  9. 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.

  10. Internal hemipelvectomy with intraoperative and external beam radiotherapy in the limb-sparing treatment of a pelvic girdle chondrosarcoma

    NARCIS (Netherlands)

    Hoekstra, HJ; Szabo, BG

    The case of a patient with an extensive pelvic girdle chondrosarcoma treated with internal hemipelvectomy and intraoperative radiotherapy, followed by adjuvant high-dose external beam radiotherapy, with a successful attempt in achieving long-term local tumor control and limb-sparing treatment is

  11. A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.

    Science.gov (United States)

    Choi, Ji-Won; Kim, Duk-Kyung; Kim, Jin-Kyoung; Lee, Eun-Jee; Kim, Jea-Youn

    2018-01-01

    Postoperative ileus (POI) is an important factor prolonging the length of hospital stay following colorectal surgery. We retrospectively explored whether there is a clinically relevant association between intraoperative hypothermia and POI in patients who underwent laparoscopic colorectal surgery for malignancy within the setting of an enhanced recovery after surgery (ERAS) program between April 2016 and January 2017 at our institution. In total, 637 patients were analyzed, of whom 122 (19.2%) developed clinically and radiologically diagnosed POI. Overall, 530 (83.2%) patients experienced intraoperative hypothermia. Although the mean lowest core temperature was lower in patients with POI than those without POI (35.3 ± 0.5°C vs. 35.5 ± 0.5°C, P = 0.004), the independence of intraoperative hypothermia was not confirmed based on multivariate logistic regression analysis. In addition to three variables (high age-adjusted Charlson comorbidity index score, long duration of surgery, high maximum pain score during the first 3 days postoperatively), cumulative dose of rescue opioids used during the first 3 days postoperatively was identified as an independent risk factor of POI (odds ratio = 1.027 for each 1-morphine equivalent [mg] increase, 95% confidence interval = 1.014-1.040, P POI within an ERAS pathway, in which items other than thermal measures might offset its negative impact on POI. However, as it was associated with delayed discharge from the hospital, intraoperative maintenance of normothermia is still needed.

  12. Clinical implementation of intraoperative cone-beam CT in head and neck surgery

    Science.gov (United States)

    Daly, M. J.; Chan, H.; Nithiananthan, S.; Qiu, J.; Barker, E.; Bachar, G.; Dixon, B. J.; Irish, J. C.; Siewerdsen, J. H.

    2011-03-01

    A prototype mobile C-arm for cone-beam CT (CBCT) has been translated to a prospective clinical trial in head and neck surgery. The flat-panel CBCT C-arm was developed in collaboration with Siemens Healthcare, and demonstrates both sub-mm spatial resolution and soft-tissue visibility at low radiation dose (e.g., software based on the open-source Image-Guided Surgery Toolkit (IGSTK). The CBCT C-arm has been successfully deployed in 15 head and neck cases and streamlined into the surgical environment using human factors engineering methods and expert feedback from surgeons, nurses, and anesthetists. Intraoperative imaging is implemented in a manner that maintains operating field sterility, reduces image artifacts (e.g., carbon fiber OR table) and minimizes radiation exposure. Image reviews conducted with surgical staff indicate bony detail and soft-tissue visualization sufficient for intraoperative guidance, with additional artifact management (e.g., metal, scatter) promising further improvements. Clinical trial deployment suggests a role for intraoperative CBCT in guiding complex head and neck surgical tasks, including planning mandible and maxilla resection margins, guiding subcranial and endonasal approaches to skull base tumours, and verifying maxillofacial reconstruction alignment. Ongoing translational research into complimentary image-guidance subsystems include novel methods for real-time tool tracking, fusion of endoscopic video and CBCT, and deformable registration of preoperative volumes and planning contours with intraoperative CBCT.

  13. The intraoperative use of ultrasound facilitates significantly the arthroscopic debridement of calcific rotator cuff tendinitis.

    Science.gov (United States)

    Sabeti, M; Schmidt, M; Ziai, P; Graf, A; Nemecek, E; Schueller-Weidekamm, C

    2014-05-01

    During arthroscopy, the localization of calcific deposit in patients suffering from calcifying tendinitis can be demanding and time consuming, frequently using ionizing radiation. Intraoperative ultrasound has been recently promoted, facilitating deposit localization and reducing radiation dose. In this prospective, randomized, controlled and clinical observer-blinded pilot trial, 20 patients with calcific tendinitis were operated. In group I, the deposit was localized conventionally. In group II, the deposit was localized using intraoperative ultrasound. The needle punctures to detect the deposit and operation times were noted. Patients were postoperatively evaluated after 2 and 6 weeks and 9 months. In group II, the needle punctures to detect the deposit were significantly lower than in group I (p < 0.0001). Operation time to localize the deposit was also significantly less in group II (p < 0.033). In both groups, patients improved significantly with increased shoulder function (p < 0.0001) and decreased pain (p < 0.0001) 2 weeks and 9 months (p < 0.001) after surgery. The difference between the groups was not significant. Excellent radiological findings were obtained in both groups after 9 months. Intraoperative US significantly facilitates the detection of calcific deposits during arthroscopic debridement by speeding up surgery and reducing the number of needle punctures. Hence, we have changed our method of detecting calcific deposits intraoperatively from fluoroscopy to ultrasound.

  14. Fast skin dose estimation system for interventional radiology.

    Science.gov (United States)

    Takata, Takeshi; Kotoku, Jun'ichi; Maejima, Hideyuki; Kumagai, Shinobu; Arai, Norikazu; Kobayashi, Takenori; Shiraishi, Kenshiro; Yamamoto, Masayoshi; Kondo, Hiroshi; Furui, Shigeru

    2018-03-01

    To minimise the radiation dermatitis related to interventional radiology (IR), rapid and accurate dose estimation has been sought for all procedures. We propose a technique for estimating the patient skin dose rapidly and accurately using Monte Carlo (MC) simulation with a graphical processing unit (GPU, GTX 1080; Nvidia Corp.). The skin dose distribution is simulated based on an individual patient's computed tomography (CT) dataset for fluoroscopic conditions after the CT dataset has been segmented into air, water and bone based on pixel values. The skin is assumed to be one layer at the outer surface of the body. Fluoroscopic conditions are obtained from a log file of a fluoroscopic examination. Estimating the absorbed skin dose distribution requires calibration of the dose simulated by our system. For this purpose, a linear function was used to approximate the relation between the simulated dose and the measured dose using radiophotoluminescence (RPL) glass dosimeters in a water-equivalent phantom. Differences of maximum skin dose between our system and the Particle and Heavy Ion Transport code System (PHITS) were as high as 6.1%. The relative statistical error (2 σ) for the simulated dose obtained using our system was ≤3.5%. Using a GPU, the simulation on the chest CT dataset aiming at the heart was within 3.49 s on average: the GPU is 122 times faster than a CPU (Core i7-7700K; Intel Corp.). Our system (using the GPU, the log file, and the CT dataset) estimated the skin dose more rapidly and more accurately than conventional methods.

  15. The Art of Intraoperative Glioma Identification

    Directory of Open Access Journals (Sweden)

    Zoe Z Zhang

    2015-07-01

    Full Text Available A major dilemma in brain tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of 1 image-based navigation, 2 intraoperative sampling, 3 electrophysiological monitoring, and 4 enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease.

  16. 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.

  17. 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

  18. 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)

  19. 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.

  20. 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.

  1. 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.

  2. Near-Infrared Intraoperative Chemiluminescence Imaging

    KAUST Repository

    Büchel, Gabriel E.

    2016-08-03

    Intraoperative imaging technologies recently entered the operating room, and their implementation is revolutionizing how physicians plan, monitor, and perform surgical interventions. In this work, we present a novel surgical imaging reporter system: intraoperative chemiluminescence imaging (ICI). To this end, we have leveraged the ability of a chemiluminescent metal complex to generate near-infrared light upon exposure to an aqueous solution of Ce4+ in the presence of reducing tissue or blood components. An optical camera spatially resolves the resulting photon flux. We describe the construction and application of a prototype imaging setup, which achieves a detection limit as low as 6.9pmolcm-2 of the transition-metal-based ICI agent. As a proof of concept, we use ICI for the invivo detection of our transition metal tracer following both systemic and subdermal injections. The very high signal-to-noise ratios make ICI an interesting candidate for the development of new intraoperative imaging technologies. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Near-Infrared Intraoperative Chemiluminescence Imaging

    KAUST Repository

    Bü chel, Gabriel E.; Carney, Brandon; Shaffer, Travis M.; Tang, Jun; Austin, Christine; Arora, Manish; Zeglis, Brian M.; Grimm, Jan; Eppinger, Jö rg; Reiner, Thomas

    2016-01-01

    Intraoperative imaging technologies recently entered the operating room, and their implementation is revolutionizing how physicians plan, monitor, and perform surgical interventions. In this work, we present a novel surgical imaging reporter system: intraoperative chemiluminescence imaging (ICI). To this end, we have leveraged the ability of a chemiluminescent metal complex to generate near-infrared light upon exposure to an aqueous solution of Ce4+ in the presence of reducing tissue or blood components. An optical camera spatially resolves the resulting photon flux. We describe the construction and application of a prototype imaging setup, which achieves a detection limit as low as 6.9pmolcm-2 of the transition-metal-based ICI agent. As a proof of concept, we use ICI for the invivo detection of our transition metal tracer following both systemic and subdermal injections. The very high signal-to-noise ratios make ICI an interesting candidate for the development of new intraoperative imaging technologies. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Multispectral open-air intraoperative fluorescence imaging.

    Science.gov (United States)

    Behrooz, Ali; Waterman, Peter; Vasquez, Kristine O; Meganck, Jeff; Peterson, Jeffrey D; Faqir, Ilias; Kempner, Joshua

    2017-08-01

    Intraoperative fluorescence imaging informs decisions regarding surgical margins by detecting and localizing signals from fluorescent reporters, labeling targets such as malignant tissues. This guidance reduces the likelihood of undetected malignant tissue remaining after resection, eliminating the need for additional treatment or surgery. The primary challenges in performing open-air intraoperative fluorescence imaging come from the weak intensity of the fluorescence signal in the presence of strong surgical and ambient illumination, and the auto-fluorescence of non-target components, such as tissue, especially in the visible spectral window (400-650 nm). In this work, a multispectral open-air fluorescence imaging system is presented for translational image-guided intraoperative applications, which overcomes these challenges. The system is capable of imaging weak fluorescence signals with nanomolar sensitivity in the presence of surgical illumination. This is done using synchronized fluorescence excitation and image acquisition with real-time background subtraction. Additionally, the system uses a liquid crystal tunable filter for acquisition of multispectral images that are used to spectrally unmix target fluorescence from non-target auto-fluorescence. Results are validated by preclinical studies on murine models and translational canine oncology models.

  5. Intraoperative lung ultrasound: A clinicodynamic perspective

    Directory of Open Access Journals (Sweden)

    Amit Kumar Mittal

    2016-01-01

    Full Text Available In the era of evidence-based medicine, ultrasonography has emerged as an important and indispensable tool in clinical practice in various specialties including critical care. Lung ultrasound (LUS has a wide potential in various surgical and clinical situations for timely and easy detection of an impending crisis such as pulmonary edema, endobronchial tube migration, pneumothorax, atelectasis, pleural effusion, and various other causes of desaturation before it clinically ensues to critical level. Although ultrasonography is frequently used in nerve blocks, airway handling, and vascular access, LUS for routine intraoperative monitoring and in crisis management still necessitates recognition. After reviewing the various articles regarding the use of LUS in critical care, we found, that LUS can be used in various intraoperative circumstances similar to Intensive Care Unit with some limitations. Except for few attempts in the intraoperative detection of pneumothorax, LUS is hardly used but has wider perspective for routine and crisis management in real-time. If anesthesiologists add LUS in their routine monitoring armamentarium, it can assist to move a step ahead in the dynamic management of critically ill and high-risk patients.

  6. Influence of volume on intraoperatively irradiated canine ureters

    International Nuclear Information System (INIS)

    Gillette, S.M.; Powers, B.E.; Thames, H.D.; Vujaskovic, Z.; LaRue, S.M.; Park, R.D.; Gillette, E.L.

    1995-01-01

    Purpose/Objective: Intraoperative radiation therapy (IORT) is used to deliver high single doses of radiation to the tumor bed following surgical removal of various abdominal malignancies. The advantage of IORT is the ability to remove sensitive normal tissues from the treatment field and limit the volume of normal tissue irradiated. The purpose of this study was to determine dose-volume relationships for retroperitoneal tissues. Materials and methods: 134 adult beagle dogs were irradiated to the surgically exposed paraaortic area. Normal tissues included in the treatment field were aorta, peripheral nerve, ureter, bone and the muscle. Groups of 4 - 8 dogs were irradiated to doses ranging from 18 - 54 Gy for a 2x5 cm field, from 12 - 46 Gy for a 4x5 cm field, and 12 - 42 Gy to an 8x5 cm field. The radiations were done using 6 MeV electrons from a linear accelerator. Dogs were observed for three years after radiation at which time they were euthanatized, perfused and tissues taken for histologic and histomorphometric evaluation. Transverse sections of the ureter were taken from the proximal, middle and distal segments. Histologically, proximal portions of the ureters with greater than 5 times normal diameter were considered to have severe hydroureter. Ureteral strictures and hydroneophrosis were evaluated by excretory urograms. Excretory urograms were done prior to treatment and annually after treatment or prior to necropsy for each dog in the experiments. A grading system was devised for predicting ureteral stenosis based on ureteral and renal pelvic dilatation. Results: A strong dose and volume relationship was identified for ureteral injury using the mixture model analysis which takes into account latency as well as dose. Subsequent to earlier edema, fibrin and vessel damage, progressive fibrosis developed and likely caused uteral stricture resulting in hydroureter. Severe hydroureter was observed as early as three months. The ED 50 for hydroureter determined

  7. Assessment of peak skin dose in interventional cardiology: A comparison between Gafchromic film and dosimetric software em.dose.

    Science.gov (United States)

    Greffier, J; Van Ngoc Ty, C; Bonniaud, G; Moliner, G; Ledermann, B; Schmutz, L; Cornillet, L; Cayla, G; Beregi, J P; Pereira, F

    2017-06-01

    To compare the use of a dose mapping software to Gafchromic film measurement for a simplified peak skin dose (PSD) estimation in interventional cardiology procedure. The study was conducted on a total of 40 cardiac procedures (20 complex coronary angioplasty of chronic total occlusion (CTO) and 20 coronary angiography and coronary angioplasty (CA-PTCA)) conducted between January 2014 to December 2015. PSD measurement (PSD Film ) was obtained by placing XR-RV3 Gafchromic under the patient's back for each procedure. PSD (PSD em.dose ) was computed with the software em.dose©. The calculation was performed on the dose metrics collected from the private dose report of each procedure. Two calculation methods (method A: fluoroscopic kerma equally spread on cine acquisition and B: fluoroscopic kerma is added to one air Kerma cine acquisition that contributes to the PSD) were used to calculate the fluoroscopic dose contribution as fluoroscopic data were not recorded in our interventional room. Statistical analyses were carried out to compare PSD Film and PSD em.dose . The PSD Film median (1st quartile; 3rd quartile) was 0.251(0.190;0.336)Gy for CA-PTCA and 1.453(0.767;2.011)Gy for CTO. For method-A, the PSD em.dose was 0.248(0.182;0.369)Gy for CA-PTCA and 1.601(0.892;2.178)Gy for CTO, and 0.267(0.223;0.446)Gy and 1.75 (0.912;2.584)Gy for method-B, respectively. For the two methods, the correlation between PSD Film and PSD em.dose was strong. For all cardiology procedures investigated, the mean deviation between PSD Film and PSD em.dose was 3.4±21.1% for method-A and 17.3%±23.9% for method-B. The dose mapping software is convenient to calculate peak skin dose in interventional cardiology. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  8. Intraoperative floppy iris and prevalence of intraoperative complications: results from ophthalmic surgery outcomes database.

    Science.gov (United States)

    Vollman, David E; Gonzalez-Gonzalez, Luis A; Chomsky, Amy; Daly, Mary K; Baze, Elizabeth; Lawrence, Mary

    2014-06-01

    To estimate the prevalence of untoward events during cataract surgery with the use of pupillary expansion devices and intraoperative floppy iris (IFIS). Retrospective analysis of 4923 cataract surgery cases from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project. Outcomes from 5 Veterans Affairs medical centers were analyzed, including use of alpha-blockers (both selective and nonselective), IFIS, intraoperative iris trauma, intraoperative iris prolapse, posterior capsular tear, anterior capsule tear, intraoperative vitreous prolapse, and use of pupillary expansion devices. P values were calculated using the χ(2) test. A total of 1254 patients (25.5%) took alpha-blockers preoperatively (selective, 587; nonselective, 627; both, 40). Of these 1254 patients, 428 patients (34.1%) had documented IFIS. However, 75.2% of patients with IFIS (428/569) had taken alpha-blockers preoperatively (P < .00001). A total of 430 patients (8.7%) had a pupillary expansion device used during their cataract surgery, of which 186 patients (43.4%) had IFIS (P < .0001). Eighty-six patients with IFIS had at least 1 intraoperative complication and 39 patients with IFIS had more than 1 intraoperative complication (P < .001). The use of either selective or nonselective alpha-antagonists preoperatively demonstrated a significant risk of IFIS. Nonselective alpha-antagonists caused IFIS at a higher prevalence than previously reported. This study did demonstrate statistically significant increased odds of surgical complications in patients with IFIS vs those without IFIS in all groups (those taking selective and nonselective alpha-antagonists and also those not taking medications). Published by Elsevier Inc.

  9. ESTIMATION OF THE CONVERSION COEFFICIENTS FROM DOSE-AREA PRODUCT TO EFFECTIVE DOSE FOR BARIUM MEAL EXAMINATIONS FOR ADULT PATIENTS

    Directory of Open Access Journals (Sweden)

    A. V. Vodovatov

    2018-01-01

    Full Text Available Fluoroscopic examinations of the upper gastro-intestinal tract and, especially, barium meal examinations, are commonly performed in a majority of hospitals. These examinations are associated both with substantial individual patient doses and contribution to the collective dose from medical exposure. Effective dose estimation for this type of examinations is complicated due to: 1 the necessity to simulate the moving X-ray irradiation field; 2 differences in study structure for the individual patients; 3 subjectivity of the operators; and 4 differences in the X-ray equipment. The aim of the current study was to estimate conversion coefficients from dose-area product to effective dose for barium meal examinations for the over couch and under couch exposure conditions. The study was based on data collected in the X-ray unit of the surgical department of the St-Petersburg Mariinsky hospital. A model of patient exposure during barium meal examination was developed based on the collected data on fluoroscopy protocols and adult patient irradiation geometry. Conversion coefficients were calculated using PCXMC 2.0 software. Complete examinations were converted into a set of typical fluoroscopy phases and X-ray images, specified by the examined anatomical region and the projection of patient exposure. Conversion coefficients from dose-area product to effective dose were calculated for each phase of the examination and for the complete examination. The resulting values of the conversion coefficients are comparable with published data. Variations in the absolute values of the conversion coefficients can be explained by differences in clinical protocols, models for the estimation of the effective dose and parameters of barium meal examinations. The proposed approach for estimation of effective dose considers such important features of fluoroscopic examinations as: 1 non-uniform structure of examination, 2 significant movement of the X-ray tube within a single

  10. Outcome of renal transplantation with and without intra-operative diuretics.

    Science.gov (United States)

    Hanif, F; Macrae, A N; Littlejohn, M G; Clancy, M J; Murio, E

    2011-01-01

    This paper presents an e-survey of current clinical practice of use of intra-operative diuretics during renal transplantation in the United Kingdom and a study to compare outcome of renal transplants carried out with or without intra-operative diuretics in our centre. An e-mail questionnaire to renal transplant surgeons exploring their practice of renal transplantation with or without intra-operative diuretics, the type of a diuretic/s if used and the relevant doses. An observational study comparing the outcome of renal transplant recipients, group no-diuretics (GND, n = 80) carried out from 2004 to 2008 versus group diuretics (GD n = 69) renal transplant recipients who received intra-operative diuretics over a one year period is presented. Outcome measures were incidence of delayed graft function and a comparison of graft survival in both groups. Forty surgeons answered from 18 transplant centres with a response rate of 67%. 13 surgeons do not use diuretics. Mannitol is used by 10/40, Furosemide 6/40 and 11 surgeons use a combination of both. In comparative study there was no significant overall difference in one year graft survival of GD versus GND (N = 65/69, 94% and 75/80, 94% respectively, p = 0.08) and the incidence of delayed graft function was also comparable (16/69, 23% and 21/80, 26% respectively, p = 0.07). The donor characteristics in both groups were comparable. The study showed variation in clinical practice on the use of intra-operative diuretics in renal transplantation and it did not demonstrate that the use of diuretics can improve renal graft survival. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  11. Experimental study of the intra-operative radiation therapy for pancreatic cancer

    International Nuclear Information System (INIS)

    Kodera, Taro; Matsuno, Seiki; Kobari, Masao; Akaishi, Satoshi; Sakamoto, Kiyohiko

    1988-01-01

    The radiosensitivity of pancreatic cancer, optimum dose of irradiation and the effect of 1-[4'-Hydroxy-2'-Butenoxy) Methyl]-2-Nitrosoimidaole (RK-28) on irradiation were investigated using an experimental pancreatic cancer of hamster and the following results were obtained: i) The mean lethal dose (Do) and the 50 % tumor control dose (TCD 50 ) against the pancreatic cancer were 3.5 Gy and 73.7 ± 6.9 Gy, respectively. These results indicate that the pancreatic cancer is resistant to irradiation, which could be explained by the existence of hypoxic cells consisting of 35 % of the tumor. ii) The dose of intraoperative irradiation (10 - 40 Gy) seemed to be insufficient to bring long-term anti-tumor effect and long-term survival since that dose resulted in only temporary regression of the tumor. iii) The hypoxic cell sensitizer (RK28), which is known to specifically enhance the sensitivity of hypoxic cells to irradiation, lowered TCD 50 of the pancreatic cancer to 53.8 ± 1.57 Gy. Therefore, RK-28 was effective in the treatment of the experimental pancreatic cancer (the enhancement ratio : 1.37). When combined with 30 or 40 Gy of irradiation, which is applicable to intraoperative irradiation, RK-28 induced a longer period of tumor suppression and a higher tumor regression ratio than irradiation alone. These results indicate that RK-28 significantly increases the effect of intraoperative irradiation and this combination therapy could possibly induce remarkable effect on tumor regression and long-term survival. (author)

  12. The role and impact of reference doses on diagnostic radiology, how to use them at the national level?

    International Nuclear Information System (INIS)

    Nikodemova, D.; Horvathova, M.; Karkus, R.

    2003-01-01

    Results of patient dose audits reported in this paper for several types of examinations and various technical units have shown the importance of applications of reference dose levels in radiological practice. On the basis of national surveys slightly lower or higher standard dose reference levels (DRL) values could be justified. Continuing revision of DRL values and their extension to other types of radiographic and fluoroscopic examinations is needed

  13. Patient dose reduction during voiding cystourethrography

    International Nuclear Information System (INIS)

    Ward, Valerie L.

    2006-01-01

    Voiding cystourethrography (VCUG) is a commonly performed examination in a pediatric uroradiology practice. This article contains suggestions on how the radiation dose to a child from VCUG can be made ''as low as reasonably achievable'' (ALARA). The pediatric radiologist should consider the appropriateness of the clinical indication before performing VCUG and utilize radiation exposure techniques and parameters during VCUG to reduce radiation exposure to a child. The medical physicist and fluoroscope manufacturer can also work together to optimize a pulsed-fluoroscopy unit and further reduce the radiation exposure. Laboratory and clinical research is necessary to investigate methods that reduce radiation exposures during VCUG, and current research is presented here. (orig.)

  14. Intraoperative mechanical ventilation: state of the art.

    Science.gov (United States)

    Ball, Lorenzo; Costantino, Federico; Orefice, Giulia; Chandrapatham, Karthikka; Pelosi, Paolo

    2017-10-01

    Mechanical ventilation is a cornerstone of the intraoperative management of the surgical patient and is still mandatory in several surgical procedures. In the last decades, research focused on preventing postoperative pulmonary complications (PPCs), both improving risk stratification through the use of predictive scores and protecting the lung adopting so-called protective ventilation strategies. The aim of this review was to give an up-to-date overview of the currently suggested intraoperative ventilation strategies, along with their pathophysiologic rationale, with a focus on challenging conditions, such as obesity, one-lung ventilation and cardiopulmonary bypass. While anesthesia and mechanical ventilation are becoming increasingly safe practices, the contribution to surgical mortality attributable to postoperative lung injury is not negligible: for these reasons, the prevention of PPCs, including the use of protective mechanical ventilation is mandatory. Mechanical ventilation should be optimized providing an adequate respiratory support while minimizing unwanted negative effects. Due to the high number of surgical procedures performed daily, the impact on patients' health and healthcare costs can be relevant, even when new strategies result in an apparently small improvement of outcome. A protective intraoperative ventilation should include a low tidal volume of 6-8 mL/kg of predicted body weight, plateau pressures ideally below 16 cmH2O, the lowest possible driving pressure, moderate-low PEEP levels except in obese patients, laparoscopy and long surgical procedures that might benefit of a slightly higher PEEP. The work of the anesthesiologist should start with a careful preoperative visit to assess the risk, and a close postoperative monitoring.

  15. INTRAOPERATIVE PHOTODYNAMIC THERAPY FOR PERITONEAL MESOTHELIOMA

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2017-01-01

    Full Text Available Abstract Results of application of a new technology of intraoperative photodynamic therapy (IOFDT in patients with peritoneal mesothelioma developed at P. Herzen Moscow Oncology Research Institute are presented. The study included 8 patients. 3 patients underwent surgery in various amount: 1 – limited peritonectomy in the volume of tumor foci resection and resection of a large omentum, 1 – limited peritonectomy in the volume of tumor foci resection and atypical resection of the right lobe of the liver, 1 – only resection of the large omentum due to the fact that the tumor was located only in a large omentum and no signs of lesions of the parietal peritoneum was revealed by intraoperative revision. Surgical intervention in these patients was concluded by IOPDT. The remaining 5 patients underwent only IOPDT. After the treatment, two patients underwent additional courses of laparoscopic IOPDT. Of the 8 patients enrolled in the study, 4 died from the underlying disease, 1 from cardiovascular disease with recurrence of the disease, 1 from cardiovascular disease without signs of recurrence, 2 were monitored for 6 months and 146 months (12 years. Thus, in the group of patients with peritoneal mesothelioma, the maximum observation period was 146.44 months, the median survival was 48.4 months, the total specific 1-year survival was 85.7±13.2%, the three-year survival was 68.5±18.6%, the 5-year survival was 45.7 ± 22.4 %. The average life expectancy after treatment of patients with repeated courses of laparoscopic IOPDT was 87 months, without repeated courses – 35.8 months. Thus, life expectancy was higher in patients with repeated courses of laparoscopic IOPDT. Small sample size caused to the rarity of this pathology does not allow for statistically significant conclusions. However, the results of the study indicate the prospects of multi-course intraoperative photodynamic therapy in patients with peritoneal mesothelioma.

  16. Palliative resection with intraoperative radiotherapy for bile duct carcinoma at the liver hilus

    International Nuclear Information System (INIS)

    Iwasaki, Yoji; Okamura, Takao; Todoroki, Ken; Ohara, Kiyoshi

    1984-01-01

    In 10 patients undergoing palliative resection of the bile duct or both the bile duct and the liver, residual lesions (including the liver parenchyma, bile duct and major blood vessels) were given intraoperative irradiation of 20-35 Gy from a 25 MeV betatoron. Intraoperative radiotherapy was also performed in 3 patients without resection. Autopsy and clinical findings revealed severe liver damage as postoperative complications, suggesting the influence of irradiation. Therefore, exposure doses and the irradiated field have been reduced recently. An average duration of survival was 6.5 months in 8 patients excluding two who are alive (10 months and 8 months, respectively after operation). It was 8.3 months in 6 patients excluding two who died as a result of operative complications. (Namekawa, K.)

  17. Intraoperative measurement of parathyroid hormone: A Copernican revolution in the surgical treatment of hyperparathyroidism.

    Science.gov (United States)

    Gioviale, Maria Concetta; Damiano, Giuseppe; Altomare, Roberta; Maione, Carolina; Buscemi, Salvatore; Buscemi, Giuseppe; Lo Monte, Attilio Ignazio

    2016-04-01

    Intraoperative parathyroid hormone (PTH) monitoring in the setting of the operating room represents a valuable example of the rationale use of the laboratory diagnostic in a patient-oriented approach. Rapid intraoperative PTH (ioPTH) assay is a valid tool for an accurate evaluation of the success of parathyroid surgery. The reliability of the user-friendly portable systems as well as the collaboration between operators and surgical staff allow the one-site monitoring of the ioPTH decrements on the course of the surgical management of hyperparathyroidism. The rapid answer provided by an effective decrement of PTH during parathyroidectomy contributes dramatically to the efficacy of parathyroid surgery and the reduction of the number of re-operations. Therefore the dose of ioPTH is a valid and reliable support for the success of the intervention of parathyroidectomy at controlled costs. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Spinal infection: Evaluation with MR imaging and intraoperative spinal US

    International Nuclear Information System (INIS)

    Donovan Post, M.J.; Montalvo, B.M.; Quencer, R.M.; Katz, B.H.; Green, B.A.; Elsmont, F.

    1987-01-01

    MR spine images and/or intraoperative US scans in 15 patients were reviewed retrospectively and correlated with clinical and pathologic data to determine the diagnostic value of these modalities in spinal infection. In osteomyelitis and retrospinal abscess MR imaging was definitive; in myelitis it was positive but nonspecific. In epidural abscess concomitant with meningitis, myelography with CT and intraoperative US were superior to MR imaging. Intraoperative US could be used to distinguish these processes and to monitor surgical decompression. The authors recommend that MR imaging be performed at the screening examination in cases of spinal infection, accompanied by intraoperative US in all surgical cases

  19. In vivo virtual intraoperative surgical photoacoustic microscopy

    International Nuclear Information System (INIS)

    Han, Seunghoon; Kim, Sehui; Kim, Jeehyun; Lee, Changho; Jeon, Mansik; Kim, Chulhong

    2013-01-01

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo

  20. In vivo virtual intraoperative surgical photoacoustic microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Han, Seunghoon, E-mail: hsh860504@gmail.com; Kim, Sehui, E-mail: sehui0916@nate.com; Kim, Jeehyun, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [School of Electrical Engineering and Computer Science, Kyungpook National University, Daegu 702-701 (Korea, Republic of); Lee, Changho, E-mail: ch31037@postech.edu; Jeon, Mansik, E-mail: msjeon@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Kim, Chulhong, E-mail: jeehk@knu.ac.kr, E-mail: chulhong@postech.edu [Department of Creative IT Engineering, Pohang University of Science and Technology (POSTECH), Pohang 790-784 (Korea, Republic of); Department of Biomedical Engineering, The State University of New York at Buffalo, Buffalo, New York 14221 (United States)

    2013-11-11

    We developed a virtual intraoperative surgical photoacoustic microscopy system by combining with a commercial surgical microscope and photoacoustic microscope (PAM). By sharing the common optical path in the microscope and PAM system, we could acquire the PAM and microscope images simultaneously. Moreover, by employing a beam projector to back-project 2D PAM images onto the microscope view plane as augmented reality, the conventional microscopic and 2D cross-sectional PAM images are concurrently mapped on the plane via an ocular lens of the microscope in real-time. Further, we guided needle insertion into phantom ex vivo and mice skins in vivo.

  1. Versatile intraoperative MRI in neurosurgery and radiology.

    Science.gov (United States)

    Yrjänä, S K; Katisko, J P; Ojala, R O; Tervonen, O; Schiffbauer, H; Koivukangas, J

    2002-03-01

    Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. While in our setting the IMRI project was initiated by the neurosurgeons, the need for wider use of the facilities was recognised since the beginning of the planning phase in 1996. An organisational model was developed that allowed for development of neurosurgical applications, radiological imaging, and radiological interventions and for the research and development work of the vendor. A resistive 0.23 T MR scanner was installed in a dedicated operating room environment. Unique to this scanner is the ability to turn off the magnet, allowing for normal OR activities and devices, and to turn on the magnet as needed with a relatively short six-minute ramp up time. A staged surgical technique was perfected, allowing for transfer of data to the neuronavigator outside the scanner during surgery. In neurosurgery, IMRI was used as one part of a neuronavigational system that included ultrasound imaging, intra-operative cortical stimulation during awake procedures, electrocorticography and two neuronavigators. 34 neurosurgical cases included 27 brain tumour resections, 5 brain tumour biopsies, 1 extirpation of an arterio-venous malformation, and 1 haematoma evacuation. The scanner could also be used for normal clinical imaging where obese patients, children, claustophobic patients and postoperative control examinations were the major groups. The radiologists performed 110 interventions, including bone and abdominal biopsies, nerve root infiltrations and local pain therapies, with the optical needle tracking system under continuous MRI guidance. The organisational model allowed frequent use of the facilities for both neurosurgery and radiology

  2. 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)

  3. 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

  4. 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.

  5. Fluoroscopically Guided Extraforaminal Cervical Nerve Root Blocks: Analysis of Epidural Flow of the Injectate with Respect to Needle Tip Position

    Science.gov (United States)

    Shipley, Kyle; Riew, K. Daniel; Gilula, Louis A.

    2013-01-01

    Study Design Retrospective evaluation of consecutively performed fluoroscopically guided cervical nerve root blocks. Objective To describe the incidence of injectate central epidural flow with respect to needle tip position during fluoroscopically guided extraforaminal cervical nerve root blocks (ECNRBs). Methods Between February 19, 2003 and June 11, 2003, 132 consecutive fluoroscopically guided ECNRBs performed with contrast media in the final injected material (injectate) were reviewed on 95 patients with average of 1.3 injections per patient. Fluoroscopic spot images documenting the procedure were obtained as part of standard quality assurance. An independent observer not directly involved in the procedures retrospectively reviewed the images, and the data were placed into a database. Image review was performed to determine optimal needle tip positioning for injectate epidural flow. Results Central epidural injectate flow was obtained in only 28.9% of injections with the needle tip lateral to midline of the lateral mass (zone 2). 83.8% of injectate went into epidural space when the needle tip was medial to midline of the lateral mass (zone 3). 100% of injectate flowed epidurally when the needle tip was medial to or at the medial cortex of the lateral mass (zone 4). There was no statistically significant difference with regards to central epidural flow and the needle tip position on lateral view. Conclusion To ensure central epidural flow with ECNRBs one must be prepared to pass the needle tip medial to midplane of the lateral mass or to medial cortex of the lateral mass. Approximately 16% of ECNRBs with needle tip medial to midline of the lateral mass did not flow into epidural space. One cannot claim a nerve block is an epidural block unless epidural flow of injectate is observed. PMID:24494176

  6. 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...

  7. Brain tumors in eloquent areas: A European multicenter survey of intraoperative mapping techniques, intraoperative seizures occurrence, and antiepileptic drug prophylaxis.

    Science.gov (United States)

    Spena, Giannantonio; Schucht, Philippe; Seidel, Kathleen; Rutten, Geert-Jan; Freyschlag, Christian Franz; D'Agata, Federico; Costi, Emanule; Zappa, Francesca; Fontanella, Marco; Fontaine, Denys; Almairac, Fabien; Cavallo, Michele; De Bonis, Pasquale; Conesa, Gerardo; Foroglou, Nicholas; Gil-Robles, Santiago; Mandonnet, Emanuel; Martino, Juan; Picht, Thomas; Viegas, Catarina; Wager, Michel; Pallud, Johan

    2017-04-01

    Intraoperative mapping and monitoring techniques for eloquent area tumors are routinely used world wide. Very few data are available regarding mapping and monitoring methods and preferences, intraoperative seizures occurrence and perioperative antiepileptic drug management. A questionnaire was sent to 20 European centers with experience in intraoperative mapping or neurophysiological monitoring for the treatment of eloquent area tumors. Fifteen centers returned the completed questionnaires. Data was available on 2098 patients. 863 patients (41.1%) were operated on through awake surgery and intraoperative mapping, while 1235 patients (58.8%) received asleep surgery and intraoperative electrophysiological monitoring or mapping. There was great heterogeneity between centers with some totally AW oriented (up to 100%) and other almost totally ASL oriented (up to 92%) (31% SD). For awake surgery, 79.9% centers preferred an asleep-awake-asleep anesthesia protocol. Only 53.3% of the centers used ECoG or transcutaneous EEG. The incidence of intraoperative seizures varied significantly between centers, ranging from 2.5% to 54% (p mapping technique and the risk of intraoperative seizures. Moreover, history of preoperative seizures can significantly increase the risk of intraoperative seizures (p mapping and monitoring protocols and the management of peri- and intraoperative seizures. This data can help identify specific aspects that need to be investigated in prospective and controlled studies.

  8. Intraoperative Electron Radiotherapy for the Management of Aggressive Fibromatosis

    International Nuclear Information System (INIS)

    Roeder, Falk; Timke, Carmen; Oertel, Susanne; Hensley, Frank W.; Bischof, Marc; Muenter, Marc W.; Weitz, Juergen; Buchler, Markus W.; Lehner, Burkhard; Debus, Juergen; Krempien, Robert

    2010-01-01

    Purpose: We analyzed our experience with intraoperative electron radiotherapy (IOERT) followed by moderate doses of external beam radiotherapy (EBRT) after organ-sparing surgery in patients with primary or recurrent aggressive fibromatosis. Methods and Materials: Indication for IOERT and postoperative EBRT as an individual treatment approach to avoid mutilating surgical procedures was seen when complete surgical removal seemed to be unlikely or impossible. A total of 31 lesions in 30 patients were treated by surgery and IOERT with a median dose of 12 Gy. Median age was 31 years (range, 13-59 years). Resection status was close margin in six lesions, microscopically positive in 13, and macroscopically positive in 12. Median tumor size was 9 cm. In all, 25 patients received additional EBRT, with a median dose of 45 Gy (range, 36-54 Gy). Results: After a median follow-up of 32 months (range, 3-139 months), no disease-related deaths occurred. A total of five local recurrences were seen, resulting in actuarial 3-year local control rates of 82% overall and 91% inside the IOERT areas. Trends to improved local control were seen for older age (>31 years) and negative margins, but none of these factors reached significance. Perioperative complications were found in six patients, in particular as wound healing disturbances in five patients and venous thrombosis in one patient. Late toxicity was seen in five patients. Conclusion: Introduction of IOERT into a multimodal treatment approach in patients with aggressive fibromatosis is feasible with low toxicity and yielded good local control rates even in patients with microscopical or gross residual disease.

  9. Effectiveness of Fluoroscopic and US - Guided Percutaneous Catheter Drainage for Iliopsoas Abscess through the Anterolateral Transabdominal Approach

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ho Cheol; Shin, Tae Beom; Park, Mee Jung; Kim, Ji Eun; Choi, Hye Young; Bae, Kyung Soo; Choi, Dae Seob; Na, Jae Boem; Jeong, Seong Hoon [Gyeongsang National University Hospital, College of Medicine, Jinju (Korea, Republic of)

    2011-02-15

    We evaluated the effectiveness of performing fluoroscopic and ultrasonography guided percutaneous catheter drainage (PCD) through the anterolateral transabdominal approach for treating iliopsoas abscess. From January 2008 to December 2009, fluoroscopic and US-guided PCD through the anterolateral transabdominal approach was performed on sixteen iliopsoas abscesses of fourteen patients (7 males and 7 females; mean age: 63 years; age range: 30-87 years). Six abscesses were on the right side and ten abscesses were on the left side. The location of the abscesses were the psoas muscle (n=7), the iliacus muscle (n=7) and the iliopsoas muscle (n=2). All the procedures were performed under fluoroscopy and US guidance in the angiography room. The clinical findings before and after the procedure, the duration of catheter insertion and the procedure-related complications were evaluated. 15 out of the 16 iliopsoas abscesses were effectively treated. The duration of catheter insertion was 5- 27 days (mean: 14.6) days. No patient had significant complications during or after drainage. One patient died of uncontrolled diabetes complications and shock on the 9th day after percutaneous catheter drainage. One recurrence was noted 5 months after removal of the catheter. This patient underwent aspiration and antibiotic treatment for this lesion and the patient improved. Fluoroscopic and US-guided PCD for iliopsoas abscess through the anterolateral transabdominal approach is an effective and safe procedure

  10. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Intraoperative MRI in pediatric brain tumors

    Energy Technology Data Exchange (ETDEWEB)

    Choudhri, Asim F. [Le Bonheur Children' s Hospital, Department of Radiology, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Radiology, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Neurosurgery, Memphis, TN (United States); University of Tennessee Health Science Center, Department of Ophthalmology, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Siddiqui, Adeel [University of Tennessee Health Science Center, Department of Radiology, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Klimo, Paul; Boop, Frederick A. [University of Tennessee Health Science Center, Department of Neurosurgery, Memphis, TN (United States); Le Bonheur Children' s Hospital, Le Bonheur Neuroscience Institute, Memphis, TN (United States); Semmes-Murphey Neurologic and Spine Institute, Memphis, TN (United States); St. Jude Children' s Hospital, Division of Neurosurgery, Department of Surgery, Memphis, TN (United States)

    2015-09-15

    Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children. (orig.)

  13. Intraoperative MRI in pediatric brain tumors

    International Nuclear Information System (INIS)

    Choudhri, Asim F.; Siddiqui, Adeel; Klimo, Paul; Boop, Frederick A.

    2015-01-01

    Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children. (orig.)

  14. [Threefold intraoperative electrophysiological monitoring of vestibular neurectomy].

    Science.gov (United States)

    Hausler, R; Kasper, A

    1991-01-01

    A threefold intraoperative monitoring of facial nerve, auditory nerve and vestibular nerve function was performed in 14 cases of retrosigmoidal neurectomy. The facial nerve was monitoring with a pressure transducer placed against the cheek (Opalarm system). The auditory nerve was monitored with acoustically (click) evoked early potentials and the vestibular nerve was monitored with electrically evoked vestibular potentials obtained by direct stimulation (biphasic current pulses of 0.75-mA p-p, 100 us, 20/s) of the exposed vestibular nerve in the cerebellopontine angle before, during and after neurectomy. A characteristic vertex negative peak having a latency of approximately 2 ms and approximately 0.5 uV amplitude was obtained between a forehead and an ipsilateral ear lobe electrode (2 x 1,000 averaged responses over 10 ms) before the neurectomy. This response disappeared after selective vestibular nerve section proximal to the stimulation site. A diminished response amplitude was measured after incomplete nerve section. Simultaneous acoustic masking had no influence on the vestibular potential. The 14 operated patients became all free of vertiginous spells and drop-attacks except one patient who developed a contralateral Menière's. Facial nerve function remained normal in all. Hearing preservation was obtained in 12 patients (86%). The threefold intraoperative monitoring has turned out to be an additional safety factor for facial and auditory nerve preservation and, thanks to the recording of vestibular potentials, it increased the efficiency of vestibular neurectomy.

  15. Single-Fraction Intraoperative Radiotherapy for Breast Cancer: Early Cosmetic Results

    International Nuclear Information System (INIS)

    Beal, Kathryn; McCormick, Beryl; Zelefsky, Michael J.; Borgen, Patrick; Fey, Jane; Goldberg, Jessica; Sacchini, Virgilio

    2007-01-01

    Purpose: To evaluate the cosmetic outcome of patients treated with wide local excision and intraoperative radiotherapy for early-stage breast cancer. Methods and Materials: A total of 50 women were treated on a pilot study to evaluate the feasibility of intraoperative radiotherapy at wide local excision. The eligibility criteria included age >60, tumor size ≤2.0 cm, clinically negative lymph nodes, and biopsy-established diagnosis. After wide local excision, a custom breast applicator was placed in the excision cavity, and a dose of 20 Gy was prescribed to a depth of 1 cm. After 18 patients were treated, the dose was constrained laterally to 18 Gy. The cosmetic outcome was evaluated by photographs at baseline and at 6 and 12 months postoperatively. Four examiners graded the photographs for symmetry, edema, discoloration, contour, and scarring. The grades were evaluated in relationship to the volume of irradiated tissue, tumor location, and dose at the lateral aspects of the cavity. Results: The median volume of tissue receiving 100% of the prescription dose was 47 cm 3 (range, 20-97 cm 3 ). Patients with ≤47 cm 3 of treated tissue had better cosmetic outcomes than did the women who had >47 cm 3 of treated tissue. Women who had received 18 Gy at the lateral aspects of their cavities had better cosmetic outcomes than did women who had received 20 Gy at the lateral aspects. When comparing the 6- and 12-month results, the scores remained stable for 63%, improved for 17%, and worsened for 20%. Conclusion: Intraoperative radiotherapy appears feasible for selected patients. A favorable cosmetic outcome appears to be related to a smaller treatment volume. The cosmetic outcome is acceptable, although additional follow-up is necessary

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

    Directory of Open Access Journals (Sweden)

    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.

  17. 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.

  18. 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

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

    Science.gov (United States)

    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.

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

    Directory of Open Access Journals (Sweden)

    "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.

  1. 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.

  2. Fluoroscopically Guided Transcervical Fallopian Tube Recanalization of Post-Sterilization Reversal Mid-Tubal Obstructions

    International Nuclear Information System (INIS)

    Houston, J. Graeme; Anderson, David; Mills, John; Harrold, Anthony

    2000-01-01

    Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion. Cases of FTR in mid-tubal occlusion were included in this study. Technical success (defined as complete tubal patency) using a standard guidewire and hydrophilic glidewire, the number of patients with at least one patent tube, and the intrauterine and ectopic pregnancy rates were determined.Results: Twenty-six infertile patients with previous sterilization reversal underwent HSG. Eight of 26 (31%) patients (mean age 32 years, range 23-37 years), had attempted FTR for mid-tubal occlusion at the site of surgical anastomosis. Fourteen tubes were attempted as there were two previous salpingectomies. Technical success was achieved in eight of 14 (57%) tubes attempted, resulting in five of eight (62%) patients having at least one patent tube. At follow-up (mean 18 months, range 12-28 months) in these five patients there was one intrauterine pregnancy. There were no ectopic pregnancies.Conclusions: FTR in mid-tubal obstruction in infertile patients following sterilization reversal surgery is technically feasible and may result in intrauterine pregnancy. In this small group there was a lower technical success rate and lower pregnancy rate than in unselected proximal tubal occlusion

  3. The Resection Map : A proposal for intraoperative hepatectomy guidance

    NARCIS (Netherlands)

    Lamata, P.; Jalote-Parmar, A.; Lamata, F.; Declerck, J.

    2008-01-01

    Objective - To propose a new concept of an intra-operative 3D visualisation system to support hepatectomies. This system aims at improving the transfer of pre-operative planning into the intra-operative stage, both in laparoscopic and open approaches. Materials and methods - User (surgeon) centred

  4. Precision IORT - Image guided intraoperative radiation therapy (igIORT) using online treatment planning including tissue heterogeneity correction.

    Science.gov (United States)

    Schneider, Frank; Bludau, Frederic; Clausen, Sven; Fleckenstein, Jens; Obertacke, Udo; Wenz, Frederik

    2017-05-01

    To the present date, IORT has been eye and hand guided without treatment planning and tissue heterogeneity correction. This limits the precision of the application and the precise documentation of the location and the deposited dose in the tissue. Here we present a set-up where we use image guidance by intraoperative cone beam computed tomography (CBCT) for precise online Monte Carlo treatment planning including tissue heterogeneity correction. An IORT was performed during balloon kyphoplasty using a dedicated Needle Applicator. An intraoperative CBCT was registered with a pre-op CT. Treatment planning was performed in Radiance using a hybrid Monte Carlo algorithm simulating dose in homogeneous (MCwater) and heterogeneous medium (MChet). Dose distributions on CBCT and pre-op CT were compared with each other. Spinal cord and the metastasis doses were evaluated. The MCwater calculations showed a spherical dose distribution as expected. The minimum target dose for the MChet simulations on pre-op CT was increased by 40% while the maximum spinal cord dose was decreased by 35%. Due to the artefacts on the CBCT the comparison between MChet simulations on CBCT and pre-op CT showed differences up to 50% in dose. igIORT and online treatment planning improves the accuracy of IORT. However, the current set-up is limited by CT artefacts. Fusing an intraoperative CBCT with a pre-op CT allows the combination of an accurate dose calculation with the knowledge of the correct source/applicator position. This method can be also used for pre-operative treatment planning followed by image guided surgery. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  5. Intraoperative radiation therapy for locally advanced gynecological malignancies

    International Nuclear Information System (INIS)

    Haddock, M.G.; Petersen, I.A.; Webb, M.J.; Wilson, T.O.; Podratz, K.C.; Gunderson, L.L.

    1996-01-01

    Purpose: Evaluate disease control and survival in patients with locally advanced gynecological malignancies who received intraoperative radiation therapy with electrons (IOERT) as a component of treatment. Methods and Materials: Between March 1983 and June 1995, 63 patients (pts) with locally advanced primary (9 pts) or recurrent (54 pts) gynecological malignancies received IOERT as a component of attempted curative therapy. The site of origin was uterine cervix in 40 pts, uterine corpus in 16 pts, vagina in 5 pts, and ovary in 2 pts. Thirty-eight patients with recurrent disease had been previously irradiated (median prior RT dose 5040 cGy, range 900-8400). External beam radiotherapy (EBRT) was given to 43 of 63 pts either before or after IOERT (900-6570 cGy, median 4960 cGy). Chemotherapy was given to 21 pts prior to IOERT and following IOERT in 2 pts. IOERT doses ranged from 800 cGy to 2500 cGy with a median of 1750 cGy. The median IOERT dose was 2000 cGy in 20 patients with gross residual disease and 1500 cGy in 43 patients with microscopic residual disease. Endpoints included central control within the IOERT cone, local control, distant failure, disease free survival and overall survival. Variables evaluated for impact on disease outcome included tumor grade, primary site, prior RT, IOERT dose, EBRT dose, residual disease at time of IOERT, and use of chemotherapy. Results: Survival and disease control data are presented in the table below. There was no impact of any disease or treatment related variable on local or central failure. Pts with microscopic residual disease at the time of IOERT had significantly fewer distant metastases than pts with gross residual (5 yr 31% vs. 77%, p = 0.001) and improved survival (5 yr 37% vs. 10%, p = 0.02). Patients with recurrent disease after previous RT had survival and disease control rates which were similar to those seen in pts without priot RT. Toxicity ≥ grade 3 due to IOERT was observed in 11 pts (17%). Conclusion: A

  6. Intra-operative radiation therapy in cancer of the pancreas

    International Nuclear Information System (INIS)

    Dubois, J.B.; Gu, S.D.; Saint-Aubert, B.; Joyeux, H.; Solassol, C.; Pujol, H.

    1991-01-01

    We report our experience concerning 22 pancreatic carcinoma bearing patients treated with intra-operative radiation therapy (IORT) after complete surgical excision: duodenopancreatectomy: 15 patients; isthmic and caudal pancreatectomy: 2 patients; total pancreatectomy: 5 patients. The dose delivered to the tumor bed was 20 Gy in 12 patients, 18 Gy in 3 patients and 15 Gy in 7 patients. Three patients died within the 1st month post-surgery from intercurrent diseases. Post-operative morbidity was not significantly modified by IORT as compared to purely surgical treated patients. Out of 19 evaluable patients, we observed local control in 16 patients (79.4%). Causes of death (15/19 patients) were: distant metastases with local control: 7 patients; in situ local failure: 3 patients; regional recurrence outside of the IORT fields: 2 patients; intercurrent diseases: 3 patients. Four patients are still alive without evolutive disease. The median overall survival is 6 months. The mean overall survival is 10.56 months. Excluding patients who died from complications and intercurrent diseases, the median survival is 10 mths and the mean survival 14.5 mths. These results emphasize the improvement in local control with IORT, but without significant improvement in survival which is dependent on local evolution and also systemic disease [fr

  7. A basic study of intraoperative radiation on the stomach

    International Nuclear Information System (INIS)

    Aoki, Tetsuya

    1978-01-01

    In a basic study of intraoperative radiation on the stomach, adult dogs were laparotomized, and radiated on the stomach and gastroduodenal anastomosed part with an electron beam to 1,000 - 4,000 rads to observed its effects on hematologic and histologic findings. 1) No leukopenia occurred with the radiation, but secondary effects such as anemia and hypoproteinemia were noted. 2) On the gastric wall, the mucosa was most severely effected by the radiation, presenting such changes as erosion, atrophy, disappearance of glandular tissue, and fibrosis with the lapse of time. 3) The radiation on the stomach to 3,000 rads was followed by ulceration in one month, by the start of repair of the ulceration in three months, and by its healing in eight months. Histologic examination disclosed no evident damages to the blood vessels by the radiation. 4) Delayed healing of the anastomosed part was noted as an effect of the radiation on this part. 5) The findings in this experiment appear to suggest that the single tolerable dose of electron beam radiation on the stomach and the gastroduodenal anastomosed part should be 3,000 rads. (author)

  8. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Waugh, R.; McCarty, M. [Div. of Radiology, South Cleveland Hospital, South Tees Acute Hospitals NHS Trust, Marton Road, Middlesbrough, Cleveland (United Kingdom); McCallum, H.M. [Regional Medical Physics Dept., South Cleveland Hospital, Middlesbrough (United Kingdom); Montgomery, R. [Dept. of Orthopaedics, South Tees Hospitals NITS Trust, Middlesbrough (United Kingdom); Aszkenasy, M. [Tees and North East Yorkshire NHS Trust, West Lane Hospital, Middlesbrough (United Kingdom)

    2001-05-01

    Background. An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. Objective. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Materials and methods. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Results. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83 %, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Conclusion. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving. (orig.)

  9. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy.

    Science.gov (United States)

    Waugh, R; McCallum, H M; McCarty, M; Montgomery, R; Aszkenasy, M

    2001-05-01

    An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83%, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving.

  10. Paediatric pelvic imaging: optimisation of dose and technique using digital grid-controlled pulsed fluoroscopy

    International Nuclear Information System (INIS)

    Waugh, R.; McCarty, M.; McCallum, H.M.; Montgomery, R.; Aszkenasy, M.

    2001-01-01

    Background. An audit of paediatric pelvic radiographs identified deficiencies in gonad shield placement and radiographic technique. Objective. A technique using grid-controlled fluoroscopy (GCF), with hard copy images in frame grab and digital spot image (DSI) format was evaluated to optimise gonad shield placement and reduce the dose given to children with Perthes disease and Developmental Hip Dysplasia (DDH) attending for pelvic radiography. Materials and methods. Phantom and patient dose surveys of conventional and fluoroscopic techniques were carried out. Image quality and radiation dose were compared for the frame grab and DSI techniques. Retrospective evaluation was undertaken to compare their clinical acceptability. Results. Both fluoroscopic techniques gave considerably less radiation than conventional non-grid radiography (67-83 %, P < 0.05). The frame grab technique gave less radiation than DSI (P < 0.05). There was no significant difference in the clinical acceptability scores of the DSI and frame grab images. Conclusion. Fluoroscopy acquired images are now used since the fluoroscopic techniques give much less dose than conventional radiography and provide images of sufficient quality for clinical assessment. Indeed, as there was no significant difference in clinical usefulness between the frame grab and DSI techniques, it is planned to use frame grab alone, thus gaining additional dose saving. (orig.)

  11. Effects of steal-prone anatomy on intraoperative myocardial ischemia. The SPI Research Group.

    Science.gov (United States)

    Leung, J M; Hollenberg, M; O'Kelly, B F; Kao, A; Mangano, D T

    1992-11-01

    Our study objective was to determine whether the presence of steal-prone anatomy conferred an increased risk in the development of intraoperative myocardial ischemia. Coronary artery steal of collateral blood flow has been demonstrated for many vasodilators, including isoflurane, the most commonly used inhalational anesthetic agent in the United States. It has been postulated that patients with steal-prone anatomy (total occlusion of one coronary artery that is supplied distally by collateral flow from another coronary artery with a > or = 50% stenosis) may be particularly at risk for the development of intraoperative myocardial ischemia when an anesthetic with a vasodilator property is being administered. We evaluated the risk of myocardial ischemia under isoflurane anesthesia (vs. a high dose narcotic technique using sufentanil) using continuous intraoperative electrocardiography and transesophageal echocardiography in patients with and without steal-prone anatomy undergoing coronary artery bypass graft surgery. Sixty-two (33%) of the 186 patients had steal-prone anatomy: in 5 (8%) the collateral-supplying vessel was > or = 50% to 69% stenosed, in 24 (39%) it was > or = 70% to 89% stenosed and in 33 (53%) it was > or = 90% stenosed. The incidence of ischemia (transesophageal echocardiography or intraoperative electrocardiography, or both) was similar in patients with and without steal-prone coronary anatomy (18 [29%] of 62 patients vs. 39 [31%] of 124 patients, p = 0.87, 95% confidence interval = -0.13 to 0.17). The incidence of intraoperative ischemia was similar in patients who received isoflurane or sufentanil anesthesia (20 [32%] of 62 patients vs. 37 [30%] of 124 patients, p = 0.87). The incidence of tachycardia and hypotension was low (increases in heart rate = 9.8%, and decreases in systolic blood pressure = 10.8% of total monitoring time during the prebypass period compared with preoperative baseline values). The incidence of adverse cardiac outcome was

  12. Intraoperative nerve monitoring in laryngotracheal surgery.

    Science.gov (United States)

    Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

    Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Overview of intraoperative MRI in neurosurgery

    International Nuclear Information System (INIS)

    Shiino, Akihiko; Matsuda, Masayuki

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  14. Overview of intraoperative MRI in neurosurgery

    Energy Technology Data Exchange (ETDEWEB)

    Shiino, Akihiko; Matsuda, Masayuki [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-01-01

    This review describes usefulness, prospect and present problems of intraoperative MRI in neurosurgery. MRI equipments for the surgery have to have a wide, open space and have those magnets of short cylindrical, biplanar (clam shell), dual air core superconducting solenoidal (double doughnut) and targeted FOV (field of view) type. Devices required for the surgery are specific and in author's facility, they are classified into 4 zones depending on the region of their use. Application of the surgery involves biopsy, drainage of cyst and abscess, hematoma evacuation, nerve block, thermotherapy (interstitial laser, RF ablation, focused untrasonic and cryosurgery), local drug therapy, chemoablation, vascular intervention and tumor extraction, of which actual procedures and pictures are presented together with, in particular, MR-guided thermotherapy, ablation therapy of brain tumors, endoscopic surgery and minimally invasive therapy of the spine. A navigation software, 3D SlicerTM system, is introduced for interventional imaging. Safety measures are emphasized for the operation. (K.H.)

  15. Intraoperative radiotherapy. Clinical experiences and results

    Energy Technology Data Exchange (ETDEWEB)

    Calvo, F.A.; Santos, M. (Clinica Universitaria, Dept. of Oncology, Service of Radiotherapy, Pamplona (Spain)); Brady, L.W. (Hahnemann Univ., Dept. of Radiation Oncology, Philadelphia, PA (United States)) (eds.)

    1992-01-01

    This monograph reports on the largest clinical series to date in which intraoperative radiation therapy (IORT) has been used in mulitdisciplinary treatment programs for tumors of various sites and differing histological sybtype. It represents the product of 5 years' intensive work by physicians active at a leading European institution. The findings are supplemented by a thorough review of the data presented worldwide during the last two decades. The results in this book are meticulously presented and focus on the most important features of clinical research reports based on phase I-II studies (toxicity, local tumor control, and survival data). The tumor sites and histologies analyzed are: head and neck cancer, lung cancer, gastric cancer, pancreatic cancer, colorectal cancer, bladder cancer, gynecologic cancer, soft tissue sarcomas of the extremities, retroperitoneal and other central soft issue sarcomas, Ewing's sarcoma, osteosarcoma, and intracranial tumors. (orig./MG) With 60 figs.

  16. Brain mapping in tumors: intraoperative or extraoperative?

    Science.gov (United States)

    Duffau, Hugues

    2013-12-01

    In nontumoral epilepsy surgery, the main goal for all preoperative investigation is to first determine the epileptogenic zone, and then to analyze its relation to eloquent cortex, in order to control seizures while avoiding adverse postoperative neurologic outcome. To this end, in addition to neuropsychological assessment, functional neuroimaging and scalp electroencephalography, extraoperative recording, and electrical mapping, especially using subdural strip- or grid-electrodes, has been reported extensively. Nonetheless, in tumoral epilepsy surgery, the rationale is different. Indeed, the first aim is rather to maximize the extent of tumor resection while minimizing postsurgical morbidity, in order to increase the median survival as well as to preserve quality of life. As a consequence, as frequently seen in infiltrating tumors such as gliomas, where these lesions not only grow but also migrate along white matter tracts, the resection should be performed according to functional boundaries both at cortical and subcortical levels. With this in mind, extraoperative mapping by strips/grids is often not sufficient in tumoral surgery, since in essence, it allows study of the cortex but cannot map subcortical pathways. Therefore, intraoperative electrostimulation mapping, especially in awake patients, is more appropriate in tumor surgery, because this technique allows real-time detection of areas crucial for cerebral functions--eloquent cortex and fibers--throughout the resection. In summary, rather than choosing one or the other of different mapping techniques, methodology should be adapted to each pathology, that is, extraoperative mapping in nontumoral epilepsy surgery and intraoperative mapping in tumoral surgery. Wiley Periodicals, Inc. © 2013 International League Against Epilepsy.

  17. Best practices to optimize intraoperative photography.

    Science.gov (United States)

    Gaujoux, Sébastien; Ceribelli, Cecilia; Goudard, Geoffrey; Khayat, Antoine; Leconte, Mahaut; Massault, Pierre-Philippe; Balagué, Julie; Dousset, Bertrand

    2016-04-01

    Intraoperative photography is used extensively for communication, research, or teaching. The objective of the present work was to define, using a standardized methodology and literature review, the best technical conditions for intraoperative photography. Using either a smartphone camera, a bridge camera, or a single-lens reflex (SLR) camera, photographs were taken under various standard conditions by a professional photographer. All images were independently assessed blinded to technical conditions to define the best shooting conditions and methods. For better photographs, an SLR camera with manual settings should be used. Photographs should be centered and taken vertically and orthogonal to the surgical field with a linear scale to avoid error in perspective. The shooting distance should be about 75 cm using an 80-100-mm focal lens. Flash should be avoided and scialytic low-powered light should be used without focus. The operative field should be clean, wet surfaces should be avoided, and metal instruments should be hidden to avoid reflections. For SLR camera, International Organization for Standardization speed should be as low as possible, autofocus area selection mode should be on single point AF, shutter speed should be above 1/100 second, and aperture should be as narrow as possible, above f/8. For smartphone, use high dynamic range setting if available, use of flash, digital filter, effect apps, and digital zoom is not recommended. If a few basic technical rules are known and applied, high-quality photographs can be taken by amateur photographers and fit the standards accepted in clinical practice, academic communication, and publications. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Practice and bias in intraoperative pain management: results of a cross-sectional patient study and a survey of anesthesiologists

    Directory of Open Access Journals (Sweden)

    Ward S

    2018-03-01

    Full Text Available Stephen Ward,1 Charlotte Guest,2 Ian Goodall,2 Carsten Bantel3,4 1Pain Service, Barts Health, St Bartholomew’s Hospital, London, UK; 2Pain Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK; 3Section of Anaesthetics, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; 4Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Management, Universität Oldenburg, Oldenburg, Germany Background: Perioperative pain carries a considerable risk of becoming persistent; hence aggressive preventive approaches are advocated. Persistently high prevalence of postoperative pain, however, suggests anesthesiologists underuse these strategies. A prospective cross-sectional study of patients in the postanesthetic care unit (PACU and a survey of anesthesiologists were thus conducted to evaluate practice and uncover bias in intraoperative pain management. Methods: Notes of PACU patients were reviewed and information regarding surgical context, comorbidities, and analgesic administration was retrieved. Variables were analyzed for their predictive properties on pain and intraoperative analgesic management. Furthermore, clinical dose–effect estimates for intraoperative morphine were determined. Finally, anesthesiologists completed a questionnaire comprising statements regarding pain relating to surgical context and morphine administration. Results: Data of 200 patients and 55 anesthesiologists were analyzed. Prevalence of pain in PACU was 28% and was predicted by local anesthetic (LA and low-dose morphine administration. Additionally, when LA was used, little coanalgesics were employed. These results suggest a restrained approach by anesthesiologists toward intraoperative pain management. It is supported by their reluctance to administer more than 10 mg morphine, despite these individuals regarding this practice as insufficient. The hesitancy toward morphine also transpired

  19. Intraoperative radiotherapy in primary rectal cancer; Intraoperative Radiotherapie des primaeren Rektumkarzinoms

    Energy Technology Data Exchange (ETDEWEB)

    Mund, Christian

    2013-06-17

    According to the results of several studies intraoperative radiotherapy seems to influence local control for primary rectal cancer in UICC-Stage II / III positively, though recommendations in therapy cannot be given as studies of high evidence level do not exist. As IORT is rarely available and makes patient recruitment difficult, prospective randomised trials have not been carried out yet. This emphasizes the importance of non-randomised trials for an evaluation of IORT. A comparison of 21 patients with locally advanced rectal cancer who had been treated with intraoperative radiation therapy and 21 similar cases without an application of IORT could not show any significant improvements in prognosis (recurrences, metastases and disease-specific survival). Nevertheless the employment of intraoperative radiation showed a trend in improvement of local control. This hast been shown by several other studies before. Thus the application of IORT in patients with locally advanced rectal cancer is considered a useful part in multimodal treatment and should further be evaluated in specialized centres. In case-control studies 1:1-matching leads to a good comparability of groups and renders conclusions of high internal validity possible. To gain a sufficient power, this type of trials should however primarily be carried out by centres with a high number of cases.

  20. Intraoperative radiotherapy in resected pancreatic cancer: feasibility and results

    International Nuclear Information System (INIS)

    Coquard, Regis; Ayzac, Louis; Gilly, Francois-Noeel; Romestaing, Pascale; Ardiet, Jean-Michel; Sondaz, Chrystel; Sotton, Marie-Pierre; Sentenac, Irenee; Braillon, Georges; Gerard, Jean-Pierre

    1997-01-01

    Background and purpose: To evaluate the impact of intraoperative radiotherapy (IORT) combined with postoperative external beam irradiation in patients with pancreatic cancer treated with curative surgical resection. Materials and methods: From January 1986 to April 1995 25 patients (11 male and 14 female, median age 61 years) underwent a curative resection with IORT for pancreatic adenocarcinoma. The tumour was located in the head of the pancreatic gland in 22 patients, in the body in two patients and in the tail in one patient. The pathological stage was pT1 in nine patients, pT2 in nine patients, pT3 in seven patients, pN0 in 14 patients and pN1 in 11 patients. All the patients were pM0. A pancreaticoduodenectomy was performed in 22 patients, a distal pancreatectomy was performed in two patients and a total pancreatectomy was performed in one patient. The resection was considered to be complete in 20 patients. One patient had microscopic residual disease and gross residual disease was present in four patients. IORT using electrons with a median energy of 12 MeV was performed in all the patients with doses ranging from 12 to 25 Gy. Postoperative EBRT was delivered to 20 patients (median dose 44 Gy). Concurrent chemotherapy with 5-fluorouracil was given to seven patients. Results: The overall survival was 56% at 1 year, 20% at 2 years and 10% at 5 years. Nine local failures were observed. Twelve patients developed metastases without local recurrence. Twenty patients died from tumour progression and two patients died from early post-operative complications. Three patients are still alive; two patients in complete response at 17 and 94 months and one patient with hepatic metastases at 13 months. Conclusion: IORT after complete resection combined with postoperative external beam irradiation is feasible and well tolerated in patients with pancreatic adenocarcinoma

  1. Intraoperative Sensorcaine significantly improves postoperative pain management in outpatient reduction mammaplasty.

    Science.gov (United States)

    Culliford, Alfred T; Spector, Jason A; Flores, Roberto L; Louie, Otway; Choi, Mihye; Karp, Nolan S

    2007-09-15

    Breast reduction is one of the most frequently performed plastic surgical procedures in the United States; more than 160,500 patients underwent the procedure in 2005. Many outpatient reduction mammaplasty patients report the greatest postoperative discomfort in the first 48 hours. The authors' investigated the effect of intraoperative topical application of the long-acting local anesthetic agent bupivacaine (Sensorcaine or Marcaine) on postoperative pain, time to postanesthesia care unit discharge, and postoperative use of narcotic medication. In a prospective, randomized, single-blind trial, intraoperative use of Sensorcaine versus placebo (normal saline) was compared. Postoperative pain was quantified using the visual analogue scale, and time to discharge from the postanesthesia care unit was recorded. Patients documented their outpatient pain medication usage. Of the 37 patients enrolled in the study, 20 were treated with intraoperative topical Sensorcaine and 17 received placebo. Patients treated with Sensorcaine were discharged home significantly faster (2.9 hours versus 3.8 hours, p = 0.002). The control arm consistently had higher pain scores in the postanesthesia care unit (although not statistically significant) than the Sensorcaine group using the visual analogue scale system. Furthermore, patients receiving Sensorcaine required significantly less narcotic medication while recovering at home (mean, 3.5 tablets of Vicodin) than the control group (mean, 6.4 tablets; p = 0.001). There were no complications resulting from Sensorcaine usage. This prospective, randomized, single-blind study demonstrates that a single dose of intraoperative Sensorcaine provides a safe, inexpensive, and efficacious way to significantly shorten the length of postanesthesia care unit stay and significantly decrease postoperative opioid analgesic use in patients undergoing ambulatory reduction mammaplasty.

  2. Intraoperative radiation therapy in gynecologic cancer: update of the experience at a single institution

    International Nuclear Information System (INIS)

    Garton, Graciela R.; Gunderson, Leonard L.; Webb, Maurice J.; Wilson, Timothy O.; Cha, Stephen S.; Podratz, Karl C.

    1997-01-01

    Purpose: To update the Mayo Clinic experience with intraoperative radiation therapy (IORT) in patients with gynecologic cancer. Methods and Materials: Between January 1983 and June 1991, 39 patients with recurrent or locally advanced gynecologic malignancies received intraoperative radiation therapy with electrons. The anatomical area treated was pelvis (side walls or presacrum) or periaortic nodes or a combination of both. In addition to intraoperative radiation therapy, 28 patients received external beam irradiation (median dose, 45 Gy; range, 0.9 to 65.7 Gy), and 13 received chemotherapy preoperatively. At the time of intraoperative radiation therapy and after maximum debulking operation, 23 patients had microscopic residual disease and 16 had gross residual disease up to 5 cm in thickness. Median follow-up for surviving patients was 43.4 months (range, 27.1 to 125.4 months). Results: The 5-year actuarial local control with or without central control was 67.4%, and the control within the IORT field (central control) was 81%. The risk of distant metastases at 5 years was 52% (82% in patients with gross residual disease and 33% in patients with only microscopic disease postoperatively). Actuarial 5-year overall survival and disease-free survival was 31.5 and 40.5%, respectively. Patients with microscopic disease had 5-year disease-free and overall survival of 55 and 50%, respectively. Grade 3 toxicity was directly associated with IORT in six patients (15%). Conclusion: Patients with local, regionally recurrent gynecologic cancer may benefit from maximal surgical debulking and IORT with or without external beam irradiation, especially those with microscopic residual disease

  3. [Technique of intraoperative planning in prostatic brachytherapy with permanent implants of 125I or 103Pd].

    Science.gov (United States)

    Prada Gómez, Pedro José; Juan Rijo, Germán; Hevia Suarez, Miguel; Abascal García, José María; Abascal García, Ramón

    2002-12-01

    Prostatic brachytherapy with permanent 125I or 123Pd seeds implantation is a therapeutic option for organ-confined prostate cancer. We analyze the technique based on previous planning, our current intraoperative planning procedure and the reasons that moved us to introduce this change. Changes in prostate volume and spatial localization observed between previous planning and intraoperative images, and possible difficulties for seed implantation due to pubic arch interference are some of the reasons that induce us to change technique. Before the operation, we calculate the prostatic volume by transrectal ultrasound; with this information we determine the total implant activity following Wu's nomogram, and per-seed activity; therefore, it is an individual process for each patient. We perform a peripheral implant, placing 75-80% of the seeds within the peripheral prostatic zone, generally through 12-15 needles, the rest of the seeds are placed in the central prostatic zone using a maximum of 3-4 needles in high volume prostates. The day of intervention, after positioning and catheter insertion, volumetry is re-checked. Ultrasound images (from base to apex every 5 mm) are transferred to the planner were a suitable seed distribution is determined. Implantation is then performed placing all needles unloaded, and then intraoperative post-planning to allow us to check implant precision is performed after cistoscopically check that there is no urethral or bladder penetration by any needle. We finish with the insertion of seeds into the prostate. Total time for the procedure is around 90 minutes. Intraoperative planning is an additional step for the treatment of prostate cancer with permanent seeds brachytherapy, which avoids the disadvantages of previous planning and improves tumor inclusion in the ideal irradiation dose area, which will translate into better local disease control.

  4. SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

    International Nuclear Information System (INIS)

    Williams, C; Crowley, E; Wolfgang, J

    2016-01-01

    Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

  5. SU-F-T-80: A Mobile Application for Intra-Operative Electron Radiotherapy Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Williams, C [Brigham and Women’s Hospital & Dana Farber Cancer Institute, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Crowley, E; Wolfgang, J [Harvard Medical School, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States)

    2016-06-15

    Purpose: Intraoperative electron radiotherapy (IORT) poses a unique set of challenges for treatment planning. Planning must be performed in a busy operating room environment over a short timeframe often with little advance knowledge of the treatment depth or applicator size. Furthermore, IORT accelerators can have a large number of possible applicators, requiring extensive databooks that must be searched for the appropriate dosimetric parameters. The goal of this work is to develop a software tool to assist in the planning process that is suited to the challenges faced in the IORT environment. Methods: We developed a mobile application using HTML5 and Javascript that can be deployed to tablet devices suitable for use in the operating room. The user selects the desired treatment parameters cone diameter, bevel angle, and energy (a total of 141 datasets) and desired bolus. The application generates an interactive display that allows the user to dynamically select points on the depth-dose curve and to visualize the shape of the corresponding isodose contours. The user can indicate a prescription isodose line or depth. The software performs a monitor unit calculation and generates a PDF report. Results: We present our application, which is now used routinely in our IORT practice. It has been employed successfully in over 23 cases. The interactivity of the isodose distributions was found to be of particular use to physicians who are less-frequent IORT users, as well as for the education of residents and trainees. Conclusion: This software has served as a useful tool in IORT planning, and demonstrates the need for treatment planning tools that are designed for the specialized challenges encountered in IORT. This software is the subject of a license agreement with the IntraOp Medical Corporation. This software is the subject of a license agreement between Massachusetts General Hospital / Partners Healthcare and the IntraOp Medical Corporation. CLW is consulting on

  6. 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.)

  7. 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)

  8. The role of intraoperative radiation therapy in patients with pancreatic cancer.

    Science.gov (United States)

    Palta, Manisha; Willett, Christopher; Czito, Brian

    2014-04-01

    Intraoperative radiation therapy (IORT) techniques allow for the delivery of high doses of radiation therapy while excluding part or all of the nearby dose-limiting sensitive structures. Therefore, the effective radiation dose is increased and local tumor control potentially improved. This is pertinent in the case of pancreatic cancer because local failure rates are as high as 50%-80% in patients with resected and locally advanced disease. Available data in patients receiving IORT after pancreaticoduodenectomy reveal an improvement in local control, though overall survival benefit is unclear. Series of patients with locally advanced pancreatic cancer also suggest pain relief, and in select studies, improved survival associated with the inclusion of IORT. At present, no phase III data clearly supports the use of IORT in the management of pancreatic cancer. © 2013 Published by Elsevier Inc.

  9. Dose reduction in fluoroscopy with modern DSA equipment

    International Nuclear Information System (INIS)

    Waggershauser, T.; Herrmann, K.; Schaetzl, M.; Reiser, M.

    1995-01-01

    The new Multistar T.O.P. (Siemens) is equipped with various features for dose reduction. In this study pulsed fluoroscopy was tested versus standard continuous fluoroscopy and supervisions. Fluoroscope with 3, 7.5, and 15 pulses/s in the Multistar T.O.P. were compared to standard fluoroscopy and to reduced-dose supervision in a human pelvic phantom. The skin entry dose and pelvic dose were continuously registered. The supervision mode used 58% of the dose used in continuous fluoroscopy. Pulsed fluoroscopy with 15 pulses/s required 54%, 7.5 pulses/s 27% and 3 pulses/s. These provide adequate image quality with only 10% of the standard dose. (orig./MG) [de

  10. Comparison of intraoperative dosimetric implant representation with postimplant dosimetry in patients receiving prostate brachytherapy.

    Science.gov (United States)

    Stone, Nelson N; Hong, Suzanne; Lo, Yeh-Chi; Howard, Victor; Stock, Richard G

    2003-01-01

    To compare the results of intraoperative dosimetry with those of CT-based postimplant dosimetry in patients undergoing prostate seed implantation. Seventy-seven patients with T1-T3 prostate cancer received an ultrasound-guided permanent seed implant (36 received (125)I, 7 (103)Pd, and 34 a partial (103)Pd implant plus external beam radiation therapy). The implantation was augmented with an intraoperative dosimetric planning system. After the peripheral needles were placed, 5-mm axial images were acquired into the treatment planning system. Soft tissue structures (prostate, urethra, and rectum) were contoured, and exact needle positions were registered. Seeds were placed with an applicator, and their positions were entered into the planning system. The dose distributions for the implant were calculated after interior needle and seed placement. Postimplant dosimetry was performed 1 month later on the basis of CT imaging. Prostate and urethral doses were compared, by using paired t tests, for the real-time dosimetry in the operating room (OR) and the postimplant dosimetry. The mean preimplant prostate volume was 39.8 cm(3), the postneedle planning volume was 41.5 cm(3) (psystem provides a close match to the actual delivered doses. These data support the use of this system to modify the implant during surgery to achieve more consistent dosimetry results.

  11. Estimation of population doses from diagnostic medical examinations in Japan, 1974. III. Per caput mean marrow dose and leukemia significant dose

    Energy Technology Data Exchange (ETDEWEB)

    Hashizume, T; Maruyama, T; Kumamoto, Y [National Inst. of Radiological Sciences, Chiba (Japan)

    1976-03-01

    The mean per capita marrow dose and leukemia-significant dose from radiographic and fluoroscopic examinations in Japan have been estimated based on a 1974 nation wide survey of randomly sampled hospitals and clinics. To determine the mean marrow dose to an individual from a certain exposure of a given type of examination, the active marrow in the whole body was divided into 119 parts for an adult and 103 for a child. Dosimetric points on which the individual marrow doses were determined were set up in the center of each marrow part. The individual marrow doses at the dosimetric points in the beams of practical diagnostic x-rays were calculated on the basis of the exposure data on the patients selected in the nation wide survey, using depth dose curves experimentally determined for diagnostic x-rays. The mean individual marrow dose was averaged over the active marrow by summing, for each dosimetric point, the product of the fraction of active marrow exposed and the individual marrow dose at the dosimetric point. The leukemia significant dose was calculated by adopting a weighting factor that is, a leukemia significant factor. The factor was determined from the shape of the time-incidence curve for radiation-induced leukemia from the Hiroshima A-bomb and from the survival statistics for the average population. The resultant mean per capita marrow dose from radiographic and fluoroscopic examination was 37.0 and 70.0 mrad/person/year, respectively, with a total of 107.05 mrad/person/year. The leukemia significant dose was 32.1 mrad/person/year for radiographic examination and 61.2 mrad/person/year, with a total of 93.3. These values were compared with those of 1960 and 1969.

  12. Intraoperative radiotherapy (IOR) of cancers of the biliary system and pancreas

    International Nuclear Information System (INIS)

    Nakamura, Ikuo; Mori, Katsutaka; Yasunaga, Tadamasa; Takada, Chitose; Hiraoka, Takehisa; Ikei, Satoshi

    1986-01-01

    Intraoperative radiotherapy (IOR) of unresected advanced cancers of the biliary system and pancreas improves both subjective and objective symptoms. IOR with radical resection, however, provided excellent local control of the tumor bed and significantly prolonged survival time. The optimal single dose of IOR appears to be 25 to 30 Gy. Bleeding and stenosis of the stomach and duodenum were observed but were prevented by keeping the organs out of the radiotherapy energy field. IOR combined with radical resection is concluded to be an effective method of treating selected cases of cancer of the biliary system and pancreas. (author)

  13. The value of intraoperative sonography in low grade glioma surgery.

    Science.gov (United States)

    Petridis, Athanasios K; Anokhin, Maxim; Vavruska, Jan; Mahvash, Mehran; Scholz, Martin

    2015-04-01

    There is a number of different methods to localize a glioma intraoperatively. Neuronavigation, intraoperative MRI, 5-aminolevulinic acid, as well as intraoperative sonography. Every method has its advantages and disadvantages. Low grade gliomas do not show a specific signal with 5-aminolevulinic acid and are difficult to distinguish macroscopically from normal tissue. In the present study we stress out the importance of intraoperative diagnostic ultrasound for localization of low grade gliomas. We retrospectively evaluated the charts and MRIs of 34 patients with low grade gliomas operated in our department from 2011 until December 2014. The efficacy of ultrasound as an intraoperative navigational tool was assessed. In 15 patients ultrasound was used and in 19 not. Only histologically proven low grades gliomas (astrocytomas grade II) were evaluated. In none of the patients where ultrasound (combined with neuronavigation) was used (N=15) to find the tumors, the target was missed, whereas the exclusive use of neuronavigation missed the target in 5 of 19 cases of small subcortical low grade gliomas. Intraoperative ultrasound is an excellent tool in localizing low grade gliomas intraoperatively. It is an inexpensive, real time neuronavigational tool, which overcomes brain shift. Even when identifying the tumors with ultrasound is very reliable, the extend of resection and the decision to remove any residual tumor with the help of ultrasound is at the moment unreliable. Copyright © 2015 Elsevier B.V. All rights reserved.

  14. Combined intraoperative and external irradiation of the celiac artery in the rabbit: Effects on gastric mucosal blood flow; Kombinierte intraoperative und externe Bestrahlung der Arteria coeliaca beim Kaninchen: Auswirkungen auf die Durchblutung der Magenschleimhaut

    Energy Technology Data Exchange (ETDEWEB)

    Doerr, W. [Universitaetsklinikum Carl Gustav Carus, Dresden (Germany). Klinik und Poliklinik fuer Strahlentherapie]|[GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kallfass, E. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Berg, D. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany); Kummermehr, J. [GSF-Inst. fuer Strahlenbiologie, Oberschleissheim (Germany)

    1996-12-01

    Aim: To demonstrate changes in gastric mucosal blood flow caused by intraoperative radiotherapy of the celiac artery combined with external radiotherapy of the upper abdomen in a rabbit model. The study was designed to identify a possible correlation between a radiation-induced reduction in mucosal blood flow and the induction of gastric ulcer. Material and Method: Intraoperative radiation doses of 0 or 30 Gy were given to the celiac artery in rabbits. After a delay of 14 days external radiotherapy of the upper abdomen with 3x4 Gy/week to a maximum total dose of 40 Gy was initiated. Gastric mucosal blood flow was assessed by intraventricular injection of radioactively-labelled microspheres (15 {mu}m) followed by measurement of radioactivity in the mucosa. The injections were performed at various time intervals between 2 and 63 days after intraoperative radiation. Results: Intraoperative radiotherapy, including sham-intraoperative radiation, resulted in a transitory reduction of mucosal blood flow by about 50% of the control value on day 7. After a temporary recovery by day 14, a marked and permanent reduction in blood flow was assessed after week 6. This time corresponds to the time of development of gastric ulcer. Conclusions: A relationship between the time of ulcer development and of reduced gastric mucosal blood flow was observed after combined intraoperative and external radiotherapy. The mechanical component of intraoperative treatment has to be emphasized. Reduced blood flow was also seen after intraoperative radiotherapy alone, without an induction of ulcer by this treatment. Hence additional mucosal damage by external radiation must be present for the induction of gastric ulcer. (orig.) [Deutsch] Ziel: Untersuchung der Veraenderungen der Magenschleimhautdurchblutung am Kaninchen als Folge einer kombinierten intraoperativen Bestrahlung der Arteria coeliaca und externen Bestrahlung des Oberbauchs. Durch diesen Ansatz sollte ein moeglicher Zusammenhang

  15. Chromosomal aberrations and exposure doses during extracorporeal shock wave lithotripsy for renal ureteral stones

    International Nuclear Information System (INIS)

    Shao Songsheng; Feng Jialin; Weng Zhigen; Jiang Qingqi; Wang Guomin; Zhang Yuanfang; Zhang Renan

    1991-01-01

    The radiation dose and the chromosomal aberrations of peripheral lymphocytes were studied in 20 patients during ESWL. The dose was measured with calibrated thermoluminescent dosimeters. Primary results showed an average skin exposure 4.50 x 10 -3 C/kg per case. The dose level is smilar to that of the patients under-going routine fluoroscopic examination. Therefore, the radiation exposure with patients from the ESWL procedure should be considered acceptable. As chromosome changes, to reduce the radiation dose is important for the radiation cytogentics. The factors influencing exposure levels include stone characteristics and physician experience

  16. Evaluation of LiF:Mg,Ti (TLD-100 for Intraoperative Electron Radiation Therapy Quality Assurance.

    Directory of Open Access Journals (Sweden)

    Raffaele Liuzzi

    Full Text Available Purpose of the present work was to investigate thermoluminescent dosimeters (TLDs response to intraoperative electron radiation therapy (IOERT beams. In an IOERT treatment, a large single radiation dose is delivered with a high dose-per-pulse electron beam (2-12 cGy/pulse during surgery. To verify and to record the delivered dose, in vivo dosimetry is a mandatory procedure for quality assurance. The TLDs feature many advantages such as a small detector size and close tissue equivalence that make them attractive for IOERT as in vivo dosimeters.LiF:Mg,Ti dosimeters (TLD-100 were irradiated with different IOERT electron beam energies (5, 7 and 9 MeV and with a 6 MV conventional photon beam. For each energy, the TLDs were irradiated in the dose range of 0-10 Gy in step of 2 Gy. Regression analysis was performed to establish the response variation of thermoluminescent signals with dose and energy.The TLD-100 dose-response curves were obtained. In the dose range of 0-10 Gy, the calibration curve was confirmed to be linear for the conventional photon beam. In the same dose region, the quadratic model performs better than the linear model when high dose-per-pulse electron beams were used (F test; p<0.05.This study demonstrates that the TLD dose response, for doses ≤10 Gy, has a parabolic behavior in high dose-per-pulse electron beams. TLD-100 can be useful detectors for IOERT patient dosimetry if a proper calibration is provided.

  17. 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.

  18. [Cost analysis of intraoperative neurophysiological monitoring (IOM)].

    Science.gov (United States)

    Kombos, T; Suess, O; Brock, M

    2002-01-01

    A number of studies demonstrate that a significant reduction of postoperative neurological deficits can be achieved by applying intraoperative neurophysiological monitoring (IOM) methods. A cost analysis of IOM is imperative considering the strained financial situation in the public health services. The calculation model presented here comprises two cost components: material and personnel. The material costs comprise consumer goods and depreciation of capital goods. The computation base was 200 IOM cases per year. Consumer goods were calculated for each IOM procedure respectively. The following constellation served as a basis for calculating personnel costs: (a) a medical technician (salary level BAT Vc) for one hour per case; (b) a resident (BAT IIa) for the entire duration of the measurement, and (c) a senior resident (BAT Ia) only for supervision. An IOM device consisting of an 8-channel preamplifier, an electrical and acoustic stimulator and special software costs 66,467 euros on the average. With an annual depreciation of 20%, the costs are 13,293 euros per year. This amounts to 66.46 euros per case for the capital goods. For reusable materials a sum of 0.75 euro; per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euro; per case were,s a sum of 0.75 euros per case was calculated. Disposable materials were calculate for each procedure respectively. Total costs of 228.02 euros per case were, calculated for surgery on the peripheral nervous system. They amount to 196.40 euros per case for spinal interventions and to 347.63 euros per case for more complex spinal operations. Operations in the cerebellopontine angle and brain stem cost 376.63 euros and 397.33 euros per case respectively. IOM costs amount to 328.03 euros per case for surgical management of an intracranial aneurysm and to 537.15 euros per case for functional interventions. Expenses run up to 833.63 euros per case for operations near the

  19. The short and long term effects of intraoperative electron beam radiotherapy (IORT) on thoracic organs after pneumonectomy an experimental study in the canine model

    NARCIS (Netherlands)

    de Boer, Willem; Mehta, DM; Timens, W; Hoekstra, HJ

    1999-01-01

    Purpose: The tolerance of mediastinal structures and thoracic organs to intraoperative radiotherapy (IORT) was investigated in the canine model. Methods and Materials: Twenty-two adult beagles divided into three groups were subjected to a left pneumonectomy and IORT (10 MeV electrons) at doses of 20

  20. Quality control: a measure for optimization of dose in diagnostic radiology

    International Nuclear Information System (INIS)

    Abd Aziz Mhd Ramli; Muhammad Jamal Md Isa; Husaini Salleh

    2002-01-01

    Patient dose should always be a factor that is taken into account when using diagnostic X-ray equipment. There is no doubt that patients receive vastly different radiation doses for same examination under different circumstances and performance as well as safety standard of X-ray generating machine is one of the possible causes for this. MINT's experience in measuring performance and safety standard of X-ray fluoroscopic equipments in the year of 2000 indicated that 70% of the irradiating apparatus tend to deliver unnecessary exposures to patients due to various causes. Improper calibration and the usage of unoptimized fluoroscopic X-ray equipment are identified as two major causes that lead to unoptimized medical exposures to patient

  1. Disparities between resident and attending surgeon perceptions of intraoperative teaching.

    Science.gov (United States)

    Butvidas, Lynn D; Anderson, Cheryl I; Balogh, Daniel; Basson, Marc D

    2011-03-01

    This study aimed to assess attending surgeon and resident recall of good and poor intraoperative teaching experiences and how often these experiences occur at present. By web-based survey, we asked US surgeons and residents to describe their best and worst intraoperative teaching experiences during training and how often 26 common intraoperative teaching behaviors occur in their current environment. A total of 346 residents and 196 surgeons responded (51 programs; 26 states). Surgeons and residents consistently identified trainee autonomy, teacher confidence, and communication as positive, while recalling negatively contemptuous, arrogant, accusatory, or uncommunicative teachers. Residents described intraoperative teaching behaviors by faculty as substantially less frequent than faculty self-reports. Neither sex nor seniority explained these results, although women reported communicative behaviors more frequently than men. Although veteran surgeons and current trainees agree on what constitutes effective and ineffective teaching in the operating room, they disagree on how often these behaviors occur, leaving substantial room for improvement. Published by Elsevier Inc.

  2. Value of intraoperative radiotherapy in locally advanced rectal cancer

    NARCIS (Netherlands)

    Ferenschild, Floris T. J.; Vermaas, Maarten; Nuyttens, Joost J. M. E.; Graveland, Wilfried J.; Marinelli, Andreas W. K. S.; van der Sijp, Joost R.; Wiggers, Theo; Verhoef, Cornelis; Eggermont, Alexander M. M.; de Wilt, Johannes H. W.

    PURPOSE: This study was designed to analyze the results of a multimodality treatment using preoperative radiotherapy, followed by surgery and intraoperative radiotherapy in patients with primary locally advanced rectal cancer. METHODS: Between 1987 and 2002, 123 patients with initial unresectable

  3. Presurgical mapping with magnetic source imaging. Comparisons with intraoperative findings

    International Nuclear Information System (INIS)

    Roberts, T.P.L.; Ferrari, P.; Perry, D.; Rowley, H.A.; Berger, M.S.

    2000-01-01

    We compare noninvasive preoperative mapping with magnetic source imaging to intraoperative cortical stimulation mapping. These techniques were directly compared in 17 patients who underwent preoperative and postoperative somatosensory mapping of a total of 22 comparable anatomic sites (digits, face). Our findings are presented in the context of previous studies that used magnetic source imaging and functional magnetic resonance imaging as noninvasive surrogates of intraoperative mapping for the identification of sensorimotor and language-specific brain functional centers in patients with brain tumors. We found that magnetic source imaging results were reasonably concordant with intraoperative mapping findings in over 90% of cases, and that concordance could be defined as 'good' in 77% of cases. Magnetic source imaging therefore provides a viable, if coarse, identification of somatosensory areas and, consequently, can guide and reduce the time taken for intraoperative mapping procedures. (author)

  4. Intraoperative contamination influences wound discharge and periprosthetic infection

    NARCIS (Netherlands)

    Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

    Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

  5. Intraoperative management of ETT and LMA cufi pressures: a survey ...

    African Journals Online (AJOL)

    2008-07-16

    Jul 16, 2008 ... A study done by Stein et al. highlighted the inability of advanced life support ... Conclusion. There is increasing importance placed on quality assurance ... pressures – the worrying reality: a comparative audit of intra-operative.

  6. Association between intraoperative hypotension and myocardial injury after vascular surgery

    NARCIS (Netherlands)

    van Waes, JAR; Van Klei, Wilton A.; Wijeysundera, Duminda N.; Van Wolfswinkel, Leo; Lindsay, Thomas F.; Beattie, W. Scott

    2016-01-01

    Background: Postoperative myocardial injury occurs frequently after noncardiac surgery and is strongly associated with mortality. Intraoperative hypotension (IOH) is hypothesized to be a possible cause. The aim of this study was to determine the association between IOH and postoperative myocardial

  7. Intraoperative contamination influences wound discharge and periprosthetic infection

    NARCIS (Netherlands)

    Knobben, Bas A. S.; Engelsma, Yde; Neut, Danielle

    2006-01-01

    Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged

  8. Intraoperative transesophageal echocardiography in congenital heart diseases surgery

    International Nuclear Information System (INIS)

    Ozores Suarez, Francisco Javier; Perez de Ordaz, Luis Bravo

    2010-01-01

    The intraoperative transesophageal echocardiography is very used in pediatric cardiovascular surgery. The aim of present paper was to determine its impact on the surgery immediate results after a previous experience of authors with this type of procedure

  9. Sentinel lymph node biopsy: An audit of intraoperative assessment ...

    African Journals Online (AJOL)

    2015-07-02

    Jul 2, 2015 ... Sentinel lymph node biopsy: An audit of ... cytotechnology service ... To audit results from intraoperative assessment of sentinel lymph node ..... out, and turnaround time in gynecologic cytology quality assurance: Findings.

  10. Results of intraoperative radiotherapy for pancreatic cancers

    International Nuclear Information System (INIS)

    Okazaki, Atsushi; Shinozaki, Jun; Noda, Masanobu

    1991-01-01

    Reported are the results and observations of the authors who, from July 1986 through December 1989, have used electron beam intraoperative radiotherapy (IORT) on 20 patients with locally advanced pancreatic cancers, said number including 3 patients given a resection. In 14 of the 17 unresected patients, a chief symptom was pain, and 8 patients were given a celiac plexus block at the same time. The results and observations are given below. Life-threatening complications occurred in two patients, i.e., an insufficient pancreatojejunostomy, and a perforative peritonitis. In 12 of 13 evaluable patients, pain control was achieved for a mean period of 5 months, indicating that an IORT with celiac plexus block may be useful for palliation. In the resected patients, the mean survival time was 6 months, whereas in the unresected patients, the mean survival time was 7 months. The common cause of death in the unresected patients was a metastatic dissemination. Finally, in 3 of the 5 unresected patients, marked effects such as massive fibrosis were seen in the pancreatic tumor on autopsy. (author)

  11. Perspectives in Intraoperative Diagnostics of Human Gliomas

    Directory of Open Access Journals (Sweden)

    O. Tyurikova

    2015-01-01

    Full Text Available Amongst large a variety of oncological diseases, malignant gliomas represent one of the most severe types of tumors. They are also the most common type of the brain tumors and account for over half of the astrocytic tumors. According to different sources, the average life expectancy of patients with various glioblastomas varies between 10 and 12 months and that of patients with anaplastic astrocytic tumors between 20 and 24 months. Therefore, studies of the physiology of transformed glial cells are critical for the development of treatment methods. Modern medical approaches offer complex procedures, including the microsurgical tumor removal, radiotherapy, and chemotherapy, supplemented with photodynamic therapy and immunotherapy. The most radical of them is surgical resection, which allows removing the largest part of the tumor, reduces the intracranial hypertension, and minimizes the degree of neurological deficit. However, complete removal of the tumor remains impossible. The main limitations are insufficient visualization of glioma boundaries, due to its infiltrative growth, and the necessity to preserve healthy tissue. This review is devoted to the description of advantages and disadvantages of modern intraoperative diagnostics of human gliomas and highlights potential perspectives for development of their treatment.

  12. An experimental study on the effect of intraoperative irradiation on the healing of anastomosed small intestine

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Heung Suk; Kang, Ik Won; Ha, Sung Whan; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1983-03-15

    To evaluate the influence of intraoperative irradiation on the healing of jejunal anastomosis, an experimental study was undertaken using a total of 150 rats. The bursting pressure of the normal jejunum was obtained in group I, Group II was subjected to resection and anastomosis, and group III was irradiated on the anastomosed jejunum with a single dose of 1,000 rads. Healing process was evaluated by measuring bursting pressure of the anastomosed jejunum on each postoperative day from 2nd to 14th, and on 21th day. Bursting pressure was tested by inflating the loop of gut with water, and bursting sites were observed. The results obtained are summarized as follows: 1. The bursting pressure of the anastomosed jejunum retained normal strength by the 7th postoperative day in the nonirradiated group, whereas by the 11th postoperative day in the irradiated group. 2. Irradiation caused delay in the healing of anastomosis of the jejunum until the 10th postoperative day; but after then, there was no significant difference in bursting pressure between both groups. 3. In the jejunal segments with normal strength, bursting occurred exclusively at the non-anastomotic site in both groups; Bursting started along the mesenteric border in the non-irradiated group, whereas rupture usually occurred on the antimessenteric border in the irradiated group. In the jejunal segments with subnormal strength, bursting usually started on the mesenteric border of the anastomotic site in both groups. The results indicate that intraoperative irradiation with a single dose of 1,000 rads causes no harmful effect on the healing of anastomosis of the jejunum in rats. Therefore, this study suggests the possibility of more effective clinical application of intraoperative irradiation.

  13. An experimental study on the effect of intraoperative irradiation on the healing of anastomosed small intestine

    International Nuclear Information System (INIS)

    Seo, Heung Suk; Kang, Ik Won; Ha, Sung Whan; Han, Man Chung

    1983-01-01

    To evaluate the influence of intraoperative irradiation on the healing of jejunal anastomosis, an experimental study was undertaken using a total of 150 rats. The bursting pressure of the normal jejunum was obtained in group I, Group II was subjected to resection and anastomosis, and group III was irradiated on the anastomosed jejunum with a single dose of 1,000 rads. Healing process was evaluated by measuring bursting pressure of the anastomosed jejunum on each postoperative day from 2nd to 14th, and on 21th day. Bursting pressure was tested by inflating the loop of gut with water, and bursting sites were observed. The results obtained are summarized as follows: 1. The bursting pressure of the anastomosed jejunum retained normal strength by the 7th postoperative day in the nonirradiated group, whereas by the 11th postoperative day in the irradiated group. 2. Irradiation caused delay in the healing of anastomosis of the jejunum until the 10th postoperative day; but after then, there was no significant difference in bursting pressure between both groups. 3. In the jejunal segments with normal strength, bursting occurred exclusively at the non-anastomotic site in both groups; Bursting started along the mesenteric border in the non-irradiated group, whereas rupture usually occurred on the antimessenteric border in the irradiated group. In the jejunal segments with subnormal strength, bursting usually started on the mesenteric border of the anastomotic site in both groups. The results indicate that intraoperative irradiation with a single dose of 1,000 rads causes no harmful effect on the healing of anastomosis of the jejunum in rats. Therefore, this study suggests the possibility of more effective clinical application of intraoperative irradiation

  14. Variations of Patient Doses in Interventional Examinations at Different Angiographic Units

    International Nuclear Information System (INIS)

    Bor, Dogan; Toklu, Tuerkay; Olgar, Turan; Sancak, Tanzer; Cekirge, Saruhan; Onal, Baran; Bilgic, Sadik

    2006-01-01

    Purpose. We analyzed doses for various angiographic procedures using different X-ray systems in order to assess dose variations. Methods. Dose-area product (DAP), skin doses from thermoluminescent dosimeters and air kerma measurements of 308 patients (239 diagnostic and 69 interventional) were assessed for five different angiographic units. All fluoroscopic and radiographic exposure parameters were recorded online for single and multiprojection studies. Radiation outputs of each X-ray system were also measured for all the modes of exposure using standard protocols for such measurements. Results. In general, the complexity of the angiographic procedure was found to be the most important reason for high radiation doses. Skill of the radiologist, management of the exposure parameters and calibration of the system are the other factors to be considered. Lateral cerebral interventional studies carry the highest risk for deterministic effects on the lens of the eye. Effective doses were calculated from DAP measurements and maximum fatal cancer risk factors were found for carotid studies. Conclusions. Interventional radiologists should measure patient doses for their examinations. If there is a lack of necessary instrumentation for this purpose, then published dose reports should be used in order to predict the dose levels from some of the exposure parameters. Patient dose information should include not only the measured quantity but also the measured radiation output of the X-ray unit and exposure parameters used during radiographic and fluoroscopic exposures

  15. 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.

  16. Intraoperative Assessment of Tricuspid Valve Function After Conservative Repair

    Science.gov (United States)

    Revuelta, J.M.; Gomez-Duran, C.; Garcia-Rinaldi, R.; Gallagher, M.W.

    1982-01-01

    It is desirable to repair coexistent tricuspid valve pathology at the time of mitral valve corrections. Conservative tricuspid repair may consist of commissurotomy, annuloplasty, or both. It is important that the repair be appropriate or tricuspid valve replacement may be necessary. A simple reproducible method of intraoperative testing for tricuspid valve insufficiency has been developed and used in 25 patients. Fifteen patients have been recatheterized, and the correlation between the intraoperative and postoperative findings has been consistent. PMID:15226931

  17. Lumbar Lordosis of Spinal Stenosis Patients during Intraoperative Prone Positioning

    OpenAIRE

    Lee, Su-Keon; Lee, Seung-Hwan; Song, Kyung-Sub; Park, Byung-Moon; Lim, Sang-Youn; Jang, Geun; Lee, Beom-Seok; Moon, Seong-Hwan; Lee, Hwan-Mo

    2016-01-01

    Background To evaluate the effect of spondylolisthesis on lumbar lordosis on the OSI (Jackson; Orthopaedic Systems Inc.) frame. Restoration of lumbar lordosis is important for maintaining sagittal balance. Physiologic lumbar lordosis has to be gained by intraoperative prone positioning with a hip extension and posterior instrumentation technique. There are some debates about changing lumbar lordosis on the OSI frame after an intraoperative prone position. We evaluated the effect of spondyloli...

  18. Intraoperative ultrasonography in detection of hepatic metastases from colorectal cancer

    DEFF Research Database (Denmark)

    Rafaelsen, Søren Rafael; Kronborg, Ole; Fenger, Claus

    1995-01-01

    PURPOSE: This study was designed to compare diagnostic accuracies of measuring liver enzymes, preoperative ultrasonography, surgical examination, and intraoperative ultrasonography for detection of liver metastases from colorectal cancer. METHODS: Blind, prospective comparisons of diagnostic...... examinations mentioned above were performed in 295 consecutive patients with colorectal cancer. An experienced ultrasonologist performed the preoperative examinations, and results were unknown to the other experienced ultrasonologist who performed the intraoperative examinations. The latter, also was unaware...

  19. Dosimetry measurements of X-Ray machine operating at ordinary radiology and fluoroscopic examinations

    International Nuclear Information System (INIS)

    Ayad, M.; Bakazi, A.; Elharby, H.

    2002-01-01

    An assessment of radiation dose levels inside diagnostic radiology rooms at King Khalid University Hospital was made. The measurements were taken using lithium Flouride detectors Also, an assessment of doses received by patients during some radiographic examinations especially at fluoroscopy has been measured. It has been noted that when rare-earth image intensifying screens were used the radiation dose received by the patient was reduced by 60%. It has been shown that a lead glass viewer caused a reduction of the radiation intensity by more than 50%. The variation of dose rate with the operating conditions of the X-ray tube has been studied, as well as the machine factor (P)

  20. Endoscopy dose examinations at the Sao Paulo University Hospital

    International Nuclear Information System (INIS)

    Aldred, M.A.; Siqueira P, W.; Fonseca F, A.M. da; Nucci, J.R.; Yoshimura, E. M.; Okuno, E.

    1996-01-01

    During some specific endoscopic examinations, radiographic and fluoroscopic images of patients are taken with the medical staff near to them. To evaluate the equivalent and effective doses in these occupational exposures, simulated examinations have been performed, using an anthropomorphic phantom in place of one of the members of the staff. Thermoluminescent dosimeters were attached in various positions of the phantom in order to determine some organ doses. From the comparison between the experimentally determined doses the International and the Brazilian recommended occupational dose limits, the maximum number of examinations that any member of the staff can perform, was calculated. If a protective apron is used, this number is limited by the high equivalent dose to the eye lens (average of 1.67 mSv/examination) of the staff's member. (authors). 3 refs., 4 tabs

  1. Intraoperative magnetic resonance imaging to update interactive navigation in neurosurgery: method and preliminary experience.

    Science.gov (United States)

    Wirtz, C R; Bonsanto, M M; Knauth, M; Tronnier, V M; Albert, F K; Staubert, A; Kunze, S

    1997-01-01

    We report on the first successful intraoperative update of interactive image guidance based on an intraoperatively acquired magnetic resonance imaging (MRI) date set. To date, intraoperative imaging methods such as ultrasound, computerized tomography (CT), or MRI have not been successfully used to update interactive navigation. We developed a method of imaging patients intraoperatively with the surgical field exposed in an MRI scanner (Magnetom Open; Siemens Corp., Erlangen, Germany). In 12 patients, intraoperatively acquired 3D data sets were used for successful recalibration of neuronavigation, accounting for any anatomical changes caused by surgical manipulations. The MKM Microscope (Zeiss Corp., Oberkochen, Germany) was used as navigational system. With implantable fiducial markers, an accuracy of 0.84 +/- 0.4 mm for intraoperative reregistration was achieved. Residual tumor detected on MRI was consequently resected using navigation with the intraoperative data. No adverse effects were observed from intraoperative imaging or the use of navigation with intraoperative images, demonstrating the feasibility of recalibrating navigation with intraoperative MRI.

  2. Intraoperative Secondary Insults During Orthopedic Surgery in Traumatic Brain Injury.

    Science.gov (United States)

    Algarra, Nelson N; Lele, Abhijit V; Prathep, Sumidtra; Souter, Michael J; Vavilala, Monica S; Qiu, Qian; Sharma, Deepak

    2017-07-01

    Secondary insults worsen outcomes after traumatic brain injury (TBI). However, data on intraoperative secondary insults are sparse. The primary aim of this study was to examine the prevalence of intraoperative secondary insults during orthopedic surgery after moderate-severe TBI. We also examined the impact of intraoperative secondary insults on postoperative head computed tomographic scan, intracranial pressure (ICP), and escalation of care within 24 hours of surgery. We reviewed medical records of TBI patients 18 years and above with Glasgow Coma Scale score Secondary insults examined were: systemic hypotension (systolic blood pressurehypertension (ICP>20 mm Hg), cerebral hypotension (cerebral perfusion pressure40 mm Hg), hypocarbia (end-tidal CO2hypertension), hyperglycemia (glucose>200 mg/dL), hypoglycemia (glucose38°C). A total of 78 patients (41 [18 to 81] y, 68% male) met the inclusion criteria. The most common intraoperative secondary insults were systemic hypotension (60%), intracranial hypertension and cerebral hypotension (50% and 45%, respectively, in patients with ICP monitoring), hypercarbia (32%), and hypocarbia (29%). Intraoperative secondary insults were associated with worsening of head computed tomography, postoperative decrease of Glasgow Coma Scale score by ≥2, and escalation of care. After Bonferroni correction, association between cerebral hypotension and postoperative escalation of care remained significant (Psecondary insults were common during orthopedic surgery in patients with TBI and were associated with postoperative escalation of care. Strategies to minimize intraoperative secondary insults are needed.

  3. Intraoperative complications in pediatric neurosurgery: review of 1807 cases.

    Science.gov (United States)

    van Lindert, Erik J; Arts, Sebastian; Blok, Laura M; Hendriks, Mark P; Tielens, Luc; van Bilsen, Martine; Delye, Hans

    2016-09-01

    OBJECTIVE Minimal literature exists on the intraoperative complication rate of pediatric neurosurgical procedures with respect to both surgical and anesthesiological complications. The aim of this study, therefore, was to establish intraoperative complication rates to provide patients and parents with information on which to base their informed consent and to establish a baseline for further targeted improvement of pediatric neurosurgical care. METHODS A clinical complication registration database comprising a consecutive cohort of all pediatric neurosurgical procedures carried out in a general neurosurgical department from January 1, 2004, until July 1, 2012, was analyzed. During the study period, 1807 procedures were performed on patients below the age of 17 years. RESULTS Sixty-four intraoperative complications occurred in 62 patients (3.5% of procedures). Intraoperative mortality was 0.17% (n = 3). Seventy-eight percent of the complications (n = 50) were related to the neurosurgical procedures, whereas 22% (n = 14) were due to anesthesiology. The highest intraoperative complication rates were for cerebrovascular surgery (7.7%) and tumor surgery (7.4%). The most frequently occurring complications were cerebrovascular complications (33%). CONCLUSIONS Intraoperative complications are not exceptional during pediatric neurosurgical procedures. Awareness of these complications is the first step in preventing them.

  4. Intraoperative MRI to control the extent of brain tumor surgery

    International Nuclear Information System (INIS)

    Knauth, M.; Sartor, K.; Wirtz, C.R.; Tronnier, V.M.; Staubert, A.; Kunze, S.

    1998-01-01

    Intraoperative MRI definitely showed residual tumor in 6 of the 18 patients and resulted in ambiguous findings in 3 patients. In 7 patients surgery was continued. Early postoperative MRI showed residual tumor in 3 patients and resulted in uncertain findings in 2 patients. The rate of patients in whom complete removal of enhancing tumor could be achieved was 50% at the time of the intraoperative MR examination and 72% at the time of the early postoperative MR control. The difference in proportion of patients with 'complete tumor removal' between the groups who had been operated on using neuronavigation (NN) and intraoperative MRI (ioMRI) and those who had been operated on using only modern neurosurgical techniques except NN and ioMRI was statistically highly significant (Fisher exact test; P=0.008). Four different types of surgically induced contrast enhancement were observed. These phenomena carry different confounding potentials with residual tumor. Conclusion: Our preliminary experience with intraoperative MRI in patients with enhancing intraaxial tumors is encouraging. Combined use of neuronavigation and intraoperative MRI was able to increase the proportion of patients in whom complete removal of the enhancing parts of the tumor was achieved. Surgically induced enhancement requires careful analysis of the intraoperative MRI in order not to confuse it with residual tumor. (orig.) [de

  5. Selective serotonin reuptake inhibitors and intraoperative blood pressure.

    Science.gov (United States)

    van Haelst, Ingrid M M; van Klei, Wilton A; Doodeman, Hieronymus J; Kalkman, Cor J; Egberts, Toine C G

    2012-02-01

    The influence of selective serotonin reuptake inhibitors (SSRIs) on blood pressure is poorly understood. We hypothesized that if SSRIs have an influence on blood pressure, this might become manifest in changes in intraoperative blood pressure. We aimed to study the association between perioperative use of SSRIs and changes in intraoperative blood pressure by measuring the occurrence of intraoperative hyper- and hypotension. We conducted a retrospective observational follow-up study among patients who underwent elective primary total hip arthroplasty. The index group included users of SSRIs. The reference group included a random sample (ratio 1:3) of nonusers of an antidepressant agent. The outcome was the occurrence of intraoperative hypo- and hypertensive episodes (number, mean and total duration, and area under the curve (AUC)). The outcome was adjusted for confounding factors using regression techniques. The index group included 20 users of an SSRI. The reference group included 60 nonusers. Users of SSRIs showed fewer intraoperative hypotensive episodes, a shorter mean and total duration, and a smaller AUC when compared to the reference group. After adjustment for confounders, SSRI use was associated with a significantly shorter total duration of hypotension: mean difference of -29.4 min (95% confidence interval (CI) -50.4 to -8.3). Two users of an SSRI and two patients in the reference group had a hypertensive episode. Continuation of treatment with SSRIs before surgery was associated with a briefer duration of intraoperative hypotension.

  6. Placement of empty catheters for an HDR-emulating LDR prostate brachytherapy technique: comparison to standard intraoperative planning.

    Science.gov (United States)

    Niedermayr, Thomas R; Nguyen, Paul L; Murciano-Goroff, Yonina R; Kovtun, Konstantin A; Neubauer Sugar, Emily; Cail, Daniel W; O'Farrell, Desmond A; Hansen, Jorgen L; Cormack, Robert A; Buzurovic, Ivan; Wolfsberger, Luciant T; O'Leary, Michael P; Steele, Graeme S; Devlin, Philip M; Orio, Peter F

    2014-01-01

    We sought to determine whether placing empty catheters within the prostate and then inverse planning iodine-125 seed locations within those catheters (High Dose Rate-Emulating Low Dose Rate Prostate Brachytherapy [HELP] technique) would improve concordance between planned and achieved dosimetry compared with a standard intraoperative technique. We examined 30 consecutive low dose rate prostate cases performed by standard intraoperative technique of planning followed by needle placement/seed deposition and compared them to 30 consecutive low dose rate prostate cases performed by the HELP technique. The primary endpoint was concordance between planned percentage of the clinical target volume that receives at least 100% of the prescribed dose/dose that covers 90% of the volume of the clinical target volume (V100/D90) and the actual V100/D90 achieved at Postoperative Day 1. The HELP technique had superior concordance between the planned target dosimetry and what was actually achieved at Day 1 and Day 30. Specifically, target D90 at Day 1 was on average 33.7 Gy less than planned for the standard intraoperative technique but was only 10.5 Gy less than planned for the HELP technique (p 0.05). Placing empty needles first and optimizing the plan to the known positions of the needles resulted in improved concordance between the planned and the achieved dosimetry to the target, possibly because of elimination of errors in needle placement. Copyright © 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  7. Intraoperative radiation exposure in spinal scoliosis surgery for pediatric patients using the O-arm® imaging system.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Ando, Kei; Ito, Kenyu; Tsushima, Mikito; Morozumi, Masayoshi; Tanaka, Satoshi; Machino, Masaaki; Ota, Kyotaro; Ishiguro, Naoki; Imagama, Shiro

    2018-05-01

    The O-arm ® navigation system allows intraoperative CT imaging that can facilitate highly accurate instrumentation surgery, but radiation exposure is higher than with X-ray radiography. This is a particular concern in pediatric surgery. The purpose of this study is to examine intraoperative radiation exposure in pediatric spinal scoliosis surgery using O-arm. The subjects were 38 consecutive patients (mean age 12.9 years, range 10-17) with scoliosis who underwent spinal surgery with posterior instrumentation using O-arm. The mean number of fused vertebral levels was 11.0 (6-15). O-arm was performed before and after screw insertion, using an original protocol for the cervical, thoracic, and lumbar spine doses. The average scanning range was 6.9 (5-9) intervertebral levels per scan, with 2-7 scans per patient (mean 4.0 scans). Using O-arm, the dose per scan was 92.5 (44-130) mGy, and the mean total dose was 401 (170-826) mGy. This dose was 80.2% of the mean preoperative CT dose of 460 (231-736) mGy (P = 0.11). The total exposure dose and number of scans using intraoperative O-arm correlated strongly and significantly with the number of fused levels; however, there was no correlation with the patient's height. As the fused range became wider, several scans were required for O-arm, and the total radiation exposure became roughly the same as that in preoperative CT. Use of O-arm in our original protocol can contribute to reduction in radiation exposure.

  8. Intraoperative radiation therapy for patients with pancreatic carcinoma

    International Nuclear Information System (INIS)

    Abe, Tetsuo; Itoh, Kei; Agawa, Senichiro; Ishihara, Yukio; Konishi, Toshiro

    2001-01-01

    We studied the efficacy and complications of intraoperative radiation therapy (IORT) in 40 subjects with unresected pancreatic carcinoma (Group A) and 8 with resected pancreatic carcinoma (Group B). These 2 groups were compared to groups not treated by IORT; 59 subjects with unresected pancreatic carcinoma (Group C) and 55 with resected pancreatic carcinoma (Group D). The 6-month survival in Group A was 55%, and 1-year survival 26% compared to 20% 6-month survival and 9% 1-year survival in Group C with a median survival of 7 months in Group A and 4 months in group C; all statistically significant. Pain control was 81.8% in Group A, reduction in tumor size was 50% and reduction of tumor marker, CA19-9 was 56.3% in Group A. Survival in Groups B and D did not differ significantly. The histological efficacy of IORT in Group A was confirmed in autopsy of fibrosis and scar formation in radiation fields of the pancreas. Two patients in Group B had major morbidity leading to death; 1 from leakage in the pancreatojejunal anastomosis accompanied by pancreatic necrosis and the other from duodenal perforation with rupture of the portal vein and hepatic artery. This study demonstrates the efficacy of IORT in patients with unresected pancreatic carcinoma. Prophylactic bypass and shielding of the residual pancreas with lead or reducing the IORT or external beam radiation therapy (EBRT) dose should be considered in patients with unresected or resected pancreatic carcinoma, however, to prevent serious complications due to radiation injury of the duodenum and pancreas. (author)

  9. Fluoroscopically guided fallopian tube recanalization with a simplified set of instruments; Durchleuchtungsgesteuerte Eileiter-Rekanalisation mit vereinfachtem Instrumentarium

    Energy Technology Data Exchange (ETDEWEB)

    Schmitz-Rode, T.; Guenther, R.W. [Technische Hochschule Aachen (Germany). Klinik fuer Radiologische Diagnostik; Neulen, J. [Technische Hochschule Aachen (Germany). Frauenklinik fuer gynaekologische Endokrinologie und Reproduktionsmedizin

    2004-10-01

    Purpose: Fluoroscopically guided transcervical fallopian tube recanalization is recognized as an important step in the workup of female infertility. In the present study, a simplified set of recanalization instruments was tested. Materials and Methods: Forty-two women with infertility and sonographically confirmed or suspected uni- or bilateral tubal occlusion were examined. After vaginal placement of a plastic speculum and fixation of a tenaculum, a 4F glide catheter with a 0.89 mm glidewire was advanced transcervically. After documentation of tubal occlusion by hysterosalpingography, the uterotubal junction was catheterized with the same instruments. Under fluoroscopic guidance, the glidewire was negotiated beyond the intramural portion of the tube. Selective salpingography documented the outcome of the recanalization. Results: Hysterosalpingography confirmed tubal occlusions in 26 of 42 patients (in 12 cases unilateral and in 14 cases bilateral). Fallopian tube recanalization was successful in 23 of 26 patients (technical success rate of 88%). The resulting fertility rate was 30% (7/23), without any ectopic pregnancy. Complications such as tubal perforation, infection, or bleeding did not occur. Tubal catheterization was straightforward and smooth in 17/23 cases. For a hyperflexed uterus (6/23), a curved tip of the catheter was helpful in tubal probing. (orig.)

  10. 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.

  11. How do pediatric anesthesiologists define intraoperative hypotension?

    Science.gov (United States)

    Nafiu, Olubukola O; Voepel-Lewis, Terri; Morris, Michelle; Chimbira, Wilson T; Malviya, Shobha; Reynolds, Paul I; Tremper, Kevin K

    2009-11-01

    Although blood pressure (BP) monitoring is a recommended standard of care by the ASA, and pediatric anesthesiologists routinely monitor the BP of their patients and when appropriate treat deviations from 'normal', there is no robust definition of hypotension in any of the pediatric anesthesia texts or journals. Consequently, what constitutes hypotension in pediatric anesthesia is currently unknown. We designed a questionnaire-based survey of pediatric anesthesiologists to determine the BP ranges and thresholds used to define intraoperative hypotension (IOH). Members of the Society of Pediatric Anesthesia (SPA) and the Association of Paediatric Anaesthetists (APA) of Great Britain and Ireland were contacted through e-mail to participate in this survey. We asked a few demographic questions and five questions about specific definitions of hypotension for different age groups of patients undergoing inguinal herniorraphy, a common pediatric surgical procedure. The overall response rate was 56% (483/860), of which 76% were SPA members. Majority of the respondents (72%) work in academic institutions, while 8.9% work in institutions with fewer than 1000 annual pediatric surgical caseload. About 76% of respondents indicated that a 20-30% reduction in baseline systolic blood pressure (SBP) indicates significant hypotension in children under anesthesia. Most responders (86.7%) indicated that they use mean arterial pressure or SBP (72%) to define IOH. The mean SBP values for hypotension quoted by SPA members was about 5-7% lower across all pediatric age groups compared to values quoted by APA members (P = 0.001 for all age groups). There is great variability in the BP parameters used and the threshold used for defining and treating IOH among pediatric anesthesiologists. The majority of respondents considered a 20-30% reduction from baseline in SBP as indicative of significant hypotension. Lack of a consensus definition for a common clinical condition like IOH could have

  12. Automated intraoperative calibration for prostate cancer brachytherapy

    International Nuclear Information System (INIS)

    Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor

    2011-01-01

    Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 ± 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 ± 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 ± 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 ± 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

  13. Neurophysiologic intraoperative monitoring of the vestibulocochlear nerve.

    Science.gov (United States)

    Simon, Mirela V

    2011-12-01

    Neurosurgical procedures involving the skull base and structures within can pose a significant risk of damage to the brain stem and cranial nerves. This can have life-threatening consequences and/or result in devastating neurologic deficits. Over the past decade, intraoperative neurophysiology has significantly evolved and currently offers a great tool for live monitoring of the integrity of nervous structures. Thus, dysfunction can be identified early and prompt modification of the surgical management or operating conditions, leads to avoidance of permanent structural damage.Along these lines, the vestibulocochlear nerve (CN VIII) and, to a greater extent, the auditory pathways as they pass through the brain stem are especially at risk during cerebelopontine angle (CPA), posterior/middle fossa, or brain stem surgery. CN VIII can be damaged by several mechanisms, from vascular compromise to mechanical injury by stretch, compression, dissection, and heat injury. Additionally, cochlea itself can be significantly damaged during temporal bone drilling, by noise, mechanical destruction, or infarction, and because of rupture, occlusion, or vasospasm of the internal auditory artery.CN VIII monitoring can be successfully achieved by live recording of the function of one of its parts, the cochlear or auditory nerve (AN), using the brain stem auditory evoked potentials (BAEPs), electrocochleography (ECochG), and compound nerve action potentials (CNAPs) of the cochlear nerve.This is a review of these techniques, their principle, applications, methodology, interpretation of the evoked responses, and their change from baseline, within the context of surgical and anesthesia environments, and finally the appropriate management of these changes.

  14. Patient doses in digital cardiac imaging

    International Nuclear Information System (INIS)

    Huda, W.; Ogden, K.M.; Roskopf, M.L.; Phadke, K.

    2001-01-01

    In this pilot study, we obtained estimates of entrance skin doses and the corresponding effective doses to patients undergoing digital cardiac imaging procedures on a GE Advantx LC/LP Plus system. Data were obtained for six patients undergoing diagnostic examinations and six patients who had interventional procedures. For each patient examination, radiographic techniques for fluoroscopic and digital cine imaging were recorded, together with the irradiation geometry. The projection with the highest exposure resulted in an average skin dose of 0.64 ± 0.41 Gy (maximum of 1.6 Gy). The average patient skin doses taking into account overlapping projections was 1.1 ± 0.8 Gy (maximum of 3.0 Gy). The exposure area product (EAP) incident on the patient was converted into the energy imparted to the patient and the corresponding effective dose. The average patient effective dose was 28 ± 14 mSv (maximum 62 mSv), with the resultant average fatal cancer risk estimated to be of the order of 8x10 -3 . Average doses for interventional procedures in cardiac imaging are higher than those associated with diagnostic examinations by approximately 50%. (author)

  15. Pre- and intraoperative mitomycin C for recurrent pterygium associated with symblepharon

    Directory of Open Access Journals (Sweden)

    Mohammed I

    2013-01-01

    Full Text Available Isyaku MohammedDepartment of Ophthalmology, Aminu Kano Teaching Hospital, Kano, NigeriaBackground: Treatment of recurrent pterygium associated with symblepharon usually involves the use of tissue grafting and/or the intraoperative application of mitomycin C (MMC. For the graft, a conjunctival/limbal autograft and/or amniotic membrane may be used. This generally requires extra technical skills and assistance, an increase in the cost and duration of surgery, and a more extensive anesthesia (a complete eye block or general anesthesia. Although widely used, safety concerns have been raised over MMC in the treatment of pterygia.Objective: The objective of this case report is to report the successful use of preoperative subconjunctival injection of low-dose (0.02% MMC one month before bare sclera excision of a multirecurrent pterygium, as well as the concomitant intraoperative application of MMC to the conjunctival fornix of the same eye after the excision of an associated symblepharon.Case report: A 31-year-old man from Kano, Northern Nigeria, presented to the eye clinic with a recurrent pterygium associated with an upper lid symblepharon in his right eye. He has had five previous pterygium excisions, with the last surgery involving conjunctival autografting and subconjunctival steroid injection. He was subsequently given 0.1 mL of 0.02% MMC as a subpterygial injection; one month later he had an alcohol-assisted bare sclera pterygium excision and a symblepharolysis with the intraoperative application of 0.02% MMC for 1 minute to the upper conjunctival fornix. Except for a Tenon granuloma that was simply excised, there has been no recurrence or other complications up to a year after surgery.Conclusion: As a cheaper and technically easier treatment option, a preoperative subconjunctival MMC injection followed by bare sclera pterygium excision was found to be effective in this patient with a recurrent pterygium. As at one-year follow-up, low-dose

  16. Optically neuronavigated ultrasonography in an intraoperative magnetic resonance imaging environment.

    Science.gov (United States)

    Katisko, Jani P A; Koivukangas, John P

    2007-04-01

    To develop a clinically useful method that shows the corresponding planes of intraoperative two-dimensional ultrasonography and intraoperative magnetic resonance imaging (MRI) scans determined with an optical neuronavigator from an intraoperative three-dimensional MRI scan data set, and to determine the qualitative and the quantitative spatial correspondence between the ultrasonography and MRI scans. An ultrasound probe was interlinked with an ergonomic and MRI scan-compatible ultrasonography probe tracker to the optical neuronavigator used in a low-field intraoperative MRI scan environment for brain surgery. Spatial correspondence measurements were performed using a custom-made ultrasonography/MRI scan phantom. In this work, instruments to combine intraoperatively collected ultrasonography and MRI scan data with an optical localization method in a magnetic environment were developed. The ultrasonography transducer tracker played an important role. Furthermore, a phantom for ultrasonography and MRI scanning was produced. This is the first report, to our knowledge, regarding the possibility of combining the two most important intraoperative imaging modalities used in neurosurgery, ultrasonography and MRI scanning, to guide brain tumor surgery. The method was feasible and, as shown in an illustrative surgical case, has direct clinical impact on image-guided brain surgery. The spatial deviation between the ultrasonography and the MRI scans was, on average, 1.90 +/- 1.30 mm at depths of 0 to 120 mm from the ultrasonography probe. The overall result of this work is a unique method to guide the neurosurgical operation with neuronavigated ultrasonography imaging in an intraoperative MRI scanning environment. The relevance of the method is emphasized in minimally invasive neurosurgery.

  17. A Second Radioisotope Injection Enhances Intraoperative Sentinel Node Identification in Breast Cancer Patients without Visualized Nodes on Preoperative Lymphoscintigraphy

    International Nuclear Information System (INIS)

    Leikola, J.P.; Leppaenen, E.A.; Smitten, K.A.J. von; Leidenius, M.H.K

    2006-01-01

    Purpose: To evaluate the influence of a second radioisotope injection on the intraoperative success rate in patients with non-visualized axillary sentinel nodes (SN). Material and Methods: Altogether, 534 consecutive breast cancer patients with lymphoscintigraphy (LS) and SN biopsy and were included. An intratumoral injection of 99m Tc-labeled human albumin colloid with a median dose of 93 MBq was applied. Forty-two of the 80 patients without axillary hot spots on LS received a second tracer injection with a median dose of 70 MBq. Results: The visualization rate of axillary SN was 454/534 (85%). The intraoperative SN identification rate was 97% in patients with and 69% in patients without visualized SN in the axilla ( P <0.00005), but the success rate was higher (88%) with a second radioisotope injection than without it (47%; P <0.0002). Conclusion: The failure rate in intraoperative SN identification was minimized using a second radioisotope injection in patients without axillary SN on LS

  18. First-in-human intraoperative near-infrared fluorescence imaging of glioblastoma using cetuximab-IRDye800.

    Science.gov (United States)

    Miller, Sarah E; Tummers, Willemieke S; Teraphongphom, Nutte; van den Berg, Nynke S; Hasan, Alifia; Ertsey, Robert D; Nagpal, Seema; Recht, Lawrence D; Plowey, Edward D; Vogel, Hannes; Harsh, Griffith R; Grant, Gerald A; Li, Gordon H; Rosenthal, Eben L

    2018-04-06

    Maximizing extent of surgical resection with the least morbidity remains critical for survival in glioblastoma patients, and we hypothesize that it can be improved by enhancements in intraoperative tumor detection. In a clinical study, we determined if therapeutic antibodies could be repurposed for intraoperative imaging during resection. Fluorescently labeled cetuximab-IRDye800 was systemically administered to three patients 2 days prior to surgery. Near-infrared fluorescence imaging of tumor and histologically negative peri-tumoral tissue was performed intraoperatively and ex vivo. Fluorescence was measured as mean fluorescence intensity (MFI), and tumor-to-background ratios (TBRs) were calculated by comparing MFIs of tumor and histologically uninvolved tissue. The mean TBR was significantly higher in tumor tissue of contrast-enhancing (CE) tumors on preoperative imaging (4.0 ± 0.5) compared to non-CE tumors (1.2 ± 0.3; p = 0.02). The TBR was higher at a 100 mg dose than at 50 mg (4.3 vs. 3.6). The smallest detectable tumor volume in a closed-field setting was 70 mg with 50 mg of dye and 10 mg with 100 mg. On sections of paraffin embedded tissues, fluorescence positively correlated with histological evidence of tumor. Sensitivity and specificity of tumor fluorescence for viable tumor detection was calculated and fluorescence was found to be highly sensitive (73.0% for 50 mg dose, 98.2% for 100 mg dose) and specific (66.3% for 50 mg dose, 69.8% for 100 mg dose) for viable tumor tissue in CE tumors while normal peri-tumoral tissue showed minimal fluorescence. This first-in-human study demonstrates the feasibility and safety of antibody based imaging for CE glioblastomas.

  19. Indocyanine green for intraoperative localization of ureter.

    Science.gov (United States)

    Siddighi, Sam; Yune, Junchan Joshua; Hardesty, Jeffrey

    2014-10-01

    Intraurethral injection of indocyanine green (ICG; Akorn, Lake Forest, IL) and visualization under near-infrared (NIR) light allows for real-time delineation of the ureter. This technology can be helpful to prevent iatrogenic ureteral injury during pelvic surgery. Patients were scheduled to undergo robot-assisted laparoscopic sacrocolpopexy. Before the robotic surgery started, the tip of a 6-F ureteral catheter was inserted into the ureteral orifice. Twenty-five milligrams of ICG was dissolved in 10-mL of sterile water and injected through the open catheter. The same procedure was repeated on the opposite side. The ICG reversibly stained the inside lining of the ureter by binding to proteins on urothelial layer. During the course of robotic surgery, the NIR laser on the da Vinci Si surgical robot (Intuitive Surgical, Inc, Sunnyvale, CA) was used to excite ICG molecules, and infrared emission was captured by the da Vinci filtered lens system and electronically converted to green color. Thus, the ureter fluoresced green, which allowed its definitive identification throughout the entire case. In all cases of >10 patients, we were able to visualize bilateral ureters with this technology, even though there was some variation in brightness that depended on the depth of the ureter from the peritoneal surface. For example, in a morbidly obese patient, the ureters were not as bright green. There were no intraoperative or postoperative adverse effects attributable to ICG administration for up to 2 months of observation. In our experience, this novel method of intraurethral ICG injection was helpful to identify the entire course of ureter and allowed a safe approach to tissues that were adjacent to the urinary tract. The advantage of our technique is that it requires the insertion of just the tip of ureteral catheter. Despite our limited cohort of patients, our findings are consistent with previous reports of the excellent safety profile of intravenous and intrabiliary ICG

  20. The use of intraoperative computed tomography navigation in pituitary surgery promises a better intraoperative orientation in special cases

    Directory of Open Access Journals (Sweden)

    Stefan Linsler

    2016-01-01

    Full Text Available Objective: The safety of endoscopic skull base surgery can be enhanced by accurate navigation in preoperative computed tomography (CT and magnetic resonance imaging (MRI. Here, we report our initial experience of real-time intraoperative CT-guided navigation surgery for pituitary tumors in childhood. Materials and Methods: We report the case of a 15-year-old girl with a huge growth hormone-secreting pituitary adenoma with supra- and perisellar extension. Furthermore, the skull base was infiltrated. In this case, we performed an endonasal transsphenoidal approach for debulking the adenoma and for chiasma decompression. We used an MRI neuronavigation (Medtronic Stealth Air System which was registered via intraoperative CT scan (Siemens CT Somatom. Preexisting MRI studies (navigation protocol were fused with the intraoperative CT scans to enable three-dimensional navigation based on MR and CT imaging data. Intraoperatively, we did a further CT scan for resection control. Results: The intraoperative accuracy of the neuronavigation was excellent. There was an adjustment of <1 mm. The navigation was very helpful for orientation on the destroyed skull base in the sphenoid sinus. After opening the sellar region and tumor debulking, we did a CT scan for resection control because the extent of resection was not credible evaluable in this huge infiltrating adenoma. Thereby, we were able to demonstrate a sufficient decompression of the chiasma and complete resection of the medial part of the adenoma in the intraoperative CT images. Conclusions: The use of intraoperative CT/MRI-guided neuronavigation for transsphenoidal surgery is a time-effective, safe, and technically beneficial technique for special cases.

  1. 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

  2. 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

  3. 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

  4. Intraoperative use of ultrasonography by small subcortical lesions

    International Nuclear Information System (INIS)

    Kondoff, Sl.; Gabrovski, St.; Krustev, E.; Poptodorov, G.; Gabrovski, N.; Uzunov, K.

    2004-01-01

    The aim of this study is to present the possibilities for use of intraoperative ultrasound (US) diagnostics as a method of image guided surgical navigation in neurosurgery. During an US scan of normal and pathologically changed tissues as well as volume taking lesion images are received in real time intraoperative display allowing dynamic control of the surgical radicalism and at the same time minimal invasiveness to the neural structures. Intraoperative ultrasound with real-time display characteristics finds a very wide application: subcortical and deeply localized tumour lesions, haematomas, large and giant aneurysms, arteriovenous (AV) malformations, spinal tumours and cysts. The real time dynamic scan is based on the B-mod. This method is founded on the US characteristic of reflecting in a different manner at the borderline of two mediums with different density as well as tissues with various physical and chemical characteristics. The reflection is partially absorbed depending on the acoustic impedance of the biologic field. We use a LOGIC200PRO unit with two probes I-type and T-type having a 'wedge of space' - 35 mm and working frequencies of 6 MHz and 7 MHz appropriate for visualizing lesions at a depth of 25 to 60 mm.The advantages of the Intraoperative US diagnostics are: non-invasiveness; real time display - i.e. presents the imminent intraoperative changes; it is a good alternative to other image-guided technologies; accessible price of the US unit

  5. Selected versus routine use of intraoperative cholangiography during laparoscopic cholecystectomy.

    Science.gov (United States)

    Pickuth, D

    1995-12-01

    Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments, however, this is discussed controversially. We have developed a new diagnostic strategy to detect bile duct stones. The concept is based on an ultrasound examination and on a screening for the presence of six risk indicators of choledocholithiasis. 120 consecutive patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of six risk indicators of choledocholithiasis: history of jaundice; history of pancreatitis; hyperbilirubinemia; hyperamylasemia; dilated bile duct; unclear ultrasound findings. The sensitivity of ultrasound and of intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. 20% of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (p concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that the routine use of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy is not necessary.

  6. Role of scrape cytology in the intraoperative diagnosis of tumor

    Directory of Open Access Journals (Sweden)

    Kolte Sachin

    2010-01-01

    Full Text Available Background : Rapid diagnosis of surgically removed specimens has created many controversies and a single completely reliable method has not yet been developed. Histopathology of a paraffin section remains the ultimate gold standard in tissue diagnosis. Frozen section is routinely used by the surgical pathology laboratories for intraoperative diagnosis. The use of either frozen section or cytological examination alone has an acceptable rate (93-97% of correct diagnosis, with regard to interpretation of benign versus malignant. Aim : To evaluate the utility of scrape cytology for the rapid diagnosis of surgically removed tumors and its utilisation for learning cytopathology. Materials and Methods : 75 surgically removed specimens from various organs and systems were studied. Scrapings were taken from each specimen before formalin fixation and stained by modified rapid Papanicolaou staining. Results : Of the 75 cases studied, 73 could be correctly differentiated into benign and malignant tumors, with an accuracy rate of 97.3%. Conclusions : Intraoperative scrape cytology is useful for intraoperative diagnosis of tumor, where facilities for frozen section are not available. The skill and expertise developed by routinely practicing intraoperative cytology can be applied to the interpretation of fine needle aspirate smears. Thus, apart from its diagnostic role, intraoperative cytology can become a very useful learning tool in the field of cytopathology.

  7. [Factors related to intraoperative retinal breaks in macular hole surgery].

    Science.gov (United States)

    Kumagai, K; Ogino, N; Demizu, S; Atsumi, K; Kurihara, H; Iwaki, M; Ishigooka, H; Tachi, N

    2001-02-01

    To evaluate the factors of intraoperative retinal breaks in macular hole surgery. This study included 558 eyes of 506 patients who underwent idiopathic macular hole surgery by one surgeon. Multiple regression was performed using the variables of gender, age, affected eye, lens status, stage, duration of symptoms, hole size, axial length, and lattice degeneration. The rate of retinal breaks was higher in stage 3 (16.0%) than in stage 4 (8.2%) (p = 0.014). In eyes with lattice degeneration intraoperative retinal breaks occurred in about 40% of the cases. Major factors were as follows: lattice degeneration (r = 0.24, p lattice degeneration, and gender (r = -0.18, p = 0.035) in eyes of stage 4 without lattice degeneration. The factors of intraoperative retinal breaks in macular hole surgery were lattice degeneration in all eyes and stage 3 in eyes without lattice degeneration. The high incidence of intraoperative retinal breaks in stage 3 was mainly due to the occurrence of posterior vitreous detachment. Male gender was a significant factor associated with intraoperative retinal breaks.

  8. Intraoperative parathyroid hormone assay-cutting the Gordian knot

    Directory of Open Access Journals (Sweden)

    Chandralekha Tampi

    2014-01-01

    Full Text Available Background: Hyperparathyroidism is treated by surgical excision of the hyperfunctioning parathyroid gland. In case of adenoma the single abnormal gland is removed, while in hyperplasias, a subtotal excision, that is, three-and-a-half of the four glands are removed. This therapeutic decision is made intraoperatively through frozen section evaluation and is sometimes problematic, due to a histological overlap between hyperplasia and the adenoma. The intraoperative parathyroid hormone (IOPTH assay, propogated in recent years, offers an elegant solution, with a high success rate, due to its ability to identify the removal of all hyperfunctioning parathyroid tissue. Aim: To study the feasibility of using IOPTH in our setting. Materials and Methods: Seven patients undergoing surgery for primary hyperparathyroidism had their IOPTH levels evaluated, along with the routine frozen and paraffin sections. Results: All seven patients showed more than a 50% intraoperative fall in serum PTH after excision of the abnormal gland. This was indicative of an adenoma and was confirmed by histopathological examination and normalization of serum calcium postoperatively. Conclusion: The intraoperative parathyroid hormone is a sensitive and specific guide to a complete removal of the abnormal parathyroid tissue. It can be incorporated without difficulty as an intraoperative guide and is superior to frozen section diagnosis in parathyroid surgery.

  9. Intraoperative adverse events associated with extremely preterm cesarean deliveries.

    Science.gov (United States)

    Bertholdt, Charline; Menard, Sophie; Delorme, Pierre; Lamau, Marie-Charlotte; Goffinet, François; Le Ray, Camille

    2018-05-01

    At the same time as survival is increasing among premature babies born before 26 weeks of gestation, the rates of cesarean deliveries before 26 weeks is also rising. Our purpose was to compare the frequency of intraoperative adverse events during cesarean deliveries in two gestational age groups: 24-25 weeks and 26-27 weeks. This single-center retrospective cohort study included all women with cesarean deliveries performed before 28 +0 weeks from 2007 through 2015. It compared the frequency of intraoperative adverse events between two groups: those at 24-25 weeks of gestation and at 26-27 weeks. Intraoperative adverse events were a classical incision, transplacental incision, difficulty in fetal extraction (explicitly mentioned in the surgical report), postpartum hemorrhage (≥500 mL of blood loss), and injury to internal organs. A composite outcome including at least one of these events enabled us to analyze the risk factors for intraoperative adverse events with univariate and multivariable analysis. Stratified analyses by the indication for the cesarean were performed. We compared 74 cesarean deliveries at 24-25 weeks of gestation and 214 at 26-27 weeks. Intraoperative adverse events occurred at higher rates in the 24-25-week group (63.5 vs. 30.8%, p cesarean. These results should help obstetricians and women making decisions about cesarean deliveries at these extremely low gestational ages. © 2018 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Intraoperative and early postoperative complications of manual sutureless cataract extraction.

    Science.gov (United States)

    Iqbal, Yasir; Zia, Sohail; Baig Mirza, Aneeq Ullah

    2014-04-01

    To determine the intraoperative and early postoperative complications of manual sutureless cataract extraction. Case series. Redo Eye Hospital, Rawalpindi, Pakistan, from January 2009 to December 2010. Three hundred patients of cataract through purposive non-probability sampling were selected. The patients underwent manual sutureless cataract surgery (MSCS) by single experienced surgeon and intraoperative complications were documented. The surgical technique was modified to deal with any intraoperative complications accordingly. Patients were examined on the first postoperative day and on the first postoperative week for any postoperative complications. The data was entered in Statistical Package for Social Sciences (SPSS) version 13.0 and the results were calculated in frequencies. Among the 300 cases, 81.3% surgeries went uneventful whereas 18.6% had some complication. The common intraoperative complications were superior button-hole formation in 5%; posterior capsular rent in 5% and premature entry with iris prolapse in 3% cases. Postoperatively, the commonly encountered complications were striate keratopathy in 9.6% and hyphema 9%. At first week follow-up, 4% had striate keratopathy and 0.6% had hyphema. Striate keratopathy resolved with topical medication on subsequent follow-up. A total of 9 cases (3%) underwent second surgery: 2 cases for lens matter wash, 2 cases for hyphema and 5 cases needed suturing of wound for shallow anterior chamber due to wound leak. Superior button-hole formation, posterior capsular rent and premature entry were the common intraoperative complications of MSCS whereas the common early postoperative complications were striate keratopathy and hyphema.

  11. Evaluation of occupational radiation dose of extremities on hysterosalpingography

    International Nuclear Information System (INIS)

    Filipov, D.; Kotowski, S.T.A.

    2017-01-01

    In the Hysterosalpingography (HSG) exam there is always a professional present with their hands very close to the radiation field. Based on CNEN, individuals occupationally exposed to radiation have equivalent dose limit values for the extremities (500 mSv / year). The objective of the study was to verify the equivalent dose in the hand region of an IOE (Occupationally Exposed Individual) that performs the HSG test and to compare it with the CNEN limit and with similar studies. A humanoid phantom was used to simulate the patient and an ionization chamber, which was placed in the place commonly occupied by the professional. The equivalent hand dose result (∼ 30 mSv / year) equals 6% of the CNEN annual dose limit, but is close to most studies using fluoroscopes. Therefore, the optimization of radiological protection is necessary to reduce these results

  12. Radiation protection for an intraoperative X-ray source compared to C-arm fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, Frank; Clausen, Sven; Jahnke, Anika; Steil, Volker; Wenz, Frederik [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Radiation Oncology; Bludau, Frederic; Obertacke, Udo [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Trauma Surgery; Suetterlin, Marc [Heidelberg Univ., University Medical Center Mannheim (Germany). Dept. of Obstetrics and Gynaecology

    2014-10-01

    Background: Intraoperative radiotherapy (IORT) using the INTRABEAM {sup registered} system promises a flexible use regarding radiation protection compared to other approaches such as electron treatment or HDR brachytherapy with {sup 192}Ir or {sup 60}Co. In this study we compared dose rate measurements of breast- and Kypho-IORT with C-arm fluoroscopy which is needed to estimate radiation protection areas. Materials and Methods: C-arm fluoroscopy, breast- and Kypho-IORTs were performed using phantoms (silicon breast or bucket of water). Dose rates were measured at the phantom's surface, at 30 cm, 100 cm and 200 cm distance. Those measurements were confirmed during 10 Kypho-IORT and 10 breast-IORT patient treatments. Results: The measured dose rates were in the same magnitude for all three paradigms and ranges from 20 μSv/h during a simulated breast-IORT at two meter distance up to 64 mSv/h directly at the surface of a simulated Kypho-IORT. Those measurements result in a circle of controlled area (yearly doses > 6 mSv) for each paradigm of about 4 m ± 2 m. Discussion/Conclusions: All three paradigms show comparable dose rates which implies that the radiation protection is straight forward and confirms the flexible use of the INTRABEAM {sup registered} system. (orig.)

  13. Extremity doses to interventional radiologists

    International Nuclear Information System (INIS)

    Wihtby, M.; Martin, C. J.

    2002-01-01

    Radiologists performing interventional procedures are often required to stand close to the patient's side when carrying out manipulations under fluoroscopic control. This can result in their extremities receiving a high radiation dose, due to scattered radiation. These doses are sometimes high enough to warrant that the radiologist in question be designated a classified radiation worker. Classification in the UK is a result of any worker receiving or likely to receive in the course of their duties in excess of 3/10ths of any annual dose limit (500mSv to extremities, skin). The doses to the legs of radiologists have received less attention than those to the hands, however the doses may be high, due to the proximity of the legs and feet to scattered radiation. The legs can be exposed to a relatively high level of scattered radiation as the radiation in produced from scatter of the un attenuated beam from the bottom of the patient couch. The routine monitoring of extremity doses in interventional radiology is difficult due to several factors. Firstly a wide range of interventional procedures in undertaken in every radiology department, and these procedures require many different techniques, equipment and skills. This means that the position the radiologist adopts in relation to scattering medium and therefore their exposure, depends heavily on the type of procedure. As the hands which manipulate the catheters within the patient are often located close to the patients side and to the area under irradiation, the distribution of dose across the hands can be variable, with very high localised doses, making routine monitoring difficult. The purpose of this study was to determine the magnitude and distribution of dose to the hands and legs of interventional radiologists carrying out a wide range of both diagnostic and therapeutic interventional procedures. To ascertain the most effective method of monitoring the highest dose in accordance with the Basic safety standards

  14. Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Vaidya, Jayant S., E-mail: jayant.vaidya@ucl.ac.uk [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Baum, Michael [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Tobias, Jeffrey S. [Department of Radiation Oncology, University College London Hospitals, London (United Kingdom); Wenz, Frederik [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Massarut, Samuele [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Keshtgar, Mohammed [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Hilaris, Basil [Radiation Oncology, Our Lady of Mercy, New York Medical College, New York (United States); Saunders, Christobel [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Williams, Norman R.; Brew-Graves, Chris [Research Department of Surgery, Division of Surgery and Interventional Science, University College London, London (United Kingdom); Corica, Tammy [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Roncadin, Mario [Surgery and Radiation Oncology, Centro di Riferimento Oncologico (CRO), Aviano (Italy); Kraus-Tiefenbacher, Uta; Suetterlin, Marc [Radiation Oncology and Gynaecology, University Medical Centre of Mannheim (Germany); Bulsara, Max [Institute of Health and Rehabilitation Research, University of Notre Dame, Fremantle, Western Australia (Australia); Joseph, David [Radiation Oncology, Sir Charles Gairdner Hospital and School of Surgery, University of Western Australia, Perth (Australia)

    2011-11-15

    Purpose: We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. Methods and Materials: A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. Results: The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Conclusions: Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

  15. Ten years of intraoperative floppy iris syndrome in the era of α-blockers

    Science.gov (United States)

    Mohamad Al-Ali, Badereddin; Radmayr, Christian; Weber, Maria; Horninger, Wolfgang; Findl, Oliver; Plas, Eugen

    2017-01-01

    Introduction The use of alpha-1 receptor antagonists in the treatment of benign prostatic hyperplasia (BPH) has created a problem in ophthalmic surgery, the so-called intraoperative floppy iris syndrome (IFIS). This consists of a billowing iris, insufficient pupillary dilation with progressive intraoperative miosis, and protrusion of iris tissue through the tunnel and side port incision that are made for access to the anterior chamber during surgery. IFIS presents particular difficulties in cataract surgery which is carried out through the pupil with manipulations in the immediate vicinity of the iris. The complications range from poor visibility of the operative field to iris damage with the surgical instruments and to rupture of the posterior capsule, with loss of lens material into the vitreous body. Material and methods A comprehensive literature review was performed using MEDLINE with MeSH terms and keywords ‘benign prostatic hyperplasia’, ‘intraoperative floppy iris syndrome’, ‘adrenergic alpha-antagonist’ and ‘cataract surgery’. In addition, reference lists from identified publications were reviewed to identify reports and studies of interest from 2001 to 2017. Results The A total of 95% of experienced ophthalmologic surgeons reported that systematic treatment with tamsulosin represents a challenging surgical condition increasing the risk of complications. Alpha-blockers are commonly prescribed, with 1,079,505 packages of tamsulosin prescribed each month in 2014 in Austria. Dose modification may be one way to reduce the risk of IFIS. A lower incidence of IFIS was reported in patients on tamsulosin in Japan, but the recommended dosage was lower than that used in Europe and the US (0.2 mg vs. 0.4 mg). Conclusions We showed that not all patients taking tamsulosin experience IFIS. Moreover, larger investigations with a prospective design are needed, including studies to monitor the pre- and post-therapeutic ophthalmologic changes under tamsulosin

  16. Comparison of Real-Time Intraoperative Ultrasound-Based Dosimetry With Postoperative Computed Tomography-Based Dosimetry for Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Nag, Subir; Shi Peipei; Liu Bingren; Gupta, Nilendu; Bahnson, Robert R.; Wang, Jian Z.

    2008-01-01

    Purpose: To evaluate whether real-time intraoperative ultrasound (US)-based dosimetry can replace conventional postoperative computed tomography (CT)-based dosimetry in prostate brachytherapy. Methods and Materials: Between December 2001 and November 2002, 82 patients underwent 103 Pd prostate brachytherapy. An interplant treatment planning system was used for real-time intraoperative transrectal US-guided treatment planning. The dose distribution was updated according to the estimated seed position to obtain the dose-volume histograms. Postoperative CT-based dosimetry was performed a few hours later using the Theraplan-Plus treatment planning system. The dosimetric parameters obtained from the two imaging modalities were compared. Results: The results of this study revealed correlations between the US- and CT-based dosimetry. However, large variations were found in the implant-quality parameters of the two modalities, including the doses covering 100%, 90%, and 80% of the prostate volume and prostate volumes covered by 100%, 150%, and 200% of the prescription dose. The mean relative difference was 38% and 16% for doses covering 100% and 90% of the prostate volume and 10% and 21% for prostate volumes covered by 100% and 150% of the prescription dose, respectively. The CT-based volume covered by 200% of the prescription dose was about 30% greater than the US-based one. Compared with CT-based dosimetry, US-based dosimetry significantly underestimated the dose to normal organs, especially for the rectum. The average US-based maximal dose and volume covered by 100% of the prescription dose for the rectum was 72 Gy and 0.01 cm 3 , respectively, much lower than the 159 Gy and 0.65 cm 3 obtained using CT-based dosimetry. Conclusion: Although dosimetry using intraoperative US-based planning provides preliminary real-time information, it does not accurately reflect the postoperative CT-based dosimetry. Until studies have determined whether US-based dosimetry or

  17. Intraoperative monitoring technician: a new member of the surgical team.

    Science.gov (United States)

    Brown, Molly S; Brown, Debra S

    2011-02-01

    As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes. Copyright © 2011 AORN, Inc. Published by Elsevier Inc. All rights reserved.

  18. Intraoperative ultrasonography for presumed brain metastases: a case series study

    Directory of Open Access Journals (Sweden)

    Helder Picarelli

    2012-10-01

    Full Text Available Brain metastases (BM are one of the most common intracranial tumors and surgical treatment can improve both the functional outcomes and patient survival, particularly when systemic disease is controlled. Image-guided BM resection using intraoperative exams, such as intraoperative ultrasound (IOUS, can lead to better surgical results. METHODS: To evaluate the use of IOUS for BM resection, 20 consecutives patients were operated using IOUS to locate tumors, identify their anatomical relationships and surgical cavity after resection. Technical difficulties, complications, recurrence and survival rates were noted. RESULTS: IOUS proved effective for locating, determining borders and defining the anatomical relationships of BM, as well as to identify incomplete tumor resection. No complications related to IOUS were seen. CONCLUSION: IOUS is a practical supporting method for the resection of BM, but further studies comparing this method with other intraoperative exams are needed to evaluate its actual contribution and reliability.

  19. Intraoperative magnetic resonance imaging for neurosurgery – An anaesthesiologist's challenge

    Directory of Open Access Journals (Sweden)

    Rajashree U Gandhe

    2018-01-01

    Full Text Available Intraoperative magnetic resonance imaging (MRI-guided neurosurgery has gained popularity over the years globally. These surgeries require a dedicated operating room and MRI-compatible anaesthesia equipment. The anaesthesiologist providing care in this setup needs to be experienced and vigilant to ensure patient safety. Strict adherence to MRI safety checklists and regular personnel training would avoid potential accidents and life-threatening emergencies. Teamwork, good communication, preprocedure planning, and familiarity with the surroundings are very important for safe care and good outcomes. We performed a literature search in Google Scholar, PubMed and Cochrane databases for original and reviewed articles for the origins, development and applications of intraoperative MRI in neurosurgical procedures. Much of the research has emphasised on the surgical indications than the anaesthetic challenges faced during intraoperative MRI guided surgery. The purpose of this review is to discuss the anaesthetic concerns specific to this unique environment.

  20. 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

  1. 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)

  2. Intraoperative cyclorotation and pupil centroid shift during LASIK and PRK.

    Science.gov (United States)

    Narváez, Julio; Brucks, Matthew; Zimmerman, Grenith; Bekendam, Peter; Bacon, Gregory; Schmid, Kristin

    2012-05-01

    To determine the degree of cyclorotation and centroid shift in the x and y axis that occurs intraoperatively during LASIK and photorefractive keratectomy (PRK). Intraoperative cyclorotation and centroid shift were measured in 63 eyes from 34 patients with a mean age of 34 years (range: 20 to 56 years) undergoing either LASIK or PRK. Preoperatively, an iris image of each eye was obtained with the VISX WaveScan Wavefront System (Abbott Medical Optics Inc) with iris registration. A VISX Star S4 (Abbott Medical Optics Inc) laser was later used to measure cyclotorsion and pupil centroid shift at the beginning of the refractive procedure and after flap creation or epithelial removal. The mean change in intraoperative cyclorotation was 1.48±1.11° in LASIK eyes and 2.02±2.63° in PRK eyes. Cyclorotation direction changed by >2° in 21% of eyes after flap creation in LASIK and in 32% of eyes after epithelial removal in PRK. The respective mean intraoperative shift in the x axis and y axis was 0.13±0.15 mm and 0.17±0.14 mm, respectively, in LASIK eyes, and 0.09±0.07 mm and 0.10±0.13 mm, respectively, in PRK eyes. Intraoperative centroid shifts >100 μm in either the x axis or y axis occurred in 71% of LASIK eyes and 55% of PRK eyes. Significant changes in cyclotorsion and centroid shifts were noted prior to surgery as well as intraoperatively with both LASIK and PRK. It may be advantageous to engage iris registration immediately prior to ablation to provide a reference point representative of eye position at the initiation of laser delivery. Copyright 2012, SLACK Incorporated.

  3. Glioma surgery using intraoperative tractography and MEP monitoring

    International Nuclear Information System (INIS)

    Maesawa, Satoshi; Nakahara, Norimoto; Watanabe, Tadashi; Fujii, Masazumi; Yoshida, Jun

    2009-01-01

    In surgery of gliomas in motor-eloquent locations, it is essential to maximize resection while minimizing motor deficits. We attempted to identify the cortico-spinal tract (CST) by intraoperative-diffusion tensor imaging (DTI) tractography, combined with electrophysiological mapping using direct subcortical stimulation during tumor resection. Our techniques and preliminary results are reported. Tumors were removed from twelve patients with gliomas in and around the CST using high-field intraoperative MRI and neuronavigation system (BrainSUITE). DTI-based tractography was implemented for navigation of CST pre-and intraoperatively. When the CST was close to the manipulating area, direct subcortical stimulation was performed, and motor evoked potential (MEP)-responses were examined. Locations of CST indicated by pre- and intraoperative tractography (pre- or intra-CST-tractography), and locations identified by subcortical stimulation were recorded, and those correlations were examined. Imaging and functional outcomes were reviewed. Total resections were achieved in 10 patients (83.4%). Two patients developed transient deterioration of motor function (16.6%), and permanent paresis was seen in one (8.3%). The distance from intra-CST-tractography to corresponding sites by subcortical stimulation was 4.5 mm in average (standard deviation (SD)=4.2), and significantly shorter than from pre-CST-tractography. That distance correlated significantly with the i