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1.
Medicine (Baltimore) ; 99(8): e19259, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080133

RESUMO

BACKGROUND: The aim of this study was to evaluate the effectiveness and safety of surgical treatment of intra-articular distal radius fractures (DRFs) with the assistance of three-dimensional (3D) printing technique. METHODS: Patients with intra-articular DRFs in our hospital from February 2017 to November 2018 were enrolled in this study, and were randomly assigned to 2 parallel groups to receive surgical treatment with the assistance of 3D printing technique or not. For patients in the 3D printing group, the surgical procedure was simulated with 3D physical model before surgery. Volar plate and K-wire fixation were performed in all patients. Patients in the 2 groups were compared in terms of intraoperative indexes and postoperative function. RESULTS: A total of 32 patients were included in our study. During surgery, mean operation time in the 3D model group was significantly lower than that in the routine group (P < .001). Besides, significantly less blood was lost in the 3D model group than that in the routine group (P < .001). Furthermore, the 3D model group had a significantly less times of intraoperative fluoroscopy than that in the routine group (P = .002). However, the 3D model group showed no significant difference in visual analog scale (VAS) score, the disabilities of the arm, shoulder, and hand (DASH) score, or active wrist range of motion (ROM) in comparison with the routine group (P > .05). CONCLUSION: With the assistance of 3D printing technique, the operation time, amount of intraoperative bleeding, and times of intraoperative fluoroscopy can be reduced during the surgical treatment of intra-articular DRFs with volar plating and K-wire fixation. This technique is safe and effective, and is worth spreading in other orthopedic surgeries.


Assuntos
Simulação por Computador , Fixação Interna de Fraturas/métodos , Fraturas Intra-Articulares/cirurgia , Impressão Tridimensional , Fraturas do Rádio/cirurgia , Adulto , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Placas Ósseas , Fios Ortopédicos , Avaliação da Deficiência , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Duração da Cirurgia , Cuidados Pré-Operatórios , Fraturas do Rádio/diagnóstico por imagem , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X , Escala Visual Analógica
2.
Bone Joint J ; 102-B(1): 5-10, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888369

RESUMO

AIMS: Intraoperative 3D navigation (ION) allows high accuracy to be achieved in spinal surgery, but poor workflow has prevented its widespread uptake. The technical demands on ION when used in patients with adolescent idiopathic scoliosis (AIS) are higher than for other more established indications. Lean principles have been applied to industry and to health care with good effects. While ensuring optimal accuracy of instrumentation and safety, the implementation of ION and its associated productivity was evaluated in this study for AIS surgery in order to enhance the workflow of this technique. The aim was to optimize the use of ION by the application of lean principles in AIS surgery. METHODS: A total of 20 consecutive patients with AIS were treated with ION corrective spinal surgery. Both qualitative and quantitative analysis was performed with real-time modifications. Operating time, scan time, dose length product (measure of CT radiation exposure), use of fluoroscopy, the influence of the reference frame, blood loss, and neuromonitoring were assessed. RESULTS: The greatest gains in productivity were in avoiding repeat intraoperative scans (a mean of 248 minutes for patients who had two scans, and a mean 180 minutes for those who had a single scan). Optimizing accuracy was the biggest factor influencing this, which was reliant on incremental changes to the operating setup and technique. CONCLUSION: The application of lean principles to the introduction of ION for AIS surgery helps assimilate this method into the environment of the operating theatre. Data and stakeholder analysis identified a reproducible technique for using ION for AIS surgery, reducing operating time, and radiation exposure. Cite this article: Bone Joint J. 2020;102-B(1):5-10.


Assuntos
Neuronavegação/métodos , Escoliose/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Parafusos Ósseos/estatística & dados numéricos , Desenho de Equipamento , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Bloqueadores Neuromusculares/administração & dosagem , Neuronavegação/instrumentação , Duração da Cirurgia , Posicionamento do Paciente , Doses de Radiação , Resultado do Tratamento
3.
Radiol Med ; 125(3): 296-305, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31845091

RESUMO

The advances in technology have led to a growing trend in population exposure to radiation emerging from the invention of high-dose procedures. It is, for example, estimated that annually 1.2% of cancers are induced by radiological scans in Norway. This study aims to investigate and discuss the frequency and dose trends of radiological examinations in Europe. European Commission (EC) launched projects to gain information for medical exposures in 2004 and 2011. In this study, the European Commission Radiation Protection (RP) reports No. 154 and 180 have been reviewed. The RP 154 countries' data were extracted from both reports, and the average variation trend of the number of examinations and effective doses were studied. According to the results, plain radiography and fluoroscopy witnessed a reduction in the frequency and effective dose per examination. Nevertheless, European collective dose encountered an average increase of 23%, which resulted from a growing tendency for implementation of high-dose procedures such as CT scans and interventional examinations. It is worth noting that most of the CT procedures have undergone an increase in effective dose per examination. Although demand and dose per examination in some radiological procedures (such as intravenous urography (IVU) have been reduced, population collective dose is still rising due to the increasing demand for CT scan procedures. Even though the individual risks are not considerable, it can, in a large scale, threaten the health of the people at the present time. Due to this fact, better justification should be addressed so as to reduce population exposure.


Assuntos
Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/tendências , Radiografia/tendências , Tomografia Computadorizada por Raios X/tendências , Europa (Continente)/epidemiologia , Fluoroscopia/estatística & dados numéricos , Fluoroscopia/tendências , Humanos , Neoplasias Induzidas por Radiação/epidemiologia , Noruega/epidemiologia , Doses de Radiação , Proteção Radiológica , Radiografia/estatística & dados numéricos , Radiografia Intervencionista/estatística & dados numéricos , Radiologia/tendências , Tomografia Computadorizada por Raios X/estatística & dados numéricos
4.
Arch Orthop Trauma Surg ; 139(11): 1579-1586, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31278509

RESUMO

INTRODUCTION: When locking intramedullary nails, inserting the distal interlocking screw accurately and quickly with less radiation exposure is very important. The purpose of this randomized control study was to compare radiation exposure and accuracy of distal locking screws between free-hand fluoroscopic guidance and the use of a distal targeting system (DTS). MATERIALS AND METHODS: Inclusion criteria of this study were patients older than 60 years who need an intramedullary nailing due to unstable intertrochanteric and subtrochanteric fracture. The primary outcome was the attempt numbers of image intensifier during the insertion of distal locking screws. Secondary outcomes were operative time and angles between distal locking screws and nail. RESULTS: A total of 36 patients participated in the study. Eighteen patients using free-hand fluoroscopic guidance were assigned to Group I while 18 patients using DTS were assigned to Group II. The number of attempts of image intensifier during distal screw insertion (57.3 ± 31.42 vs. 11.5 ± 7.41, p < 0.001), ratio of attempt number for distal screws to the total attempts (0.33 ± 0.21 vs. 0.12 ± 0.08, p = 0.001), the number of hand exposure to image intensifier directly (75.0 ± 29.55 vs. 13.5 ± 19.07, p < 0.001), and the time of radiation exposure during distal screws insertion (42.57 ± 2.42 s vs. 12.72 ± 8.10 s, p < 0.001) were significantly lower in Group II compared to those in Group I. And, operation time (96.3 min ± 18.94 vs. 76.1 min ± 14.10, p < 0.001) was also statistically significantly lower in Group II. Both distal locking screws were significantly closer to perpendicular direction to the nail in Group II. CONCLUSION: The attempt number of image intensifier during the insertion of two distal locking screws was significantly reduced with DTS compared with that with free hand fluoroscopic guidance. Angle between distal locking screws and nail was also more accurate using DTS.


Assuntos
Fluoroscopia , Fixação Intramedular de Fraturas , Exposição à Radiação/estatística & dados numéricos , Cirurgia Assistida por Computador , Fluoroscopia/instrumentação , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Humanos , Período Intraoperatório , Pessoa de Meia-Idade , Duração da Cirurgia , Cirurgia Assistida por Computador/instrumentação , Cirurgia Assistida por Computador/métodos , Cirurgia Assistida por Computador/estatística & dados numéricos
5.
Eur Radiol ; 29(7): 3390-3400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31016441

RESUMO

OBJECTIVE: Percutaneous biliary interventions (PBIs) can be associated with a high patient radiation dose, which can be reduced when national diagnostic reference levels (DRLs) are kept in mind. The aim of this multicentre study was to investigate patient radiation exposure in different percutaneous biliary interventions, in order to recommend national DRLs. METHODS: A questionnaire asking for the dose area product (DAP) and the fluoroscopy time (FT) in different PBIs with ultrasound- or fluoroscopy-guided bile duct punctures was sent to 200 advanced care hospitals. Recommended national DRLs are set at the 75th percentile of all DAPs. RESULTS: Twenty-three facilities (9 interventional radiology depts. and 14 gastroenterology depts.) returned the questionnaire (12%). Five hundred sixty-five PBIs with 19 different interventions were included in the analysis. DAPs (range 4-21,510 cGy·cm2) and FTs (range 0.07-180.33 min) varied substantially depending on the centre and type of PBI. The DAPs of initial PBIs were significantly (p < 0.0001) higher (median 2162 cGy·cm2) than those of follow-up PBIs (median 464 cGy·cm2). There was no significant difference between initial PBIs with ultrasound-guided bile duct puncture (2162 cGy·cm2) and initial PBIs with fluoroscopy-guided bile duct puncture (2132 cGy·cm2) (p = 0.85). FT varied substantially (0.07-180.33 min). CONCLUSIONS: DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. PBI with US-guided bile duct puncture did not reduce DAP, when compared to PBI with fluoroscopy-guided bile duct puncture. National DRLs of 4300 cGy·cm2 for initial PBIs and 1400 cGy·cm2 for follow-up PBIs are recommended. KEY POINTS: • DAPs and FTs in percutaneous biliary interventions showed substantial variations depending on the centre and the type of PBI. • PBI with US-guided bile duct puncture did not reduce DAP when compared to PBI with fluoroscopy-guided bile duct puncture. • DRLs of 4300 cGy·cm2for initial PBIs (establishing a transhepatic tract) and 1400 cGy·cm2for follow-up PBIs (transhepatic tract already established) are recommended.


Assuntos
Sistema Biliar/diagnóstico por imagem , Doses de Radiação , Exposição à Radiação/estatística & dados numéricos , Radiologia Intervencionista/estatística & dados numéricos , Adulto , Procedimentos Cirúrgicos do Sistema Biliar/métodos , Feminino , Fluoroscopia/estatística & dados numéricos , Alemanha , Humanos , Masculino , Radiografia Intervencionista/estatística & dados numéricos , Radiologia Intervencionista/normas , Valores de Referência , Estudos Retrospectivos , Stents
6.
Orthop Surg ; 11(1): 34-41, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30834705

RESUMO

OBJECTIVE: To assess the clinical efficacy of TiRobot-assisted percutaneous cannulated screw fixation in the treatment of femoral neck fractures. METHODS: From September 2015 to July 2017, 26 patients with unilateral femoral neck fractures were treated with TiRobot-assisted percutaneous cannulated screw fixation. The femoral necks were fixed using three cannulated screws with robot assistance applying the following procedure: image acquisition, path planning, and needle and screw placement. The results of the treatment, including operation duration, frequency of fluoroscopy use, implant placement accuracy, intraoperative bleeding, total drilling, surgical complications, fracture healing time, fracture healing rate, and Harris scores at the last follow-up, were recorded and compared with 23 similar patients who underwent conventional manual positioning surgery. RESULTS: A total of 147 cannulated screws were placed in all patients. The TiRobot group had shorter operation duration (62.6 ± 8.7 min vs 72.4 ± 10.3 min) and fracture healing time (5.1 ± 2.4 months vs 5.9 ± 2.8 months) than the conventional group (P > 0.05). The robot group had significantly less use of fluoroscopy (26.5 ± 7.4 times vs 51.3 ± 9.4 times), intraoperative bleeding (8.2 ± 5.3 mL vs 36.4 ± 12.5 mL), and total drilling (9.4 ± 4.2 times vs 18.3 ± 9.1 times) than the conventional group (all P < 0.05). The screw parallelism was significantly improved (24.0 ± 0.6 points vs 21.5 ± 1.2 points) and the neck-width coverage (72.0 ± 6.7 mm2 vs 53.8 ± 10.4 mm2 ) was significantly enlarged compared to the conventional group (P < 0.05). Only three guiding needles were used to penetrate the femoral head during manual insertion in the TiRobot group, which was significantly lower than that in the conventional group (3/78, 3.8% vs 9/69, 13.0%; P < 0.05). Other complications such as wound infection, vascular or nerve injury, screw loosening, and secondary screw displacement, did not occur in the two groups. There was no significant difference between the two groups in fracture healing rate (88.4% vs 82.6%) and Harris scores at the last follow up (88.2 ± 3.6 points vs 87.3 ± 4.7 points; P > 0.05). CONCLUSION: TiRobot-assisted percutaneous cannulated screw fixation of femoral neck fractures is advantageous over conventional surgery with manual positioning due to easier manipulation, more accurate screw insertion, less invasion, and less radiation exposure, suggesting that it is a better method to stabilize femoral neck fractures.


Assuntos
Parafusos Ósseos , Fraturas do Colo Femoral/cirurgia , Fixação Interna de Fraturas/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Seguimentos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Estudos Prospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Resultado do Tratamento
7.
Occup Environ Med ; 76(5): 317-325, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30890565

RESUMO

OBJECTIVES: To assess radiation exposure-related work history and risk of cataract and cataract surgery among radiologic technologists assisting with fluoroscopically guided interventional procedures (FGIP). METHODS: This retrospective study included 35 751 radiologic technologists who reported being cataract-free at baseline (1994-1998) and completed a follow-up questionnaire (2013-2014). Frequencies of assisting with 21 types of FGIP and use of radiation protection equipment during five time periods (before 1970, 1970-1979, 1980-1989, 1990-1999, 2000-2009) were derived from an additional self-administered questionnaire in 2013-2014. Multivariable-adjusted relative risks (RRs) for self-reported cataract diagnosis and cataract surgery were estimated according to FGIP work history. RESULTS: During follow-up, 9372 technologists reported incident physician-diagnosed cataract; 4278 of incident cases reported undergoing cataract surgery. Technologists who ever assisted with FGIP had increased risk for cataract compared with those who never assisted with FGIP (RR: 1.18, 95% CI 1.11 to 1.25). Risk increased with increasing cumulative number of FGIP; the RR for technologists who assisted with >5000 FGIP compared with those who never assisted was 1.38 (95% CI 1.24 to 1.53; p trend <0.001). These associations were more pronounced for FGIP when technologists were located ≤3 feet (≤0.9 m) from the patient compared with >3 feet (>0.9 m) (RRs for >5000 at ≤3 feet vs never FGIP were 1.48, 95% CI 1.27 to 1.74 and 1.15, 95% CI 0.98 to 1.35, respectively; pdifference=0.04). Similar risks, although not statistically significant, were observed for cataract surgery. CONCLUSION: Technologists who reported assisting with FGIP, particularly high-volume FGIP within 3 feet of the patient, had increased risk of incident cataract. Additional investigation should evaluate estimated dose response and medically validated cataract type.


Assuntos
Catarata/diagnóstico , Diagnóstico por Imagem/efeitos adversos , Medição de Risco/normas , Adulto , Catarata/epidemiologia , Estudos de Coortes , Diagnóstico por Imagem/estatística & dados numéricos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários
8.
Eur J Gastroenterol Hepatol ; 31(4): 463-470, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30830881

RESUMO

BACKGROUND: The increasing complexity involved in procedures requiring fluoroscopy such as endoscopic retrograde cholangiopancreatography (ERCP) results in heightened screening times with attendant radiation exposure during these procedures. There is increasing awareness of tissue-reactions to the lens of the eye due to radiation exposure, with evidence suggesting that threshold doses may be lower than previously considered. MATERIALS AND METHODS: A literature search was performed to identify studies involving ERCP in which radiation exposure was reported. Demographic data and data on fluoroscopy time and ocular exposure were extracted. Fixed and random-effects meta-analyses were conducted. RESULTS: Twenty-six studies (8016 procedures) were identified, of which 10 studies (818 procedures) contained data on ocular exposure. The mean screening time per procedure was 3.9 min with a mean of three images captured per procedure. On fixed effects meta-analysis, the point estimate for the effective ocular exposure dose per procedure was 0.018 (95% confidence interval: 0.017-0.019) mSv. On random-effects meta-analysis, the effective ocular exposure dose was 0.139 (0.118-0.160) mSv (Q=2590.78, I=99.5, P<0.001). On comparing these point estimates to the ocular dose limit of 20 mSv/year, 1111 ERCPs (using fixed effects data) and 144 ERCPs (using random-effects data), with a mean of 627 ERCPs/individual/year, could deliver an ocular radiation dose equivalent to this dose limit. CONCLUSION: Ocular radiation exposures in high-volume ERCP operators (>200 procedures/year) and operators performing complex ERCPs involving prolonged fluoroscopy, need to exercise caution in relation to ocular exposure. Shielding using lead-lined glasses may be reasonable in this group.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Olho/efeitos da radiação , Fluoroscopia/efeitos adversos , Exposição Ocupacional/análise , Exposição à Radiação/análise , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colangiopancreatografia Retrógrada Endoscópica/estatística & dados numéricos , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Exposição Ocupacional/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação/estatística & dados numéricos , Radiologistas/estatística & dados numéricos
9.
Am Heart J ; 210: 1-8, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30711875

RESUMO

BACKGROUND: Coronary angiography and intervention to saphenous venous grafts (SVGs) remain challenging. This study aimed to investigate the feasibility and safety of the radial approach compared to femoral access in a large cohort of patients undergoing SVG angiography and intervention. METHODS: Data from 1,481 patients from Canada, United States, and Spain who underwent procedures between 2010 and 2016 were collected. Patients must have undergone SVG coronary angiography and/or intervention. Demographics, procedural data, and in-hospital complications were recorded. RESULTS: Procedures were undertaken by either the radial (n = 863, 211 intervention) or femoral (n = 618, 260 intervention) approach. The mean number of SVGs per patient was similar between groups (radial 2.3 ± 0.7 vs femoral 2.6 ± 1.1, P = .61), but the radial group required a fewer number of catheters (2.6 ± 1.7 vs 4.1 ± 1.1, P < .001). Fluoroscopy time was comparable between groups, and there was a trend toward lower contrast volume in the radial group (P = .045). Overall, the total dose of heparin was significantly higher in the radial group (P < .001); however, radial patients experienced significantly less access-site bleeding complications (P < .001). Outpatients undergoing radial SVG interventions had a higher likelihood of a same-day discharge home (P < .001). CONCLUSIONS: Radial access for SVG angiography and intervention is safe and feasible, without increasing fluoroscopy time. In experienced centers, radial access was associated with fewer catheters used, lower contrast volume, and lower rate of vascular access-site bleeding complications. Moreover, outpatients undergoing SVG percutaneous coronary intervention though the radial approach had a higher likelihood of a same-day discharge home.


Assuntos
Angiografia Coronária/métodos , Artéria Femoral , Intervenção Coronária Percutânea/métodos , Artéria Radial , Veia Safena/diagnóstico por imagem , Idoso , Índice de Massa Corporal , Canadá , Ponte de Artéria Coronária , Estudos de Viabilidade , Feminino , Fluoroscopia/estatística & dados numéricos , Hematoma/etiologia , Humanos , Masculino , Duração da Cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/estatística & dados numéricos , Inibidores da Agregação de Plaquetas/administração & dosagem , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos , Estudos Retrospectivos , Segurança , Veia Safena/transplante , Espanha , Estados Unidos
10.
Injury ; 50(3): 690-696, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30792004

RESUMO

OBJECTIVE: Fracture line of the sacrum always involves the Zone II region because sacral foramina are anatomically and physiologically weak regions of the sacrum. The purpose of this study is to compare the therapeutic effects of a sacroiliac screw and a minimally invasive adjustable plate (MIAP) for Zone II sacral fractures. METHODS: Patients with unilateral Zone II sacral fractures fixed with a unilateral sacroiliac screw or MIAP from August 2009 to January 2016 were recruited into this study and were divided into two groups: group A (sacroiliac screw) and group B (MIAP). Surgical time, blood loss, frequency of intraoperative fluoroscopy, and relative complications were reviewed. Radiographs and CT scans were routinely acquired to evaluate the fracture displacement and reduction quality. Fracture healing was evaluated in the radiographs at each follow-up. Functional outcome was assessed based upon the Majeed scoring system at the final follow-up. RESULTS: Thirty-one patients in group A and thirty-nine patients in group B were included in this study. No significant differences in average surgical time (P = 0.221) or blood loss (P = 0.234) were noted between group A and group B. The mean frequency of intraoperative fluoroscopy was 15.74±2.98 in group A and 6.08±1.94 in group B (P = 0.000). All fractures healed well within four months in all patients, and the healing time exhibited no significant difference between the two groups (P = 0.579). Satisfactory rates of reduction quality and functional outcome were not statistically different between the two groups (P > 0.05). The complication rate was 16.13% (5/31) in group A and 5.13% (2/39) in group B (P = 0.222). CONCLUSION: MIAP has a fixation effect and exhibits reduction potential for Zone II sacral fractures. Favourable radiographic and functional results could be obtained through the MIAP technique, which is easy to conduct without pre-contouring. Compared with the unilateral S1 sacroiliac screw technique, repeated projections and iatrogenic sacral injury can be avoided.


Assuntos
Placas Ósseas , Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias/cirurgia , Articulação Sacroilíaca/cirurgia , Adulto , Feminino , Fluoroscopia/estatística & dados numéricos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/lesões , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
11.
Orthopedics ; 42(1): 42-47, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30658003

RESUMO

Several technologies are available to assist surgeons with acetabular component positioning in total hip arthroplasty. The purpose of this study was to determine whether surgical positioning software would improve cup position compared with fluoroscopy. This prospective, randomized study compared 200 primary total hip arthroplasty cups placed with and without surgical positioning software. All cases were performed by a single surgeon using the direct anterior approach with fluoroscopy. The target abduction and anteversion angles were set at 40° and 20°, respectively, and measured postoperatively. Cup placement time, total fluoroscopy time, and cup position were compared between groups. Mean abduction was 40.4° (range, 32.7°-49.0°) in the software group compared with 42.3° (range, 33.7°-51.1°) in the control group. The cups placed using software were significantly closer to the target abduction angle (P<.001) with fewer outliers. Mean anteversion was 20.8° (range, 11.2°-31.7°) in the software group compared with 21.8° (range, 11.3°-34.3°) in the control group (P=.063). Eighty-seven percent of cups in the software group fell within 5° of the abduction target, compared with only 68% in the control group (P<.01). Cup placement took longer in the software group (7:04 minutes vs 4:58 minutes, P<.001), and 2 seconds more total fluoroscopy time was used in that group as well (12.9 seconds vs 11.1 seconds, P<.001). The software improved both the accuracy and the precision of cup placement, with only modest increases in surgical time and fluoroscopy time. [Orthopedics. 2019; 42(1):42-47.].


Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril , Ajuste de Prótese/métodos , Cirurgia Assistida por Computador , Idoso , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Prospectivos , Software
12.
Vet Radiol Ultrasound ; 60(1): 81-92, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30180290

RESUMO

Radiological skills including ultrasonography and fluoroscopy, require a combination of manual dexterity and visuospatial skill to develop competency. The ability to detect veterinary students with an interest in radiology but who are deficient in these skills, may permit more individual adaptations to training programs, allowing for students training in radiology to achieve maximal potential. The objective of this cohort study was to investigate whether innate dexterity and visuospatial skill could be used to predict performance of basic ultrasound and fluoroscopic skills in veterinary students. Fifty veterinary students from the Ontario Veterinary College completed three tests of visuospatial ability, two tests of manual dexterity, a three-dimensional mouse task, an ultrasound skill-testing task, and a fluoroscopic skill-testing task. Students who reported chopstick use completed the non-dominant hand ultrasound task significantly faster than students who did not (P = 0.001). There was a significant positive association between scores on the Mental Rotations Test and time to complete the non-dominant hand ultrasound task (P = 0.011) and fluoroscopy task (P = 0.029). No variables were associated with time to complete the dominant hand ultrasound task. The results of this study suggest that visuospatial skill, as assessed by the Mental Rotations Test, is a better predictor of baseline ultrasound and endovascular fluoroscopy skill than dexterity, with the exception of reported chopstick use, in veterinary students. Visuospatial skills can be developed and may be useful to include in the veterinary curriculum for students that are deficient, or students entering a field such as diagnostic imaging.


Assuntos
Fluoroscopia/veterinária , Destreza Motora , Percepção Espacial , Estudantes , Ultrassonografia/veterinária , Percepção Visual , Adulto , Competência Clínica , Estudos de Coortes , Educação em Veterinária , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Masculino , Ontário , Faculdades de Medicina Veterinária , Ultrassonografia/estatística & dados numéricos , Adulto Jovem
13.
Heart ; 105(3): 244-250, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30279268

RESUMO

OBJECTIVES: The association between obesity and atrial fibrillation (AF) is well-established. We aimed to evaluate the impact of index body mass index (BMI) on AF recurrence at 12 months following catheter ablation using propensity-weighted analysis. In addition, periprocedural complications and fluoroscopy details were examined to assess overall safety in relationship to increasing BMI ranges. METHODS: Baseline, periprocedural and follow-up data were collected on consecutive patients scheduled for AF ablation. There were no specific exclusion criteria. Patients were categorised according to baseline BMI in order to assess the outcomes for each category. RESULTS: Among 3333 patients, 728 (21.8%) were classified as normal (BMI <25.0 kg/m2), 1537 (46.1%) as overweight (BMI 25.5-29.0 kg/m2) and 1068 (32.0%) as obese (BMI ≥30.0 kg/m2). Procedural duration and radiation dose were higher for overweight and obese patients compared with those with a normal BMI (p=0.002 and p<0.001, respectively). An index BMI ≥30 kg/m2 led to a 1.2-fold increased likelihood of experiencing recurrent AF at 12-months follow-up as compared with overweight patients (HR 1.223; 95% CI 1.047 to 1.429; p=0.011), while no significant correlation was found between overweight and normal BMI groups (HR 0.954; 95% CI 0.798 to 1.140; p=0.605) and obese versus normal BMI (HR 1.16; 95% CI 0.965 to 1.412; p=0.112). CONCLUSIONS: Patients with a baseline BMI ≥30 kg/m2 have a higher recurrence rate of AF following catheter ablation and therefore lifestyle modification to target obesity preprocedure should be considered in these patients.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fluoroscopia , Obesidade , Sobrepeso , Idoso , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/terapia , Índice de Massa Corporal , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Comorbidade , Correlação de Dados , Europa (Continente)/epidemiologia , Feminino , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/psicologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Doses de Radiação , Recidiva , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Fatores de Risco , Comportamento de Redução do Risco
14.
Eur Radiol ; 29(4): 1931-1938, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30302590

RESUMO

OBJECTIVES: To evaluate factors associated with increased fluoroscopy time or the need for complex techniques at IVC filter retrieval. METHODS: This is a single-institution retrospective cohort study of 187 consecutive patients who underwent IVC filter retrieval. An analysis was performed on associations of patient factors with increased fluoroscopy time and/or the need for complex retrieval techniques. A complex retrieval was defined as one requiring more than standard sheath and snare technique. RESULTS: Access vein during filter placement was not associated with filter tilt at placement or removal (p = 0.61 and 0.48). Neither the direction of the hook nor its relationship to the tilt was associated with the need for complex retrieval or increased retrieval fluoroscopy time (p = 0.25, 0.23, p = 0.18, 0.23). Tilt angle at placement correlated with hook apposition at time of removal (p = 0.01). Hook apposition was associated with complex retrieval and increased fluoroscopy time (p < 0.01). Larger tilt angle at placement was not associated with complex retrieval (p = 0.22), but a larger angle at removal was (p < 0.01). Longer dwell time correlated with the need for complex retrieval (p = 0.02). Filter type, sex, and age were not associated with complex retrievals (p = 0.58, p = 0.90, p = 0.99). CONCLUSION: Contrary to previous hypotheses and studies, access vein for filter placement did not affect filter tilting, and direction of filter hook-tilt relationship did not affect retrieval fluoroscopy time or the need for complex retrieval techniques. Increased filter placement angle was associated with a larger angle at removal and hook-wall apposition, both of which were associated with complex retrievals. KEY POINTS: • Filter hook orientation did not correlate with retrieval complexity. • Filter insertion vein did not correlate with filter tilt. • Filter tilt and hook apposition to the caval wall at the time of retrieval correlated with retrieval procedure complexity.


Assuntos
Remoção de Dispositivo/métodos , Filtros de Veia Cava , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
15.
Cardiovasc Intervent Radiol ; 42(3): 441-447, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30374611

RESUMO

PURPOSE: Comparing total fluoroscopy time (FT) to perform uterine artery embolization (UAE) with transradial approach (TRA) versus transfemoral approach (TFA). Our hypothesis was that there would be no significant procedural time penalty incurred, despite the learning curve associated with adopting a new approach. MATERIALS AND METHODS: A cohort study was undertaken including 66 consecutive patients undergoing UAE with either TRA/TFA between January and September 2015. Total FT was recorded prospectively for each procedure, and data subsequently analyzed retrospectively. Each operator had at least 2 years of experience as an interventional radiologist having performed at least 200 TFA UAEs. All operators had recently incorporated TRA into their practice. RESULTS: A total of 39 TFA and 27 TRA cases were included in the study; mean age for TFA group was 44.4 years (± 4.9) and for TRA group was 45.1 years (± 4.9) (p = 0.59). Mean FTs were comparable between the two groups (p = 0.86) despite a learning curve associated with TRA: The mean total FT with TFA was 20.36 min (± 9.48) compared to TRA 20.12 min (± 7.67). CONCLUSIONS: FTs for TRA UAE were comparable to TFA UAE, even though TRA had been recently adopted as a new approach. Despite the learning curve associated with developing a novel technique, operators should not expect the efficiency of their service to be significantly compromised. Introducing this safe and effective method of vascular access should therefore be considered.


Assuntos
Radiografia Intervencionista/métodos , Embolização da Artéria Uterina/métodos , Adulto , Estudos de Coortes , Feminino , Artéria Femoral/diagnóstico por imagem , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Humanos , Curva de Aprendizado , Pessoa de Meia-Idade , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Radiografia Intervencionista/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Artéria Uterina/diagnóstico por imagem
16.
Dysphagia ; 34(2): 192-200, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30456424

RESUMO

One of the major limitations of the fiberoptic endoscopic evaluation of swallowing (FEES) is related to the challenging application of temporal measures. Among them, Whiteout (WO) is due to pharyngeal and tongue base contraction and might be used as an estimation of the pharyngeal phase duration. The aims of this study were to evaluate the inter- and intrarater reliability of WO duration and to appraise the effects of age, sex, volume, and texture of the boluses on this temporal measurement. A total of 30 healthy volunteers were recruited. According to their age, the subjects were grouped into three different age groups. Each of them underwent FEES examination with different textures (liquid, semisolid, and solid) and volumes. FEES examinations were video recorded, processed with the software Daisy Viewer 2.0, which allowed the acquisition of 25 frames per second (s) and analyzed by three different raters in order to collect data on WO duration. A total of 863 swallowing acts were video recorded. Intra- and interrater reliability of WO duration were excellent. Both volume and bolus's texture significantly affected WO duration. In particular, WO duration was significantly shorter for the liquid texture than for the semisolid and solids ones. In addition, male subjects scored significantly higher values of WO duration. Finally, WO duration was significantly higher in seniors. WO duration seems to be a reliable temporal measure during FEES examination. WO duration seems to be affected by several factors such as age, sex, volume, and consistency.


Assuntos
Cinerradiografia/estatística & dados numéricos , Transtornos de Deglutição/diagnóstico por imagem , Endoscopia/estatística & dados numéricos , Tecnologia de Fibra Óptica/estatística & dados numéricos , Fluoroscopia/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Cinerradiografia/métodos , Deglutição , Endoscopia/métodos , Feminino , Tecnologia de Fibra Óptica/métodos , Fluoroscopia/métodos , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Faringe/diagnóstico por imagem , Reprodutibilidade dos Testes , Fatores Sexuais , Língua/diagnóstico por imagem , Adulto Jovem
17.
Pediatr Cardiol ; 40(3): 638-649, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30542920

RESUMO

Ionizing radiation exposure is a necessary risk entailed during congenital cardiac catheterizations. The congenital catheterization lab at Yale New Haven Children's Hospital employed quality improvement strategies to minimize radiation exposure in this vulnerable population. In two phases, we implemented six interventions, which included adding and utilizing lower fluoroscopy and digital angiography (DA) doses, increasing staff and physician radiation awareness, focusing on tighter collimation, and changing the default fluoroscopy and DA doses to lower settings. Post-intervention data were collected prospectively for all procedures in the congenital catheterization lab and compared to pre-intervention radiation data collected retrospectively. Radiation exposure was measured in total air kerma (mGy), dose area product per body weight (DAP/kg) (µGy m2/kg), and fluoroscopy time (min). Data were collected for a total of 312 cases. In considering all procedures, the DAP/kg decreased by 67.6% and air kerma decreased by 63%. Fluoroscopy time did not change over the study period. Significant decreases in radiation exposure (DAP/kg) by procedure type were seen for atrial septal defect, patent ductus arteriosus, and transcatheter pulmonary valve procedures with a 45%, 42% and 83% decrease, respectively. Air kerma decreased significantly for ASD and PDA procedures with an 80% and 72% decrease, respectively. When compared to national benchmarks, the median DAP/kg and air kerma for these procedures are lower at our institution. The decreases continue to be sustained 2 years post-interventions. Systems-based interventions can be readily implemented in the congenital cardiac catheterization lab with dramatic and sustainable radiation dose reduction for patients.


Assuntos
Cateterismo Cardíaco/efeitos adversos , Cardiopatias Congênitas/cirurgia , Exposição à Radiação/prevenção & controle , Radiografia Intervencionista/estatística & dados numéricos , Adolescente , Angiografia/efeitos adversos , Angiografia/estatística & dados numéricos , Peso Corporal , Criança , Pré-Escolar , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/estatística & dados numéricos , Humanos , Lactente , Masculino , Melhoria de Qualidade/estatística & dados numéricos , Doses de Radiação , Exposição à Radiação/estatística & dados numéricos , Radiografia Intervencionista/efeitos adversos , Estudos Retrospectivos , Fatores de Tempo
18.
Surg Laparosc Endosc Percutan Tech ; 29(1): 22-25, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30520816

RESUMO

Radiation exposure during endoscopic retrograde cholangiopancreatography is known, however, data in relation to radiation usage is unclear. We evaluate radiation exposure using fluoroscopy dose (FD) and time (FT). A prospective analysis of 197 patients undergoing endoscopic retrograde cholangiopancreatography was completed. Univariate and multivariate analyses were performed to determine characteristics associated with higher FD and FT. The mean FT was 307 seconds; the mean FD was 16.5 centigray. On univariate and multivariate analysis, indication of common bile duct stricture and pancreatic stricture, interventions including dilation and the use of plastic stents placement, procedures that were moderately or very difficult, and procedures that used magnification and high-resolution images were associated with higher FD± and longer FT. Indications of common bile duct stricture and pancreatic stricture as well as interventions of dilation, plastic stents placement, and procedures that are moderately or very difficult, involve high-resolution image leading to a higher radiation exposure. Special care should be considered in these settings.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colestase/cirurgia , Fluoroscopia/efeitos adversos , Pancreatopatias/cirurgia , Ductos Pancreáticos/cirurgia , Colangiopancreatografia Retrógrada Endoscópica/métodos , Constrição Patológica/cirurgia , Feminino , Fluoroscopia/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de Radiação , Fatores de Tempo
19.
Ulus Travma Acil Cerrahi Derg ; 24(6): 581-586, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30516260

RESUMO

BACKGROUND: The purpose of this study was to determine the comparative effectiveness of the use of single fluoroscopy versus double fluoroscopy during intramedullary nailing in the oblique position for intertrochanteric femur fractures in terms of surgery and radiation time. METHODS: Fifty-two patients (20 men, 32 women; average age: 78.2 years; range: 69-88 years) were included in the study. While double fluoroscopy was used for 25 patients, single fluoroscopy was used for the remaining 27 patients. Data of the preparation time between anesthesia and surgery, surgery time, radiation time, bleeding volume, postoperative collodiaphyseal angle between the fractures and intact parts, and the tip-apex distance (TAD) were compared. RESULTS: The surgery time in the double and single fluoroscopy groups averaged 34.48±8.92 minutes and 50.37±16.63 minutes, respectively (p<0.01). The radiation time was 42.72±16.00 seconds for the double-fluoroscopy group and 68.22±21.53 seconds for the single-fluoroscopy group (p<0.01). The surgical preparation time, bleeding volume, collodiaphyseal angle and TAD distance did not vary significantly between groups (p>0.05). CONCLUSION: The use of double fluoroscopy in the oblique position in the surgical treatment of intertrochanteric femur fractures reduced the surgical time and the anesthesia time for patients, as well as the exposure to radiation, thereby also reducing the risk of complications.


Assuntos
Fixação Intramedular de Fraturas , Fraturas do Quadril , Duração da Cirurgia , Exposição à Radiação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Pinos Ortopédicos , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Fluoroscopia/métodos , Fluoroscopia/estatística & dados numéricos , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/estatística & dados numéricos , Fraturas do Quadril/diagnóstico por imagem , Fraturas do Quadril/cirurgia , Humanos , Masculino
20.
Surg Technol Int ; 33: 277-280, 2018 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-30276786

RESUMO

PURPOSE: To determine if low-level intraoperative fluoroscopy usage is associated with increased complications during an initial series for an experienced surgeon transitioning to direct anterior approach (DAA) for total hip arthroplasty (THA). MATERIALS AND METHODS: Subjects who underwent DAA were eligible for analysis. Inclusion criteria included the first 50 subjects who underwent DA hip arthroplasty by a single surgeon (January 2013 to December 2014). Total operating room (OR) time, fluoroscopy absorbed dose, flouoroscopy time, procedure time, and complications were collected and analyzed. Subject demographics were also collected with subjects divided by date of surgery to one of two possible groups. Simple linear regression analysis was performed to determine the relation between case number and both radiation dose and fluoroscopy time. RESULTS: Subjects underwent DAA total hip arthroplasty (n=45). Total OR time ranged from 1.1hrs up to 2.5 hours. Surgeries required an average fluoroscopic time of 7.8 seconds, with improvement over the series of 3.7 seconds. The average radiation dose or fluoroscopy was 2.6 mrem per case. This resulted in a total estimated exposure of 127 mrem over a 23-month period. No patients suffered intraoperative or postoperative fractures or revisions. No significant difference was found for the groups by weight, age, height, and body mass index. Regression analysis yielded a statistically significant (p<0.05) decrease in fluoroscopy time of 0.36 seconds per case over the 45 cases studied. CONCLUSION: An experienced single surgeon's learning curve in DAA THA can be accelerated, with proper training and technique, within a lifetime case experience less than 50 procedures. Surgeons should be aware that with proper techniques and sufficiently-experienced teams, a flattened learning curve is attainable while minimizing fluoroscopy exposure and maintaining clinical outcomes.


Assuntos
Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Fluoroscopia/estatística & dados numéricos , Humanos , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
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