Search PubMed⌕ Search

PubMed · 15183701

Which navigation when?

Abstract

If a surgeon is considering purchasing a navigation system, several factors have to be evaluated including, the planned applications, the equipment already installed, and the specific knowledge of the surgeon. For use in traumatology, fluoroscopy and more specifically 3-D fluoro-based computer guidance is preferable. These technologies are based on intraoperative acquired arbitrary images in contrast to CT-based techniques, which refer to preoperative acquired images that represent a so called "cannel reality". However, image quality has to be considered as fluoro-picture quality depending on the anatomical area (eg long bones, spine, pelvis) and body mass index. CT-based navigation provides better image quality and accuracy but is not able to visualize reduction processes. Therefore personal experience in courses or by on-site teaching is recommended prior taking the decision.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

Tobias Hüfner, Florian Gebhard, Paul A Grützner, Peter Messmer, Ulrich Stöckle, Christian Krettek. 2004. Which navigation when?. https://doi.org/10.1016/j.injury.2004.05.008

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Radiation exposure to the hands of orthopaedic surgeons: are we underestimating the risk?

INTRODUCTION: Previous studies reported that the radiation exposure to the hands of orthopaedic surgeons was far below the acceptable limit. However, the risk could have been underestimated as some factors were overlooked, namely monitoring trainees during average workload, placing dosimeters over the most susceptible locations, measuring the cumulative dosage of radiation and considering the dose limit for non-classified workers. MATERIALS AND METHODS: We performed a prospective study in two centres to estimate the radiation dose to the hands of two consultant trauma surgeons and two trainees (one assisting and one operating) while performing 47 fluoroscopy-assisted procedures. We used validated thermoluminescent dosimeters (TLDs) rings and fingerstalls for monitoring the cumulative dosage. RESULTS: Trainees were at higher risk while performing intramedullary nailing and during assistance. Higher radiation doses were recorded from dominant index fingers and particularly fingertips. CONCLUSION: The risk of radiation exposure appears to be higher than previously reported. Fingertips are more susceptible to radiation exposure and should therefore be monitored in forthcoming studies.

Fluoroscopy↗

Evaluation of inter- and intrafraction organ motion during intensity modulated radiation therapy (IMRT) for localized prostate cancer measured by a newly developed on-board image-guided system.

PURPOSE: To investigate prostatic organ motion at both setup and intrafraction using an onboard image-guided system. An intrafraction field-based repositioning method also was evaluated. MATERIALS AND METHODS: A dual fluoroscopy with amorphous-silicon flat panel (DFFP) system was used for the three-dimensional registration of implanted markers in the prostate of eight organ-confined cancer patients planned for treatment with intensity modulated radiation therapy (IMRT). Day-to-day motion errors were quantified and intrafraction displacements of more than +/-1 mm were corrected. RESULTS: Among 214 fractions and 565 system views, day-to-day mean magnitude of marker discrepancy +/- standard deviation (SD) was 1.76 +/- 1.4 mm, 3.14 +/- 1.6 mm, and 3.78 +/- 2.4 mm in the right-left, cranial-caudal, and anterior-posterior directions, respectively. The intrafractional mean magnitude +/- SD of marker displacement was 0.45 +/- 0.7 mm, 1.08 +/- 1.38 mm and 1.45 +/- 1.70 mm in the right-left, cranial-caudal, and anterior-posterior directions, respectively. Intrafraction corrected sessions (84/214) showed a median (range) of motion of 0.1 mm (-1.2 to 0.7 mm), -0.2 mm (-2.1 to 1.1 mm), and -0.2 mm (-1.7 to 2.0 mm) in the right-left, cranial-caudal, and anterior-posterior directions, respectively. CONCLUSION: Motion uncertainty can be considerably decreased with daily use of the DFFP system. Reduced intrafraction organ motion clearly endorsed the value of the repositioning approach, allowing a safer dose escalation protocol.

Fluoroscopy↗