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PubMed1991

Enteral feeding tubes: placement by using fluoroscopy and endoscopy.

Fluoroscopy and endoscopy are both effective for guiding placement of enteral feeding tubes, but the relative advantages and limitations of the two methods are less clear. Consequently, we studied 104 consecutive patients referred for primary fluoroscopic placement of a Frederick-Miller feeding catheter. Success rate, fluoroscopic and room times, and tube position were determined. Unsuccessful fluoroscopic placement was followed immediately by an endoscopic attempt. The success rate for fluoroscopic placement was 90% (94/104), with the tube placed into the jejunum in 53% and into the duodenum in 47%. The fluoroscopic and room times for successful fluoroscopic placements were 8.6 +/- 5.6 min (mean +/- SD) and 21.7 +/- 8.4 min, respectively. For the 10 unsuccessful placements, the fluoroscopic and room times were 16.2 +/- 5.4 min (mean +/- SD) and 45.6 +/- 18.4 min, respectively. Both time differences were significant statistically. Endoscopic placement was successful in all seven patients in whom it was attempted, with a mean time of 13.4 min. The tubes placed endoscopically were in the jejunum in 29% and in the duodenum in 71%. Our results show that fluoroscopic and endoscopic placement of enteral feeding tubes is highly effective. Fluoroscopic time in successful cases is usually less than 15 min. Endoscopic placement of feeding tubes is successful after fluoroscopic failure.

Adult↗
PubMed1996

Using the World-Wide Web to train and certify physicians in the safe use of fluoroscopy.

OBJECTIVE: We sought to create a computer-generated certification examination that concurrently tests and educates fluoroscopy users. MATERIALS AND METHODS: A trial examination was placed on the Internet for area physicians who requested fluoroscopic privileges at our institution. The name and address of each individual who achieves a passing score is automatically sent by e-mail to the examination administrator. RESULTS: Physicians expressed widespread satisfaction with this certification process. The difference in number of attempts and score of the first attempt between groups of radiologists and nonradiologists favored the radiologists (p approximately .03 in both cases) when analyzed using an unpaired t test. CONCLUSION: This examination ensures understanding of the procedural parameters that contribute to skin injury in patients and affords an easy approach to self-education.

Certification↗
PubMed2000

Glossoptosis (posterior displacement of the tongue) during sleep: a frequent cause of sleep apnea in pediatric patients referred for dynamic sleep fluoroscopy.

OBJECTIVE: The purpose of this study was to evaluate the frequency of glossoptosis (posterior displacement of the tongue) as a cause of sleep apnea in pediatric patients referred for fluoroscopic sleep studies. MATERIALS AND METHODS: Seventy consecutive dynamic fluoroscopic sleep studies performed to evaluate sleep apnea were reviewed. All patients had been sedated and examined with lateral fluoroscopy during sleep. Anatomic changes in the airway were correlated with episodes of oxygen desaturation. Cases of glossoptosis, in which the tongue moved posteriorly during sleep and abutted the posterior pharynx, resulting in airway obstruction and oxygen desaturation, were identified. Associated factors were reviewed. RESULTS: Of 70 sleep studies reviewed, glossoptosis was the cause of airway obstruction in 17 patients (24%). Mean age in these 17 patients was 3 years (range, 5 days to 13 years). Seven of the 17 children were younger than 1 year old. Only three patients had no underlying medical problems. Four patients had macroglossia (Down syndrome, n = 3; duplicated tongue, n = 1) as a cause, and three patients had micro- or retrognathia (Pierre Robin syndrome, n = 2; Rubinstein-Taybi syndrome, n =1) as a cause. Six patients had neuromuscular abnormalities. CONCLUSION: Glossoptosis was a cause of airway obstruction in 25% of pediatric patients referred for fluoroscopic sleep studies. Attention to this anatomic region is important when evaluating children with sleep apnea.

Airway Obstruction↗
PubMed2003

MR imaging-guided adrenal biopsy using an open low-field-strength scanner and MR fluoroscopy.

OBJECTIVE: The aim of our study was to test the feasibility and specific properties of MR imaging-guided adrenal biopsy using an open 0.2-T scanner and MR fluoroscopic fast imaging with steady-state free precession sequences. CONCLUSION: MR imaging-guided biopsy of the adrenal gland is feasible and safe. In all patients, appropriate specimens were obtained with full diagnostic yield and accuracy. MR fluoroscopy is particularly useful to establish an oblique paravertebral access without pleural transgression. For final needle placement, supplementary breath-hold multislice sequences are required in most cases.

Adrenal Gland Neoplasms↗
PubMed1988

Evaluation of time interval difference digital subtraction fluoroscopy in patients with cystic fibrosis.

In this study the potential of thoracic subtraction fluoroscopy has been evaluated on the basis of our experience with this functional imaging modality in patients presenting with cystic fibrosis. The method, which consists of subtracting dynamic digital fluoroscopic images of the breathing chest in the time interval difference (TID) mode, applies to the study of the lucency variations during the respiratory cycle and provides dynamic functional information about ventilation and/or perfusion and diaphragmatic kinetics, without any injection and with minimal irradiation. To assess the validity of the TID procedure, our results were compared with standard roentgenography, clinical data, and scintigraphic findings, with emphasis on the latter. The limitations and advantages of TID compared with scintigraphy are discussed. Three groups of discrepancies emerge which do not discredit TID. TID offers rather the advantage of providing anatomic pictures and unique dynamic information, which is emphasized.

Cystic Fibrosis↗
PubMed2000

[A swallowing study, based on clinico-pathological evaluation, performed by video-fluoroscopy].

A clinico-pathological evaluation was performed on patients requiring nasogastric nutritional support. As a result, it was found that nasogastric tube feeding was common in patients with cerebrovascular diseases (CVD) and senile dementia of Alzheimer's type (SDAT). Pneumonia was anamnestic in many CVD patients, which was frequently the direct indication for nasogastric tube feeding and the major cause of death in these patients. On the other hand, pneumonia was not common in SDAT in which the major indication of nasogastric tube feeding was abnormal appetite. However, pneumonia was an infrequent cause of death in SDAT compared to CVD patients. The mean age in which nasogastric tube feeding was started was 8 years older in SDAT than CVD patients, however, there was no significant difference in the duration of nasogastric tube feeding ranging from initiation to death. A swallowing study, based on a clinico-pathological evaluation, was performed by video-fluoroscopy on healthy seniors and senior patients neurological diseases. There was no abnormal finding in the healthy seniors. Findings in CVD patients with single-sided neurological diseases indicated that 27.3% had moderate abnormalities and 18.2% had severe abnormalities. In CVD with bilateral defects, 35.7% had moderate abnormalities and 42.9% had severe abnormalities. Though even single-sided CVD defects can frequently cause swallowing disorder, oral food intake was maintained in nearly half of the patients with bilateral CVD, despite high incidence of severe swallowing disorder. In the mild SDAT group, rated on a scale from 0.5 to 1.0 according to the Clinical Dementia Rating (CDR), 11.1% had moderate swallowing disorder. In the CDR 2-3 group, 23.1% had moderate disability and 15.4% had severe disability. It appears that SDAT patients do not suffer from rapid deterioration in swallowing ability, which was relatively retained in this disease group. In Parkinson's disease patients with a Yahr grade of I-II, 55.6% had normal findings and 44.4% had mild abnormalities. In Yahr grade III-IV patients, 28.6% had mild and 28.6% had severe disability. Patients with severe dysfunction had a high incidence of silent aspiration. The swallowing function was maintained in the early course of mild Parkinson's disease patients, however the ability rapidly deteriorated with the course of the disease. The radiological findings of the swallowing study supported the clinico-pathological characteristics of each disease.

Aged↗
PubMed1980

Spinal cord glioma after multiple fluoroscopies during artificial pneumothorax treatment of pulmonary tuberculosis: case report.

A patient is reported who developed multiple basal-cell carcinomas of the skin, a breast carcinoma, an astrocytoma of the spinal cord, and a bronchial carcinoid tumor following multiple fluoroscopies during artificial pneumothorax treatment for pulmonary tuberculosis. A review of the literature revealed no previously documented cases of radiation-induced gliomas of the spinal cord.

Astrocytoma↗
PubMed2003

Percutaneous trigeminal nerve radiofrequency rhizotomy guided by computerized tomography fluoroscopy. Technical note.

The authors describe a new procedure for percutaneous trigeminal radiofrequency rhizotomy. Computerized tomography fluoroscopy is used for guidance of the rhizotomy needle insertion through the foramen ovale. Ten patients were treated using this method, and in each case the target was reached with a single puncture. The potential benefits of this method are presented.

Female↗
PubMed2003

Three-dimensional fluoroscopy-guided percutaneous thoracolumbar pedicle screw placement. Technical note.

The authors sought to evaluate the feasibility and accuracy of three-dimensional (3D) fluoroscopic guidance for percutaneous placement of thoracic and lumbar pedicle screws in three cadaveric specimens. After attaching a percutaneous dynamic reference array to the surgical anatomy, an isocentric C-arm fluoroscope was used to obtain images of the region of interest. Light-emitting diodes attached to the C-arm unit were tracked using an electrooptical camera. The image data set was transferred to the image-guided workstation, which performed an automated registration. Using the workstation display, pedicle screw trajectories were planned. An image-guided drill guide was passed through a stab incision, and this was followed by sequential image-guided pedicle drilling, tapping, and screw placement. Pedicle screws of various diameters (range 4-6.5 mm) were placed in all pedicles greater than 4 mm in diameter. Postoperatively, thin-cut computerized tomography scans were obtained to determine the accuracy of screw placement. Eighty-nine (94.7%) of 94 percutaneous screws were placed completely within the cortical pedicle margins, including all 30 lumbar screws (100%) and 59 (92%) of 64 thoracic screws. The mean diameter of all thoracic pedicles was 6 mm (range 2.9-11 mm); the mean diameter of the five pedicles in which wall violations occurred was 4.6 mm (range 4.1-6.3 mm). Two of the violations were less than 2 mm beyond the cortex; the others were between 2 and 3 mm. Coupled with an image guidance system, 3D fluoroscopy allows highly accurate spinal navigation. Results of this study suggest that this technology will facilitate the application of minimally invasive techniques to the field of spine surgery.

Bone Screws↗
PubMed1998

[The method of computer-assisted orthopedic surgery based on two-dimensional fluoroscopy: the principles of action].

Surgical instruments play a major role in orthopedic surgery; usually they are controlled visually at the operation. In certain situations additional device to control instrument is needed. The aim of this paper is to present theoretical foundations, create prototype and give initial assessment of computer assisted orthopedic surgery system. Two-dimensional fluoroscopy was the base for system functioning. Lab tests and first applications in the operating room are presented. Precision of the system found allows for its use in orthopedic surgery with television monitoring.

Bone Diseases↗
PubMed2000

Radiation risks of high-dose fluoroscopy.

Radiation-induced skin injury is an underdiagnosed, significant complication for patients undergoing fluoroscopy-guided interventional procedures. With proper equipment, fluoroscopic technique, and physician education, patient radiation exposure can be decreased by 75% or more and skin injuries can be minimized.

Dose-Response Relationship, Radiation↗
PubMed2000

[The usefulness of thoracic needle biopsy under computed tomographic fluoroscopy].

Computed tomographic (CT) fluoroscopy was utilized to perform percutaneous needle biopsies in 16 patients with abnormal thoracic shadows. Biopsies were successfully performed in 15 of the patients. A diagnosis was made in 13 cases (81%; 11 of 12 malignant and 2 of 4 benign lesions). The time required to perform a biopsy ranged from 16 to 45 minutes (26.6 minutes on average). Complications were observed in 4 patients; pneumothorax occurred in 3 and hemoptysis in 1. CT-fluoroscopic guidance was indicated when the tumor was small, located near blood vessels or in the mediastinum, or poorly visualized or invisible on conventional radiographs.

Adult↗
PubMed2001

[Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking: a minimally invasive treatment for small peripheral early adenocarcinoma of the lung].

We developed a marking technique and subsequent thoracoscopic wedge resection as a diagnostic procedure for small peripheral lung nodule and a treatment for small peripheral early lung cancer. Fluoroscopy-assisted thoracoscopic surgery after computed tomography-guided bronchoscopic barium marking. Through CT-guided bronchoscopy, barium marking is done at just central to the target lesion. Thoracoscopic surgery is performed some days later. The barium marking was grasped in the forceps and resected by endostaplers under both intraoperative fluoroscopic and thoracoscopic guidance. All the lesions could be resected with enough surgical margin. This minimally invasive surgery is indicated for small peripheral in situ adenocarcinoma of the lung.

Adenocarcinoma↗
PubMed2001

Fluoroscopy-guided transpedicular trocar biopsy of the spine--results, review, and technical notes.

The purpose of this study was to evaluate the technique and value of fluoroscopy-guided percutaneous transpedicular trocar biopsy in obtaining diagnostic tissue from vertebral body lesions and to review the current literature. The bone cores from 32 patients who underwent 34 transpedicular Jamshidi trocar biopsies for lesions in the thoracic, lumbar and sacral spine were examined. All samples were examined macroscopically for length and breakage and microscopically for trabeculae, marrow, and artifacts. Each sample was graded for its value for histologic examination. The diagnostic accuracy was assessed by the patient's clinical course and follow-up examinations. In 30 (93.8%) of the 32 patients a confirmed diagnosis or exclusion of pathology could be made. In 31 (91.2%) of 34 biopsies the quality of the specimen was assessed as "excellent". Two (5.9%) specimens were "good" and one (2.9%) was "poor". There were two minor complications (5.9%). Transpedicular biopsy of the spine using a Jamshidi trocar with an internal diameter of 3.1 mm under fluoroscopic guidance can be performed safely and efficiently and provides suitable bone cores for histologic examination. A combined clinical, radiological and pathological approach to the lesions leads to an excellent diagnostic yield.

Adolescent↗
PubMed1999

Improved percutaneous slipped capital femoral epiphysis treatment: continuous biplanar fluoroscopy and proper guide wire selection.

In 1990, a report was published outlining a technique of percutaneous fixation of slipped capital femoral epiphyses dramatically diminishing the morbidity associated with the open technique. Technical difficulties are still encountered with the morbidly obese child and the percutaneous technique. Two fluoroscopic units used continuously during the technique facilitate placement of the guide wire in a more acceptable anatomic location. Guide wire stiffness was also measured and used in preoperative planning. Ten hips were treated with this technique, and a prospective analysis of the surgical time and fluoroscopy time was done. Using the new technique, we found a significant reduction in surgical and fluoroscopic times.

Bone Screws↗
PubMed2002

A virtual fluoroscopy system and its use for image guidance in unicompartmental knee surgery.

The C-arm fluoroscope is an indispensable intraoperative 2D imaging device for orthopaedic surgery. However, its frequent use in an operation presents a significant radiation hazard to the theatre staff and patient. A recent technique known as virtual fluoroscopy (VF) enhances the fluoroscope's capability for image guided surgery by tracking optically the position of the C-arm, surgical instruments and the patient. Virtuality is achieved by overlay of surgical instruments onto one or more previously captured fluoroscopic images. A key benefit of VF is that it reduces considerably the radiation hazard. This paper reports on a new VF technique for tracking and calibration of the fluoroscopic C-arm. Also reported is the use of our VF system to provide a new image guided technique for the accurate placement of the femoral component of unicompartmental knee prosthesis.

Arthroplasty, Replacement, Knee↗
PubMedDate not supplied

CT fluoroscopy-guided epidural injections: technique and results.

Lumbar epidural injections are typically performed blindly or with fluoroscopic guidance. CT fluoroscopy (CTF) can be used to guide needle placement precisely and rapidly, allowing visualization of the optimal needle path and identifying potential problems such as severe stenosis and synovial cysts before needle insertion. Operator and patient radiation dose is minimal when using the intermittent CTF technique and low mAs. By using this technique, just more than 2000 epidural steroid injections have been performed with no major complications. CTF is a useful guidance tool when performing lumbar epidural injections.

Fluoroscopy↗