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At least 73 records · Page 4Linked to original sources
PubMed2003

Accuracy of thoracic vertebral body screw placement using standard fluoroscopy, fluoroscopic image guidance, and computed tomographic image guidance: a cadaver study.

STUDY DESIGN: A surgical simulation study in human cadaver spine specimens was conducted to evaluate the accuracy of thoracic vertebral body screw placement using four different intraoperative imaging techniques. OBJECTIVE: To compare standard fluoroscopy, fluoroscopy-based image guidance with two different referencing methods, and computed tomography-based image guidance by the measuring the time required for screw placement, the radiation exposure to specimen and surgeon, and the accuracy of screw position in the thoracic spine. SUMMARY OF BACKGROUND DATA: Image guidance provides additional anatomic information to the surgeon and may improve safety of technically difficult surgical procedures. The placement of screws in the thoracic spine is a technically demanding procedure in which inaccurate screw positioning places the spinal cord, nerve roots, and paraspinal structures such as the aorta and pleural space at risk for injury. Image-guided surgery may improve the accuracy of thoracic screw placement. METHODS: Using four different intraoperative imaging methods, two experienced surgeons placed 337 vertebral body screws through the pedicles of thoracic vertebrae in 20 human cadaver thoracic spine specimens. The specimens then were examined with radiographs, computed tomography, and anatomic dissection to determine screw position. Measurements included procedure setup and screw insertion time, radiation exposure to the specimen, the surgeon's hand, the surgeon's body, frequency, direction, and magnitude of screw perforation through the cortical margins of thoracic vertebrae. RESULTS: As compared with surgery using standard fluoroscopy, fluoroscopy-based image guidance that uses multiple reference marks and computed tomography-based image guidance improves the accuracy of thoracic vertebral body screws, but increases the time required for screw placement and the specimen radiation exposure. Exposure to radiation is minimal at the surgeon's body level and dependent on surgical technique at the surgeon's hand level. Screw perforation occurs most frequently in the lateral direction. CONCLUSIONS: Fluoroscopy-based image guidance that uses only a single reference marker for the entire thoracic spine is highly inaccurate and unsafe. Systems with registration based on the instrumented vertebrae provide more accurate placement of thoracic vertebral body screws than standard fluoroscopy, but expose the patient to more radiation and require more time for screw insertion.

Adult↗
PubMed2005

Utility of computerized isocentric fluoroscopy for minimally invasive spinal surgical techniques.

OBJECTIVE: The purpose of this study was to prospectively evaluate the clinical utility and accuracy of intraoperative three-dimensional fluoroscopy as an adjunct for the placement of a complex spinal instrumentation. METHODS: The Siemens Iso-C three-dimensional fluoroscopy unit in the combination with the Stealth Treon computer volumetric navigational system was used. A total of 279 spinal instrumentation screws or transpedicular cannulations were performed in 69 patients. Accuracy, operative time, and amount of fluoroscopy utilization time were assessed for transforaminal lumbar interbody fusion (TLIF) and kyphoplasty cases. RESULTS: Only 4 percutaneous transpedicular lumbar screws out of 265 total (1.5%) were malpositioned. Average operative time for TLIF cases was 185 minutes (range 114-311 minutes) for one-level and 292.6 minutes (range 173-390 minutes) for two-level procedures. Biplanar fluoroscopy utilization time was 93 seconds (range 27-280 seconds) for one-level procedures and 216 seconds (range 80-388 seconds) for two-level procedures. Average surgery duration for kyphoplasty was 60 minutes (range 36-79 minutes) for one-level procedures and 68.5 minutes (range 65-75 minutes) for two-level cases. Biplanar fluoroscopy utilization time was 41.3 seconds per case (range 25-62 seconds). CONCLUSIONS: Use of intraoperative three-dimensional fluoroscopy for image guidance in minimally invasive complex spinal instrumentation procedures is feasible and safe. This technique provides excellent visualization of three-dimensional relationships. This potentially results in improved accuracy of screw positioning and the ability to detect misplaced screws prior to wound closure. This technique also potentially results in a significant reduction in radiation exposure for both the patient and the staff.

Adult↗
PubMed1999

[Control of percutaneous biopsy with CT fluoroscopy].

PURPOSE: Clinical evaluation of CT fluoroscopy and comparison with conventional CT guidance for monitoring of non-pulmonary percutaneous biopsy procedures. MATERIALS AND METHODS: 20 non-pulmonary CT-guided biopsy procedures were prospectively performed either with CT fluoroscopy or with conventional CT guidance. CT fluoroscopy was performed using 120 kV and 50, 70 or 90 mA at a frame-rate of three or six images per second. Number of punctures and biopsies, procedure times, radiation doses and histologic results were analyzed separately for conventional CT guidance and for CT fluoroscopy. RESULTS: With CT fluoroscopy, yield of biopsies was improved (p = 0.005, t-test) and procedure times were shorter than for conventional CT guidance (11.4 +/- 6.0 vs. 23.6 +/- 13.8 min; p = 0.03, t-test). Analysis of procedure related radiation exposure and histologic outcome showed no significant difference between conventional and fluoroscopic CT-guided procedures (p > 0.05, t-test). CONCLUSIONS: CT fluoroscopy facilitates guidance of percutaneous biopsy procedures. Compared to conventional CT assistance, procedure times are decreased while yield of biopsies is improved.

Adult↗
PubMed1975

Multiple fluoroscopy of the chest: carcinogenicity for the female breast and implications for breast cancer screening programs.

The risk of radiation carcinogenesis has been established for breast tissue from experience with total body irradiation and multiple fluoroscopy of the chest with the patient prone. The doubling dose has been estimated to lie between 20 and 50 rads. Before undertaking radiologic screening programs for breast cancer, therefore, it is necessary to determine whether exposures below this range are safe. Of 792 women who had had tuberculosis and were followed for a minimum of 20 years, 451 had had multiple fluoroscopy while supine; 341 had not had fluoroscopy. The first group received a total radiation dose to the breast averaging 17 rads (141.5 fluoroscopies); the incidence of breast cancer in this group was not increased. Had fluoroscopy been performed with the patient prone the total radiation dose would have averaged 308 rads. The difference is thought to explain the increased incidence of breast cancer attributable to fluoroscopy given with the patient prone. Mid-breast exposure with mammography or xeroradiography varies between 3 and 6 rads. Repetitive screening would, therefore, appear safe provided total exposure did not exceed 20 rads. With this restriction there would appear to be no reason to curtail screening of women for breast cancer.

Breast Neoplasms↗
PubMed2000

Positive predictive value of cardiac fluoroscopy in asymptomatic U.S. Army aviators.

The primary aim of this study was to determine the positive predictive value (PPV) of cardiac fluoroscopy in U.S. Army aviators. Cardiac fluoroscopy is one of the non-invasive tests used to screen for coronary artery disease (CAD) in the U.S. Army Cardiovascular Screening Program. The secondary objective is to determine the positive predictive value (PPV) of the combination of the aeromedical graded exercise test (GXT) and cardiac fluoroscopy. The results of these two screening tests are used to determine the need for coronary angiography. Records of 220 male aviators (mean age--42.3) who underwent coronary angiography from 1990-95 were obtained from the Aviation Epidemiology Data Register (AEDR) at Ft. Rucker, AL. These records contained results from the screening tests (GXT, cardiac fluoroscopy, and thallium scintigraphy) and coronary angiography. Significant CAD (SCAD) was present in 47 (21%), while 83 (38%) had minimal CAD (MCAD). The PPV of cardiac fluoroscopy was 81% for all CAD (34% for SCAD). GXT and thallium scintigraphy had a PPV of 62 and 67% for all CAD (23 and 45% for SCAD), respectively. The PPV's of the screening tests were not statistically different at the 95% confidence interval level. The combination of GXT and cardiac fluoroscopy had a PPV of 64% (21% for SCAD).

Adult↗
PubMed2003

[The value of using fluoroscopy during colonoscopy. A prospective randomized study].

INTRODUCTION: No randomised trials have estimated the value of using fluoroscopy for colonoscopy. The aim of our study was to estimate the rate of success using this method. MATERIAL AND METHODS: In a prospective trial 264 patients were included, 139 were examined without fluoroscopy-equipment (Group A), and 125 with fluoroscopy-equipment (Group B). We registered: Indication for colonoscopy, duration of the colonoscopy, medication, time in which X-ray was being used, whether coecum was reached or not, clinical results of the examinations and complications. In cases where coecum was not intubated the cause was registered. RESULTS: We found a significantly higher rate of success of the colonoscopy in Group B (84%) than in group A (74%) (p = 0.045). Pain and looping of the scope were the main reasons for insufficient examination. DISCUSSION: In a modern endoscopic ward fluoroscopy must be available, but it seems reasonable to start uncomplicated colonoscopies without the use of fluoroscopy. In cases where coecal intubation is not obtained, conversion to examination with fluoroscopy should be possible.

Adult↗
PubMed2003

[Procedures, spectrum and radiation exposure in CT-fluoroscopy].

PURPOSE: To assess the techniques, indications and radiation exposures incurred with CT fluoroscopy. MATERIAL AND METHODS: A 1-year period of use of CT fluoroscopy to guide diagnostic and therapeutic interventional procedures was analyzed. The spectrum of indications, different CT fluoroscopic methods and radiation exposures for the radiologist were assessed. Scatter exposures were measured with and without placement of a lead drape on the patient, with and without use of thin rubber radiation protection gloves. In addition, scattered radiation was determined for a combination of lead drape and radiation protection gloves. RESULTS: There is a wide variety for the use of CT fluoroscopy ranging from diagnostic biopsy procedures to therapeutic interventions such as radiofrequency ablation of liver metastases and CT fluoroscopy-guided osteosynthesis of fractures. Scatter exposure rates to the radiologists hand ranged from 1-320 microSv/case without use of a lead drape and without radiation protection gloves. The lead drape reduced the scattered exposure for the radiologists hand by 72%. Radiation protection gloves reduced scatter radiation by 49%. The combination of both radiation protection devices was most effective in decreasing the dose by 97%. CONCLUSIONS: CT fluoroscopy is a useful targeting method with a wide variety for interventional procedures. However, significant radiation exposures may occur. Therefore, the radiologists should be aware of different techniques of CT fluoroscopy guidance and the methods to reduce scatter radiation.

Adolescent↗
PubMedDate not supplied

Percutaneous drainage under real-time computed tomography-fluoroscopy guidance.

BACKGROUND/AIMS: The goal of our study was to assess the use of real-time computed tomography-fluoroscopy guidance for percutaneous drainage of abnormal thoracic, abdominal, and pelvic fluid collections. METHODOLOGY: The subjects were 32 patients who underwent 36 percutaneous computed tomography-fluoroscopy guided thoracic, abdominal, and pelvic drainage procedures to drain abscess (n=29), fluid collection after pancreatitis (n=3), lymphocyst after gynecological surgery (n=3), and the gallbladder transhepatically (n=1) between September 1997 and August 2003. The patient population was 28-86 years old and consisted of 19 men and 13 women. The drainage methods included a Seldinger's technique with a guidewire and serial dilators in every case. The procedures were guided by using a helical computed tomography scanner that provided real-time fluoroscopy reconstruction. RESULTS: Percutaneous drainage under real-time computed tomography-fluoroscopy guidance was successfully performed in every procedure. Real-time computed tomography-fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement. The only drainage-induced complication encountered was a subcutaneous hematoma after one procedure (2.8%). No patients had serious complications. The average procedure time was 32 minutes. CONCLUSIONS: Computed tomography-fluoroscopy is a useful method for guiding the accurate and safe drainage of abnormal thoracic, abdominal, and pelvic fluid collections.

Abscess↗
PubMed2001

Cervical spine instability: clearance using dynamic fluoroscopy.

Cle aring the cervical spine in a multiply injured trauma patient is a dilemma because clinical examination for ligamentous instability cannot be performed, and the standard cervical spine series can miss isolated ligamentous injury. Static flexion/extension views are unsafe, as the obtunded patient has no protective reflexes and cannot complain of pain during the exam. This results in a need for prolonged spinal immobilization and its attendant complications. Dynamic fluoroscopy may be useful in the detection of otherwise occult injuries.We performed a prospective study of a cervical spine clearance algorithm incorporating dynamic fluoroscopy with flexion/extension views. Inpatient records over a 3-year period were reviewed. Patient demographic data, results of cervical spine films and fluoroscopic exams, interventions based on positive results, and missed injuries were recorded.One hundred ten patients with normal spine plain films underwent dynamic fluoroscopy with flexion and extension views of the cervical spine. The average Glasgow Coma Score was 9.2 and the average revised Trauma Score was 9.5. Nine patients had evidence of cervical instability on exam. Six of these were deemed stable by the orthopedic or neurosurgical spine consultants, and these patients had their hard collars removed. One patient with positive findings had cervical immobilization with hard collar continued, a second had halo placement, and a third underwent spinal fusion for atlanto-occipital disassociation. No patients undergoing dynamic fluoroscopy were subsequently found to have missed cervical spine injury.With our protocol, 3 patients had significant cervical instability that would have been missed without dynamic fluoroscopy. Given the significant medical and legal ramifications of missed cervical spine injury and the benefits of early removal of cervical collars, more widespread use of dynamic fluoroscopy of the cervical spine is warranted.

Journal Article↗
PubMed2004

Successful bronchoscopic balloon dilation of nonmalignant tracheobronchial obstruction without fluoroscopy.

OBJECTIVE: To evaluate the safety and efficacy of bronchoscopic balloon dilation (BBD) without fluoroscopy for relief of tracheobronchial obstruction. METHODS: We performed a retrospective study of all adult patients who underwent BBD without fluoroscopy at the Tulane University Hospital and Clinic between July 1, 1997, and June 30, 2002. RESULTS: Twenty-four patients (mean [+/- SD] age, 58 +/- 14 years; 80% men) underwent 59 BBD procedures without fluoroscopy for the following conditions: iatrogenic tracheal stenosis (80%); saber-sheath trachea (4%); bronchial stenosis resulting from lung transplantation (4%); sarcoidosis (4%); Wegener granulomatosis (4%); and idiopathic stenosis (4%). All BBD procedures were performed via a rigid bronchoscope (61%) or a flexible bronchoscope (39%) without fluoroscopy. BBD was often combined with mechanical debridement (64%), stent placement (47%), or laser photoresection (19%), although in 26% of cases BBD was the only intervention. During the 59 procedures, 71 different balloon catheters were deployed a total of 112 times (deployment was defined as any use of balloon dilation in a different location, for a different purpose, or to a different inflation diameter). These 112 deployments were performed for primary dilation (49%), dilation prior to stent placement (28%), and stent seating (22%). Improvement in stenosis was achieved immediately postprocedure in all 59 procedures (100%). One balloon ruptured during inflation without clinically significant effect, and no other complications occurred. CONCLUSION: BBD without fluoroscopy for the relief of nonmalignant tracheobronchial obstruction can be safely performed through a rigid or flexible bronchoscope. It can be used alone or as an adjunct to other therapeutic modalities. In this series, 100% of airway obstructions were improved, and there were no clinically significant complications. BBD of a tracheobronchial obstruction without fluoroscopy is safe, efficacious, and cost-effective.

Adolescent↗
PubMed2001

Intraoperative accuracy evaluation of virtual fluoroscopy--a method for application in computer-assisted distal locking.

Virtual fluoroscopy integrates intraoperative C-arm fluoroscopy as an imaging modality for surgical navigation. In the operating room, the conditions for application of virtual fluoroscopy may be impaired. In such situations, the surgeon is interested in an intraoperative check to decide whether the accuracy available is sufficient to perform the scheduled procedure. The test principle is to include an artificial landmark within the fluoroscopic images acquired for virtual fluoroscopy. As this landmark is fixed outside the patient, it can be touched with the referenced tool prior to performing the procedure. A mismatch between the actual tool position at the landmark and the virtual tool position as visualized on the computer screen allows estimation of the system's accuracy. The principle described was designed for detection of inaccuracies resulting from input of nonoptimal data to the navigation system. The method was successfully applied during computer-assisted distal locking of intramedullary implants, and the test principle might be adapted for other applications of virtual fluoroscopy.

Fluoroscopy↗
PubMed2000

Surgical navigation based on fluoroscopy--clinical application for computer-assisted distal locking of intramedullary implants.

OBJECTIVE: Fluoroscopy is used to guide surgical instruments during orthopedic procedures. Radiation exposure and lack of spatial information are drawbacks of this method. Improvements are expected when fluoroscopy-based surgical navigation is used for intraoperative guidance, e.g., in computer-assisted distal locking of intramedullary implants. PATIENTS AND METHODS: The method was applied to 42 interlocking procedures during implantation of the short proximal femoral nail in 27 patients with pertrochanteric femoral fractures. Precision of interlocking, exposure time, operating time, and number of personnel required for computer-assisted distal locking were recorded. RESULTS: One misplaced interlocking screw was observed (2.3%), and contact between the drill bit and the nail during drilling was noticed in 8 cases (19%). The average exposure time was 16 seconds (range 4-42 seconds), and the procedure took an average of 43 min (range 20-70 min). The number of persons required for computer-assisted distal locking was reduced from three to one within the course of the study. CONCLUSIONS: Fluoroscopy-based surgical navigation provided precise intraoperative guidance for computer-assisted distal locking with minimal use of fluoroscopy. The complex system and related procedure times may be drawbacks in this application. Clinical studies are underway to define implants and surgical procedures where intraoperative guidance by fluoroscopy-based surgical navigation is beneficial for the patient and/or surgeon.

Computer Simulation↗
PubMed1991

Documenting the use of fluoroscopy during colonoscopic examination: a prospective study.

To determine the patterns of fluoroscopy use during colonoscopy, 500 consecutive patients undergoing colonoscopic examination were studied over a 6-month period. The procedures were performed on 195 patients by three gastroenterologists and on 305 patients by three colon and rectal surgeons. The study group comprised 237 women and 263 men aged an average of 62 years (range, 12-90 years). The results revealed that fluoroscopy was used during 37% of colonoscopic examinations. The most common indications for fluoroscopy were the treatment of sigmoid loops (42%) and the localization of the colonoscope tip (51%), totaling 93% of 312 fluoroscopic checks. The suspected position of the colonoscope tip was inaccurate in 15% (47/312) of fluoroscopic checks. The most common bowel location of the colonoscope tip during the fluoroscopic checks was the hepatic flexure (24%), followed by the cecum (21%). In all, 53% (166/312) of fluoroscopic checks involved the right colon. The selective use of fluoroscopy during more difficult cases was emphasized by the significantly longer time required for the procedure (36 vs 26 min) and the significantly lower cecal intubation rate (79% vs 99%). In summary, fluoroscopy is deemed to be a safe, reliable technique that facilitates the completion of difficult colonoscopic examinations. It is especially helpful in the treatment of sigmoid loops and in the precise localization of the position of the colonoscope tip, especially during negotiation of the right colon.

Adolescent↗
PubMed1997

[Radiation exposure in digital micturition cystourethrography in children. How much exposure by fluoroscopy?].

OBJECTIVE: Determination of the proportion of the dose-area product caused by fluoroscopy at voiding cystourethrography in children, using digital image intensifier technology. PATIENTS AND METHODS: Using computer-assisted dosimetry, we determined the dose-area product and the respective proportions of the dose-area product caused by fluoroscopy and radiography as well as the number of radiographs taken at a given examination of 40 children (8 children less than 2 years old, 15 children between 2 and 6 years old and 17 children between 6 and 15 years old). RESULTS: The computer software program correctly differentiated between fluoroscopy and radiography in 80% of cases. Incorrect results were primarily observed in newborns and young children. The total radiation dose ranged in relation to patient age from 22 to 651 cGy x cm2. Fluoroscopy was responsible for an average 78% of the applied radiation dose. CONCLUSION: Computer-assisted dosimetry is useful in determining the proportion of the dose-area product caused by fluoroscopy in older children undergoing voiding cystourethrography. When image intensifier technology is used, this accounts for more than 75% of the total radiation dose. The method is not suitable for use in small children.

Adolescent↗
PubMed2002

Dose reduction fluoroscopy in pediatrics.

BACKGROUND: It is essential that we find ways to reduce radiation exposure to children and maintain image quality. OBJECTIVES: We compared radiation dose, image quality, and spatial resolution when continuous and pulse fluoroscopy with a full and half dose are applied to a phantom. The film-screen technique was compared to fluoroscopy with the digitized spot technique (fluoro grab image) in procedures such as voiding cystourethrogram (VCUG). MATERIALS AND METHODS: Using a 15.1-cm Plexiglas phantom, we obtained dosimetry in milligrays (mGy), spatial resolution in number of line pairs per millimeter (lp/mm), and threshold contrast resolution in number of visible holes. To measure total radiation dose, we calculated the average elapsed fluoroscopy time for VCUG to be approximately 3 min and estimated the average number of exposures as 10. Dosimetry was obtained for full dose and half dose continuous, for 15 pulses per second (pps), 7.5 pps, and 3.75 pps. These were also calculated with normal, magnification 1, and magnification 2 factors. RESULTS: Results of the two most relevant parameters are shown: continuous full-dose fluoroscopy, 3 min, 10 photo spots, total dose of 28.7 mGy with 2 lp/mm of resolution and a threshold contrast of 2.2%, versus 3.75 pps half-dose fluoroscopy, 3 min, grab images, total dose of 3.7 mGy with 1.9 lp/mm of resolution and a threshold contrast of 2.3%. CONCLUSION: With minimal loss of resolution there is significant dose reduction (87%) when using 3.75 pps with digitized imaging.

Fluoroscopy↗
PubMed2001

Paediatric fluoroscopy--a survey of children's hospitals in Europe. I. Staffing, frequency of fluoroscopic procedures and investigation technique.

BACKGROUND: Fluoroscopy is an important, sometimes vital radiological procedure in paediatric patients with high variability in frequency and technique. OBJECTIVE: To obtain data on paediatric fluoroscopy practice in Europe using a simple questionnaire mailed to 191 children's hospitals. RESULTS: Eighty-eight radiology departments in 21 European countries participated in the survey. There was great variation in the size of paediatric hospitals in Europe and, consequently, the numbers of staff members (radiographers and radiologists). The total number of fluoroscopy procedures varied widely; the mean value was 1,073 examinations per year. The most frequent fluoroscopic examination was the micturating cystourethrogram, comprising 40% of total fluoroscopies. For all types of investigations there were enormous differences in the number of spot film images routinely obtained. Only a few departments have prepared protocols for junior doctors or radiographers. CONCLUSIONS: Although the number of fluoroscopic investigations per radiologist does not reflect real workload (the difficulty of the investigation was not requested), it can be stated that a considerable percentage of children's hospitals are understaffed. These results also clearly demonstrate that fluoroscopy guidelines for the most common investigations in paediatric patients are needed to improve the quality of examinations and limit radiation exposure to the patients.

Europe↗
PubMed2001

Effective dose in Albanian direct chest fluoroscopy.

In the absence of reliable supplies of X-ray film, direct fluoroscopy is still extensively used in Albania, with chest radiology a particularly common application. This paper aims to quantify both patient skin dose and the risk-related quantity effective dose for direct fluoroscopy units based in seven different Albanian X-ray departments. A standard Quality Assurance (QA) protocol was used to assess tube potential accuracy, half value layer and X-ray tube output of these units. Three groups of X-ray beam parameters were defined from the QA results, covering the range of chest posteroanterior (PA) fluoroscopy technique factors seen during the study. Organ-equivalent doses were then measured for a nominal PA chest fluoroscopy examination using a Rando anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosimeter chips. Normalised organ dose factors are listed for the three groups of beam conditions simulated. Using these factors, effective dose for the seven systems surveyed was found to be between 0.06 and 0.42 mSv for a 20 s PA chest fluoroscopy examination. Mean effective dose for this group of systems was 0.22 mSv which is a factor of 13 greater than mean effective dose for film/screen PA chest radiography in the UK, whereas entrance surface dose was a factor of 50 greater than the current EU reference level.

Albania↗
PubMed2000

Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy.

The purpose of this paper is to present our experience with real-time computed tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and to describe this technique involving puncture under laser guidance. We attempted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy. 25 procedures were performed in prone position and 5 procedures in the supine position. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7-110 s). The PNT placement was successful as a sole procedure including puncture and catheter placement in 24 of 30 cases; in the remainder of cases, puncture was performed under CT guidance but the catheter was definitively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encountering difficult access to the pelvicaliceal system.

Female↗