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At least 1,387 records · Page 77Linked to original sources
PubMed2000

[Secondary ionizing radiation generated by digital and analog coronary cineangiographic equipment: influence of external systems of radiologic protection].

BACKGROUND: Exposure to ionizing radiation is a known hazard of radiological procedures. AIM: To compare the emission of secondary ionizing radiation from two coronary angiographic equipment, one with digital and the other with analog image generation. To evaluate the effectiveness of external radiological protection devices. MATERIAL AND METHODS: Environmental and fluoroscopy generated radiation in the cephalic region of the patient was measured during diagnostic coronary angiographies. Ionizing radiation generated in anterior left oblique projection (ALO) and in anterior right oblique projection (ARO) were measured with and without leaded protections. In 19 patients (group 1), a digital equipment was used and in 21 (group 2), an analog equipment. RESULTS: Header radiation for groups 1 and 2 was 1194 +/- 337 and 364 +/- 222 microGray/h respectively (p < 0.001). During fluoroscopy and with leaded protection generated radiation for groups 1 and 2 was 612 +/- 947 and 70 +/- 61 microGray/h respectively (p < 0.001). For ALO projection, generated radiation for groups 1 and 2 was 105 +/- 47 and 71 +/- 192 microGray/h respectively (p < 0.001). During filming the radiation for ALO projection for groups 1 and 2 was 7252 +/- 9569 and 1671 +/- 2038 microGray/h respectively (p = 0.03). Out of the protection zone, registered radiation during fluoroscopy for groups 1 and 2 was 2800 +/- 1741 and 1318 +/- 954 microGray/h respectively (p < 0.001); during filming, the figures were 15,500 +/- 5840 and 18,961 +/- 10,599 microGray/h respectively (NS). CONCLUSIONS: Digital radiological equipment has a lower level of ionizing radiation emission than the analog equipment.

Adult↗
PubMed2004

Selective lumbar nerve root blocks with CT fluoroscopic guidance: technique, results, procedure time, and radiation dose.

CT fluoroscopy may be used as a rapid and effective means of guiding needle placement when performing selective lumbar nerve root blocks. In this set of patients, the average external radiation dose was 0.73 mrem per procedure, with an average of 2 seconds of CT-fluoroscopy time and four images per procedure. Average physician room time was 7 minutes. Use of intermittent CT fluoroscopy during lumbar selective nerve root blocks can result in minimal radiation dose levels and procedure times that are comparable to fluoroscopic guidance.

Bupivacaine↗
PubMed2005

Vertebroplasty in the treatment of back pain.

PURPOSE: The aim of this study is to show the utility of vertebroplasty in the treatment of some types of back pain. Vertebroplasty is a venous embolisation of the vertebral body performed under computed tomography (CT) or fluoroscopy guidance with transpedicular, anterolateral, intercostovertebral or posterolateral approach with acrylic cement. MATERIALS AND METHODS: We report our experience in 85 patients suffering from low back and thoracic pain and treated with percutaneous vertebroplasty owing to osteoporotic vertebral compression fractures, vertebral haemangiomas or secondary lytic lesions of the spine. Patient selection was performed on the basis of physical examination, magnetic resonance or less frequently, with bone scan. CT has a minor role in selected cases to evaluate the integrity of the posterior wall. We treated 55 patients affected by acute osteoporotic vertebral compression fracture, 10 patients with vertebral haemangioma and 20 patients with metastatic lesions. The patients were placed in the prone position and the procedure was performed under fluoroscopy guidance in 80 patients and under CT guidance in 5 patients affected by metastatic lesions. In no cases was phlebography performed before the treatment. The approach adopted was bilateral in 45 patients and unilateral in the remaining 30 cases. Injection with a low viscosity cement was performed under fluoroscopy guidance with extreme precision in all cases. The amount of cement injected ranged from 4 ml (thoracic level) up to 12 ml (lumbar level). RESULTS: The results were better for osteoporotic cases (95%) and patients with vertebral haemangioma (90%) than with metastatic lesions (77%), with improvement within 24-72 hours after the treatment. We noted asymptomatic cement leakage in 39 cases but only in 2 cases was there an acute radiculopathy due to epidural cement leakage, which was treated and resolved medically in 1 month. At follow-up no cases were noted of fractures of vertebral bodies adjacent to the treated vertebrae. DISCUSSION AND CONCLUSIONS: Since the first case of vertebroplasty was used in vertebral haemangioma, the possibility of using this technique in other pathological conditions such as metastatic lesions and osteoporotic compression fractures has been clear. MR has a key role in the selection of patients while bone scan and CT can be useful in selected cases. Absolute controindication is local or systemic infection while relative controindications are epidural extension of the neoplastic lesion, vertebra plana, clinical signs of myelopathy or radiculopathy and coagulation disorders. The results of our study were better in patients treated for osteoporosis or haemangioma than in cancer patients. We consider percutaneous vertebroplasty a valid technique for the treatment of the pain due to osteoporotic compression fractures, vertebral haemangiomas or metastatic lesions.

Back Pain↗
PubMedDate not supplied

Correct placement of epidural steroid injections: fluoroscopic guidance and contrast administration.

We prospectively evaluated 316 caudal-approach epidural steroid injections given by staff radiologists and residents in our department over a 1-year period. Needle placement was checked with fluoroscopy and corrected if necessary. When the needle tip was within the sacral canal, nonionic contrast material was injected. If epidural contrast was not observed, the needle tip was repositioned. Of 111 procedures performed by physicians who had given fewer than 10 epidural steroid injections, 53 (47.7%) resulted in correct nonfluoroscopically directed placement of the needle. For physicians who had performed between 10 and 50 such procedures, 62 (53.4%) of 116 had correct nonfluoroscopically directed placement. For staff physicians, 55 (61.7%) of 89 placements were correct. Even when the sacral hiatus was easily palpated and a staff physician was confident that he or she was within the epidural space, fluoroscopy revealed incorrect placement 14.2% of the time (seven of 49 procedures). In addition, when the needle was positioned within the sacral canal and no blood was evident on Valsalva maneuver or aspiration, the injection was venous in 29 of 316 procedures (9.2%). The presence of blood on the needle stylus was not a reliable indicator of venous placement of the needle. Our findings indicate that fluoroscopy is essential for correct placement of epidural steroid injection. Contrast administration is necessary to avoid venous injection of steroids.

Adult↗
PubMed2007

Sacroplasty by CT and fluoroscopic guidance: is the procedure right for your patient?

BACKGROUND AND PURPOSE: Sacral insufficiency fractures are an infrequent but often disabling cause of severe low back pain. We report our results of a sacroplasty technique, using CT for needle placement and fluoroscopy to monitor the polymethylmethacrylate injection in a group of patients with sacral insufficiency fractures. METHODS: All patients had a history of chronic back pain and had an osteoporotic sacral insufficiency fracture documented by imaging before the procedure. With the patient under conscious sedation, a bone biopsy needle was placed under CT guidance; the patient was then transferred to the fluoroscopy suite, where a polymethylmethacrylate mixture was injected into the sacrum under real-time fluoroscopy. Clinical outcome was assessed by telephone. RESULTS: The procedure was performed on 13 female patients with an average age of 76 years (range, 60-88 years). A bilateral procedure was performed in 11 patients and a unilateral procedure was performed in 2 patients. An average of 4.1 mL of cement was injected for each treatment. There were no instances of cement extravasation into the central canal or sacral foramina. Long-term follow-up, averaging 15 months, was available in 6 patients. Five patients (83%) reported no symptoms of pain at all. The final patient, in whom a bilateral procedure was performed, was completely asymptomatic on the left side but reported persistent unilateral pain on the right. CONCLUSION: Sacroplasty is a safe and effective procedure in the treatment of sacral insufficiency fractures that can provide substantial pain relief and lead to a better quality of life.

Aged↗
PubMed1991

[Echocardiography-guided endomyocardial biopsy].

We have performed 20 echocardiography-guided endomyocardial biopsies in 16 patients, totalling 98 bioptic samples. In each case fluoroscopy was available to supplement the echocardiographic findings. The right ventricle was biopsied in 17 cases, the left ventricle in 3. All 3 left ventricular biopsies and 14 out of 17 right ventricular biopsies were satisfactorily guided by echocardiography. An adequate echocardiographic window was not obtained in 3 cases of right ventricular biopsies and the procedures were carried out under fluoroscopy. In 5 cases (25%), totalling 10 samples, echocardiography showed a somewhat different position of the bioptome from that suggested by fluoroscopy, thus guiding a significant repositioning of it. Finally, in one patient, echocardiography promptly visualized a severe pericardial effusion, due to cardiac perforation, thus allowing its immediate drainage.

Adult↗
PubMed1991

Endoscopically placed nasoenteral feeding tubes. Indications and techniques.

We reviewed indications, techniques, and results for endoscopic placement of nasoenteral feeding tubes by analyzing records of 29 hospitalized patients who had undergone 41 tube placements. Indications included gastric stasis after gastric surgery (11 patients), gastroparesis and reflux or both in critically ill trauma patients (10), stricture secondary to vertical banded gastroplasty (3), and partial gastric outlet obstruction (5). Two endoscopic techniques were used. The guidewire method in which a flexible, Silastic feeding tube is advanced over the guidewire to the desired site had 82 per cent success (22 of 27). Adjunct fluoroscopy achieved a 94 per cent success rate (17 of 18); success without fluoroscopy was 56 per cent (5 of 9). The pull-along method attached a suture to the feeding tube tip which was grasped with forceps and moved to the correct location (93% success; 13 of 14). Fluoroscopy was not used with this method. Feeding tubes were successfully placed in 35 of 41 attempts (85%) in 27 of 29 patients. Failures were caused by an inability to intubate the efferent limb of a gastrojejunostomy (2) and unrecognized guidewire movement (4). Tube use ranged from one day to six months. We conclude that endoscopic placement of nasoenteral feeding tubes is an effective means to establish a route for enteral nutrition in selected patients.

Endoscopy, Digestive System↗
PubMed1990

Pattern of cardiac calcification in tropical endomyocardial fibrosis.

Over a two-year period we investigated 55 patients with endomyocardial fibrosis, using two-dimensional echocardiography, color-coded echocardiography, and image intensifier fluoroscopy, to delineate the regional distribution of cardiac calcification. Thirty five patients (64%) were found to have calcification of the ventricular walls. Calcific deposits were seen in the right ventricle in 26(59%) patients and in the left ventricle in 16(44%) patients. All patients who showed calcification were in severe cardiac failure indicating late stage of the disease. When image intensifier fluoroscopy was taken as the gold standard, echocardiography had a sensitivity of 100% and a specificity of 98% in detecting cardiac calcification. The high incidence of calcification in the ventricular walls in the present study is apparently due to the systematic use of two-dimensional echocardiography and image intensifier fluoroscopy.

Adolescent↗
PubMed1990

Esophageal 24-h pH monitoring: is prior manometry necessary for correct positioning of the electrode?

In 24-h esophageal pH monitoring, the electrode is usually positioned 5 cm above the manometrically localized esophagogastric junction. In order to replace esophageal manometry for this purpose, we tested whether the esophagogastric junction can be identified correctly by fluoroscopy or the determination of the pH-step between stomach and esophagus, compared with esophageal manometry. The distance from the nares to the esophagogastric junction was determined three times with each of the three methods in 46 patients and 14 volunteers. Fluoroscopy assumed the esophagogastric junction 1.23 +/- 0.23 cm (mean +/- SE) lower than the peak pressure point determined at manometry, pH-step only 0.45 +/- 0.16 cm. With pH-step, only one subject had a difference of more than 3 cm to the manometrically defined esophagogastric junction, whether gastroesophageal reflux disease (as proven by pH monitoring) was present or not. We conclude that the esophagogastric junction can usually be identified with sufficient accuracy by the measurement of the pH-step between stomach and esophagus. Fluoroscopy is far less accurate than pH-step, and should not be used.

Adult↗
PubMed1988

Unrecognized pin penetration in slipped capital femoral epiphysis.

There are at least nine different techniques recommended to lower the incidence of femoral head penetration by fixation pins in the pinning of slipped capital femoral epiphyses. The routine use of fluoroscopy and placement of the fixation pins no closer than 8 mm (or one-third the radius of the femoral head) from the subchondral bone will leave a safe, workable margin. Confirmation of subchondral location after the procedure can be done with fluoroscopy. With the leg in maximal internal rotation, the fluoroscopic unit is rotated from anteroposterior (AP) to lateral under continuous monitoring to detect anterolateral and posteromedial quadrant penetrations. With the fluoroscopic unit in the lateral position, the foot is externally rotated 90 degrees, again under continuous monitoring, to visualize the anteromedial and posterolateral quadrants. If the femoral head cannot be well-visualized in the lateral view, use of a lateral x-ray machine and AP fluoroscopy can be helpful. Another useful technique when the head cannot be well-visualized is the injection of contrast medium through a cannulated screw.

Bone Nails↗
PubMed1981

Reduced radiation exposure in orthopaedic surgery. Experience with video disc recording in nailing of fractured hips.

Radiation exposure from conventional fluoroscopy and from video disc recording was estimated during routine nailing of hip fractures. Mean fluoroscopic time with conventional fluoroscopy was 385 +/- 168 s. and with video disc recording 24 +/- 9 s. The time required for the X-ray system to form one television image, as well as the actual radiation exposure, were measured on a phantom under conditions that simulated hip nailing. Radiation exposure was 90% less with video disc recording than with conventional fluoroscopy. The use of a video disc recorder in orthopaedic operations requiring radiographic control is strongly advocated.

Fluoroscopy↗
PubMed1993

Simplified method of evaluating dysfunction in St. Jude medical prosthetic heart valves.

The St. Jude medical valve is one of the most common heart valve prostheses used. More than 450,000 have been implanted. Patients with these prosthetic valves need full anticoagulation and close follow-up for life. Without adequate oral anticoagulation, thrombotic complications may develop. A simple method of evaluating the full range of motion of the valve leaflets can be attained by fluoroscopy. Fluoroscopy is easily available, non-invasive, and diagnostic. This article demonstrates early recognition of valve dysfunction due to thrombosis with fluoroscopy leading to prompt treatment.

Fluoroscopy↗
PubMed1995

Tubal cannulation.

While uterotubal chromopertubations were performed early in the 1970s with the introduction of hysteroscopy, cornual cannulation was extended and adapted to fluoroscopy. The disadvantages of fluoroscopy include the difficulty in ruling out tubal spasm, inability to evaluate distal tubal disease, and other pelvic abnormalities. Tubal cannulation has emerged as an excellent alternative to treat patients with cornual obstruction. Only those patients in whom cannulation fails should be subjected to microsurgical reconstruction. While cannulation with coaxial catheters began under fluoroscopy, the use of the hysteroscope simplifies the technique. With laparoscopy the hysteroscopic approach enables tubal cannulation and evaluation of the entire pelvis. Treatment of additional problems affecting the fallopian tubes, particularly adhesions and endometriosis, is possible. Laparoscopy helps in monitoring the procedure and visual assessment of tubal patency. The ability to observe the uterotubal junctions directly by hysteroscopy provides an excellent approach for tubal cannulation. There are two techniques to cannulate the fallopian tubes, either with coaxial catheters or catheters with distal balloons, but the result obtained with these two techniques is similar. The simplicity of coaxial catheters makes this approach more appealing, and with the hysteroscope one can avoid exposure to radiation. The results obtained with tubal cannulation are encouraging and this procedure should be offered as the initial method to attempt treatment of tubal cornual obstruction. Often it can represent an excellent alternative to microsurgical tubal anastomosis, avoiding a laparotomy and extended disability.

Anastomosis, Surgical↗
PubMed1996

Results of directly observed short-course chemotherapy in 112,842 Chinese patients with smear-positive tuberculosis. China Tuberculosis Control Collaboration.

BACKGROUND: Tuberculosis remains a substantial public health burden in China. The cure rate in treatment programmes has been about 50%. In 1991, a new project based on directly observed short-course chemotherapy was introduced. We report the results of the first 112,842 patients treated. METHODS: Patients with symptoms suggesting tuberculosis are referred by general health services to the tuberculosis county dispensary for physical examination and fluoroscopy. Those with suspicious findings submit three sputum samples for smear examination. Village doctors deliver free, directly observed therapy to all smear-positive patients on an outpatient basis. New cases are treated with streptomycin (750 mg), isoniazid (600 mg), pyrazinamide (2000 mg), and rifampicin (600 mg) every other day for 2 months, followed by 4 months of alternate-day isoniazid plus rifampicin. Previously treated patients receive streptomycin, isoniazid, pyrazinamide, rifampicin, and ethambutol (1250 mg) every other day for 2 months, followed by 6 months of isoniazid, rifampicin, and ethambutol. Patients are re-examined and smears are repeated at 2 months (then 3 months if still positive) and at 5 and 6 months (new cases) or 5 and 8 months (previously treated cases). FINDINGS: Nearly 1.6 million patients with suspected tuberculosis were referred for fluoroscopy between 1991 and 1994. 48% had suspicious findings on fluoroscopy and underwent sputum examination. 104,444 new smear-positive cases and 95,616 previously treated smear-positive cases have been diagnosed. Results of treatment for those enrolled up to the first quarter of 1994 show cure rates of 89.7% among new cases (55,213) and 81.1% among those previously treated (57,629). The failure rate in previously treated cases, an indicator of drug resistance, fell from 17.6% among 437 patients enrolled in 1991 to 6.2% among 7822 patients enrolled in the first quarter of 1994. INTERPRETATION: Our experience shows that high rates of compliance and cure can be achieved on a mass scale and in a short time by means of directly observed short-course chemotherapy and the WHO technical strategy for effective tuberculosis control.

Adult↗
PubMed1996

Risks of radiation exposure to orthopaedic surgeons.

The risks of occupational radiation exposure for orthopaedic surgeons has not been well documented. The use of fluoroscopy in orthopaedics has reduced morbidity and by reducing operative time and by reducing the invasiveness of procedures. Increasingly procedures requiring the use of fluoroscopy are being developed. In a prospective study we have monitored cumulative radiation exposure over a 6-month period. The exposure levels are well below the maximum dose limits for ionizing radiation as recommended by European Economic Communities EURATOM directives. Experimentally using a phantom patient it was shown that the exposure to ionizing radiation during the insertion of a dynamic hip screw was minimal. Despite the low level of exposure care should be exercised when using fluoroscopy.

Film Dosimetry↗
PubMed1998

An evaluation of the effects of semirigid cervical collars in patients with severe closed head injury.

The use of a semirigid cervical collar has been recommended to prevent further cervical spine injury in the management of trauma patients. These cervical collars are kept on obtunded patients for prolonged periods. We assessed the incidence of cervical collar related decubiti in patients with severe closed head injury (SCHI). We also assessed the utility of fluoroscopy in clearing the cervical spine of patients with SCHI. A retrospective chart review was performed on 52 consecutive patients with SCHI at a community hospital-based Level II trauma center over an 8-month period. Thirteen of 34 patients (38%) who survived >24 hours after admission developed decubiti related to the cervical collar. The patients who developed decubiti had a significantly greater duration of cervical collar placement (21.15 +/- 0.99 days) as compared with patients who did not develop decubiti (4.42 +/- 0.79 days; P = 0.001). Eight patients had their cervical spine assessed for ligamentous injury by bedside fluoroscopy. All eight patients had early collar removal; none of these patients developed decubiti. Patients with SCHI with semirigid cervical collars kept in place for prolonged periods of time are at risk for developing decubiti. Fluoroscopy in addition to standard radiographs may "clear" the cervical spine and allow early removal of these collars.

Adult↗
PubMedDate not supplied

Current issues in techniques of prostate brachytherapy.

Adenocarcinoma of the prostate is the most common malignancy diagnosed among men in the United States today. Brachytherapy permits conformal radiotherapy and dose escalation, and it offers the convenience of a single-day outpatient procedure which is very attractive to patients with a busy life-style. The reported potency preservation rates with brachytherapy are superior to both external beam radiation therapy (EBRT) and surgery. The older retropubic techniques have been replaced by ultrasound or CT-guided transperineal techniques. Prostate brachytherapy may be temporary or permanent, and the planning techniques for either approach are similar. This review briefly discusses the advantages and limitations of each. Temporary techniques may be used with low dose rate or high dose rate applications. The basic steps include assessing prostate volume by any diagnostic modality (CT or ultrasonography), determining total activity needed to encompass the gland and deliver the appropriate minimum peripheral dose, and determining the pattern of placement of the seeds within the gland. Preplanning may be done either by ultrasound or by CT. The operative technique requires the visualization of the prostate in three dimensions and is performed using combination of ultrasound and fluoroscopy or fluoroscopy in two axes. The New York Hospital technique employs CT-based preplanning along with ultrasound and fluoroscopy during the operative procedure. Special circumstances that necessitate neoadjuvant hormonal therapy include interference from the pubic arch and large volume glands. An analysis of patients with stage T2a disease treated at the New York Hospital-Queens, from 1990-1995, reveals an actuarial clinical freedom from relapse of 79% at 5 years and a 5-year biochemical freedom from relapse of 64% which is comparable to that reported for similar risk groups of disease by other centers. Potency is preserved in greater than 80% of patients in our series. Patient selection criteria include the pre-treatment prostate-specific antigen (PSA) level, tumor grade (Gleason), stage of disease, and presence or absence of bilateral positive biopsies and/or perineural invasion. Based on our review of the literature and our clinical results, we have divided patients with prostate cancer into good, intermediate and poor risk groups. We recommend brachytherapy as the sole procedure for good risk patients, and a combination of external beam radiation therapy (EBRT) and brachytherapy for the intermediate risk group. Future avenues for research include a search for improved imaging techniques and possibly newer isotopes.

Actuarial Analysis↗
PubMed1979

[Delay of retinal fluorescence as a death criterion].

Retinal fluoroscopy with measurement of the arm to retina circulation time can be used to evaluate the blood supply to the brain. When the brain tissue suffers from ischaemia as a result of circulatory failure, the arm to retina circulation time will be prolonged. Sixteen patients in deep coma resulting from serious cerebral disease were examined to verify cerebral ischaemia. The results of retinal fluoroscopy and cerebral angiography agreed. We find that retinal fluoroscopy is a simple and reliable method that can be used to detect brain death in comatose patients treated by automatic ventilation. We conclude that the main cerebral circulation can be regarded as occluded if the retinal fluorescence does not appear within 25 seconds after antecubital intravenous injection of fluoresceine. We suggest that the arm to retina circulation time exceeding 25 seconds may be used as a criterion of death.

Adolescent↗