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PubMed2000

[Precision and comparison of CT-, MRI- and DL-controlled interventions exemplified by lumbar facet infiltration--an experimental study].

We evaluated the accuracy of the needle tip representation by different imaging techniques for the guidance of facet infiltrations. For visualisation of the lumbar facet joints we used a high-field magnetic resonance tomograph (MRT) with a 2.0 Tesla field and 3.5 mm slice thickness, an open low-field magnetic resonance tomography (MRT) with an 0.064 Tesla field and 9 mm slice thickness, and IMATRON electron beam computed tomograph (EBCT) with a slice thickness of 6 mm, and a mobile C-arm fluoroscope. The study was performed on 4 human cadaveric lumber spine preparations, each of which had 8 facet joints. Under imaging control, special injection needles were placed as close as possible to the facet joint space. Following placement of he needle, all specimens were scanned with the electron beam tomograph using a slice thickness of 1.5 mm. The thin-slice study served as the gold standard. The distance between the tip of the needle and the facet joint was measured in all the images. Comparison of the different modalities with the gold standard revealed the following results: 1) median values of the absolute differences were 1.25 mm for high-field MRI, 1.35 mm for 6 mm EBCT, 2.05 mm for low-field MRI, and 2.30 mm for X-ray fluoroscopy. 2) While there was no statistically significant difference in the accuracy of tip localization between high-field MRI and 6" EBCT (p = 0.293), both systems were more precise than low-field MRI (p = 0.04) and X-ray fluoroscopy (p = 0.009). When choosing the best imaging technique, such additional factors as radiation, costs and time, must also be considered. Provided necessary radiological precautions are taken, and assuming careful pre-interventional planning, CT. EBCT and X-ray fluoroscopy are currently more effective than the expensive, time-consuming and costly magnetic resonance tomography.

Equipment Design↗
PubMed2002

[The radiation protective devices for interventional procedures using computed tomography].

A scattered dose and a surface dose from phantom measurements during interventional procedures with computed tomography (IVR-CT) were evaluated. To reduce the personnel exposure in IVR-CT, the new protective devices were developed and its effect evaluated. Two radiation protection devices were experimentally made using a lead vinyl sheet with lead equivalent 0.125mmPb. The first device is a lead curtain which shields the space of CT-gantry and phantom for the CT examination. The second device is a lead drape which shields on the phantom surface adjacent to the scanning plane for the CT-fluoroscopy. Scattered dose and phantom surface dose were measured with an abdominal phantom during Cine-CT (130 kV, 150 mA, 5 seconds, 10 mm section thickness). They were measured by using ionization chamber dosimeter. They were measured with and without a lead curtain and a lead drape. Scattered dose rate was measured at distance of 50-150 cm from the scanning plane. And, surface dose was measured at distance of 4-21 cm from the scanning plane on the phantom. On operator's standing position, scattered dose rates were from 8.4 to 11.6 micro Gy/sec at CT examination. The lead curtain and the lead drape reduced scattered dose rate at distance of 50 cm from the scanning plane by 66% and 58.3% respectively. Surface dose rate were 118 micro Gy/sec at distance of 5 cm from the scanning plane at CT-fluoroscopy. The lead drape reduced the surface dose by 60.5%. High scattered exposure to personnel may occur during interventional procedures using CT. They were considerably reduced during CT-arteriography by attaching the lead curtain in CT equipment. And they were substantially reduced during CT-fluoroscopy by placing the lead drape adjacent to the scanning plane, in addition, operator's hand would be protected from unnecessary radiation scattered by phantom. It was suggested that the scattered exposure to personnel could be sufficiently reduced by using radiation protection devices in IVR-CT. The radiation protection devices and the CT equipment should be improved or developed based on the radiation protection.

Humans↗
PubMed1999

[Comparison of radiation exposure of patients caused by selected interventional and angiography procedures--initial results].

PURPOSE: To determine and judge patient doses caused by selected interventional and angiographic procedures using the "Multiskip" digital C-arm unit. MATERIALS AND METHODS: The dose-area product and the fluoroscopic time were measured for 71 percutaneous transluminal angioplasties (PTA), 33 PTA with stent implantation, and 37 embolizations; in addition, they were also measured for 285 digital subtraction angiographies (DSA). In the case of 13 PTA, 10 embolizations, and 33 DSA the number of radiographs was determined, and the dose-area product was divided into two parts, fluoroscopy and radiography, applying a computer programme. RESULTS: The median values of the dose-area product and the fluoroscopic time amounted to 36 Gy cm2 and 11.5 min for PTA, 131 Gy cm2 and 14.4 min for PTA with stent implantation, 197 Gy cm2 and 24.5 min for embolisation as well as 87 Gy cm2 and 3.7 min for DSA. For the relation between dose-area products caused by fluoroscopy and radiography and the number of radiographs, median values of 0.67 and 70 for PTA, 0.58 and 153 for embolisation as well as 1.35 and 135 for DSA were determined. CONCLUSIONS: To reduce the relatively high patient doses the modification of the C-arm unit is aspired to realize pulsed fluoroscopy and automatic filter selection. Also experimental investigations will be done related to additional filtration and reduction of the image intensifier input dose rate and dose per frame, respectively. Then, the effect of dose reduction caused by these measures will be confirmed in a comparable patient study.

Angiography↗
PubMed2000

[Complications and risk of high frequency catheter ablation of tachycardiac arrhythmias].

Radiofrequency catheter ablation has established itself as a first line therapy for the curative treatment of many patients with supraventricular or atrioventricular tachycardias and also for selected types of ventricular tachycardia. The success rates of catheter ablation of various types of cardiac arrhythmias are impressively high. Procedure related complications can be attributed to the invasive nature of the technique (e.g., bleeding or other vascular complications, radiation exposure) but may also occur as a specific complication related to the type of intervention performed (e.g., complete AV-block following attempted modification of the AV-node). In patients undergoing radiofrequency ablation procedures, radiation exposure carries a small but measurable risk of malignancy and hereditary disorders. The risk of fatal malignancy has been calculated to be approximately 1/1000 per hour of fluoroscopy and the risk of significant hereditary disorders approximately 10 per 1 million live births per hour fluoroscopy time. However, it is important to realize that these risks are age and sex dependent being higher in young and/or female patients. For the physician performing catheter ablation procedures no significant risks related to fluoroscopy exposure may be expected as long as all established tools for protection are used. Based on the results of large single center studies and multicenter investigations, complications during or after radiofrequency catheter ablation of supraventricular or atrioventricular arrhythmias may occur in 4-5% of cases. Severe complications (life threatening or permanently disabling complications) may occur in approximately 1-2% of patients treated. In patients undergoing ablation of ventricular tachycardia, a higher incidence of total procedure related complications between 5-7% and severe complications (3-4%) may be expected. The higher incidence of complications in patients with ventricular tachycardia when compared to catheter ablation of supraventricular or atrioventricular tachycardia may be explained by the fact that many patients with ventricular tachycardia suffer from severe cardiovascular disease.

Adult↗
PubMed2000

[Radiofrequency catheter ablation of left-sided atrioventricular accessory pathways. Immediate and long-term results using the trans-aortic approach].

UNLABELLED: Catheter mapping and ablation of left accessory pathways may be difficult if the pathway fibre orientation is oblique across the mitral annulus. This is particularly true in case of concealed accessory pathway that conducts only in ventriculoatrial direction. The purpose of the study was to compare catheter ablation safety, efficacy, procedure and fluoroscopy times and number of radiofrequency energy deliveries for manifest and concealed left accessory pathways using retrograde transaortic approach. 56 patients (26 females) aged 41.6 +/- 15.1 years underwent 59 ablation procedures for 59 left accessory pathways. 25 (44.6%) patients with 27 concealed accessory pathways and additional 2 patients with a manifest pathway mappable only during retrograde conduction formed group I and were compared to 29 patients with a manifest accessory pathway mappable during ventricular preexcitation (group II). Ablation was acutely successful in all patients. Reablation was necessary for the pathway recurrence in 2 patients and for a different pathway in 1 patient. Deep femoral venous thrombosis complicated ablation in 1 patient. During the 14.9 +/- 8.2 (3-30) month follow-up period all the patients remain free of a pathway related tachyarrhythmia. Both the groups (I vs II) did not differ in procedure (180 +/- 76.7 vs. 187 +/- 75.8; p = 0.36) and fluoroscopy (25.3 +/- 18.6 vs. 33.5 +/- 24.7; p = 0.08) times (min) and number of radiofrequency energy deliveries (10.0 +/- 9.2 vs. 10.2 +/- 9.8; p = 0.46). CONCLUSION: Transaortic approach to the left concealed accessory pathways is safe and effective in virtually 100% of patients and, compared to manifest pathways, does not prolong procedure and fluoroscopy times nor the number of radiofrequency energy deliveries.

Adolescent↗
PubMed2002

Radiation dose and image quality in diagnostic radiology. Optimization of the dose-image quality relationship with clinical experience from scoliosis radiography, coronary intervention and a flat-panel digital detector.

UNLABELLED: X-rays are known to cause malignancies, skin damage and other side effects and they are thus potentially dangerous. Therefore, it is essential and in fact mandatory to reduce the radiation dose in diagnostic radiology as far as possible. This is also known as the ALARA (as low as reasonably achievable) principle. However, the dose is linked to image quality and the image quality may not be lowered so far that it jeopardizes the diagnostic outcome of a radiographic procedure. The process of reaching this balance between dose and image quality is called optimization. The aim of this thesis was to propose and evaluate methods for optimizing the radiation dose-image quality relationship in diagnostic radiography with a focus on clinical usefulness. The work was performed in three main parts. OPTIMIZATION OF SCOLIOSIS RADIOGRAPHY: In the first part, two recently developed methods for digital scoliosis radiography (digital exposure and pulse fluoroscopy) were evaluated and compared to the standard screen-film method. Radiation dose was measured as kerma area-product (KAP), entrance surface dose (ESD) and effective dose; image quality was assessed with a contrast-detail phantom and through visual grading analysis. Accuracy in angle measurements was also evaluated. The radiation dose for digital exposure was nearly twice as high as the screen-film method at a comparable image quality while the dose for pulsed fluoroscopy was very low but with a considerably lower image quality. The variability in angle measurements was sufficiently low for all methods. Then, the digital exposure protocol was optimized to a considerably lower dose with a slightly lower image quality compared to the baseline. FLAT-PANEL DETECTOR: In the second part, an amorphous-silicon direct digital flat-panel detector was evaluated using a contrast-detail phantom, measuring dose as entrance dose. The flat-panel detector yielded a superior image quality at a lower dose than both storage phosphor plates and screen-film. Equivalent image quality compared to storage phosphor plates was reached at about one-third of the dose. OPTIMIZATION OF PERCUTANEOUS CORONARY INTERVENTION (PCI): In the third part, influence of various settings on radiation dose and image quality in coronary catheterisation and PCI was investigated. Based on these findings, the dose rate for fluoroscopy was reduced to one-third. The dose reduction was evaluated in a clinical series of 154 PCI procedures before and 138 after the optimization. Through this optimization, the total KAP was significantly reduced to two-thirds of the original value. IN SUMMARY: This thesis indicates the possibility of dose reduction in diagnostic radiology through optimization of the radiographic process.

Coronary Angiography↗
PubMed2002

Intracardiac echocardiography: from electroanatomic correlation to clinical application in interventional electrophysiology.

Intracardiac echocardiography (ICE), using an ultrasound transducer at the tip of a percutaneously placed catheter, has recently been introduced for the visualization of the intracardiac anatomy and in order to reduce the fluoroscopy time. This review focuses predominantly on the current use of ICE in interventional electrophysiology. ICE has been shown to facilitate the targeting of specific anatomic landmarks, such as the crista terminalis, the Eustachian ridge, the tricuspid annulus, the coronary sinus ostium, and the pulmonary veins that cannot be adequately visualized at fluoroscopy. Direct imaging of these sites can be advantageous in that it facilitates the accurate guidance of the ablative procedure and shortens the fluoroscopy time. ICE has been demonstrated to be useful in the positioning and stabilization of the imaging ablation catheter, the evaluation of the lesion size and continuity and in the immediate identification of complications. Furthermore, in the last few years there has been a revival in the use of transseptal catheterization due to a larger development of radiofrequency catheter ablation in the left atrium. ICE, providing excellent views of the fossa ovalis and of the transseptal apparatus, can be safely used to prevent life-threatening complications following inadvertent puncture of anatomic structures such as the lateral wall of the left atrium or the aortic root. Moreover, ICE appears to be very useful in combining true anatomical features with electrical activation in an attempt to construct realistic electrical-anatomical maps. Finally, the three-dimensional tomographic reconstruction of intracardiac images and the phased array ICE catheter with Doppler capabilities seem to be promising tools both for the guidance of ablation procedures as well as in leading experimental studies.

Arrhythmias, Cardiac↗
PubMed2003

Real-time magnetic resonance imaging for interventional neuroradiological procedures.

Over the last two decades, interventional neuroradiologists have developed powerful techniques for the treatment of cerebrovascular disorders and brain tumors. Current interventional neuroradiological procedures are performed under X-ray fluoroscopy, which has allowed for high temporal and spatial resolution. However, these imaging techniques do not provide the treating physician with vital anatomic and functional information regarding vessel walls and the surrounding brain tissue. Better visualization of vessel structures and real-time information about the state of perfusion and metabolism of the surrounding brain tissue (real-time magnetic resonance arteriography, diffusion and perfusion-weighted imaging, apparent diffusion coefficient maps) would enhance safety and efficacy of neuroendovascular procedures available currently. Recent advances in magnetic resonance hardware and software have permitted significant enhancements in temporal and spatial resolution, which have resulted in the capability of visualizing anatomic structures with real-time fluoroscopy and angiography. This review outlines how real-time magnetic resonance procedures may replace conventional X-ray fluoroscopy in diagnostic and interventional neuroradiology during the next decade.

Brain Neoplasms↗
PubMedDate not supplied

Refractory occipital neuralgia: preoperative assessment with CT-guided nerve block prior to dorsal cervical rhizotomy.

BACKGROUND AND PURPOSE: Occipital neuralgia syndrome can cause severe refractory headaches. In a small percentage of people, these headaches can be devastating and debilitating, with the potential for complete relief following surgical rhizotomy. We describe CT fluoroscopy-guided percutaneous C2-C3 nerve block for the confirmation of diagnosis of occipital neuralgia and for demonstrating to patients the sensory effects of intradural cervical dorsal rhizotomy before the definitive surgical procedure. METHODS: Seventeen patients with occipital neuralgia underwent 32 CT fluoroscopy-guided C2 or C2 and C3 nerve root blocks. Of the 17 patients, nine had occipital neuralgia following prior neck or skull base surgeries. On the basis of the positive results of the nerve blocks in terms of temporary pain relief, all 17 patients underwent unilateral (n = 16) or bilateral (n = 1) intradural C1 (n = 9), C2 (n = 17), C3 (n = 17), or C4 (n = 7) dorsal rhizotomies. All patients were followed up for a mean of 20 months (range, 5-37 months) for assessment of pain relief. Sixteen patients were assessed for degree of satisfaction with and functional state after surgery. RESULTS: All patients had temporary relief of symptoms after percutaneous CT-guided block (positive result) and felt that occipital numbness was an acceptable alternative to pain. Immediately after surgery, all patients had complete relief from pain. At follow-up, 11 patients (64.7%) had complete relief of symptoms, two (11.8%) had partial relief, and four (23.5%) had no relief. Seven of eight (87.5%) patients without prior surgery had complete relief of symptoms and one (12.5%) patient had partial relief, as opposed to complete relief in four of nine (44.4%), partial relief in one of nine (11.2%), and no relief in four of nine (44.4%) patients with a history of prior surgery. Because of the small number of patients, this difference was not statistically significant (P =.110). Eleven of 16 (68.8%) patients stated that the surgery was worthwhile. Eight of 16 (50%) patients felt they were more active and functional after surgery, whereas 25% felt they were either unchanged or less functional than before surgery. None of the patients without a history of prior surgery reported a decreased sense of functional activity following rhizotomy. CONCLUSION: CT fluoroscopy-guided percutaneous cervical nerve block is useful for the confirmation of occipital neuralgia, for demonstrating to patients the sensory effects of nerve sectioning, and possibly as a guide for selection of patients for intradural cervical dorsal rhizotomy. Although not statistically significant, there was a trend toward better response to rhizotomy in patients without prior head or neck surgery.

Adolescent↗
PubMed2006

[Can we cure atrial flutter with radiofrequency ablation in an hour?].

BACKGROUND: Radiofrequency ablation of common atrial flutter requires the creation of a complete transmural ablation line across cavotricuspid region to achieve bidirectional conduction block. Irrigated tip catheters facilitate rapid achievement of this block by creation larger and deeper lesions. The EASTHER registry was organized to collect data about the efficacy of the procedure in small and middle volume centres in Central and Eastern Europe, all using THERMOCOOL catheter technology. METHODS: Easther is a prospective registry (April 2002-February 2003). 133 consecutive patients (81.1% male, age 59.0 +/- 10.4 years, range 30-81 years) with common atrial flutter were enrolled. Coincidence with atypical flutter was observed in 2.7%. Patients had a history of flutter of 31.0 +/- 53.6 month (range 1-403) and concomitant atrial fibrillation was observed in 42.9%. Structural heart disease was present in 38.9%. Amount of re-ablated cases was 14%. RF energy was applied during 60 sec in power-controlled mode at a setting between 40 to 50 W with an average flow rate of 19.0 ml/min. RESULTS: Acute success rate defined as bi-directional block was achieved in 93.1%, although 94.7% of cases were assessed successful by the treating electrophysiologist. Average number of RF applications was 12.0 +/- 7.0 (range 2-40) per procedure. Average delivered power varied between a minimum of 36.1 +/- 15.1 W till a maximum of 45.3 +/- 13.0 W, while the average maximum temperature observed at the same time was varied between 39.0 +/- 3.4 degrees C and 45.4 +/- 4.0 degrees C. Total procedure time was 100.1 +/- 42.7 min (range 20-280 min) and fluoroscopy time was 15.8 +/- 9.6 min (range 4-45 min). In comparable French TC registry Average total and fluoroscopy time were 46.4 +/- 33.6 min, and 10.0 +/- 6.8 min resp. In the Middle European centres total and fluoroscopy time was 96.1 +/- 40.9 min, and 15.0 +/- 8.9 min resp. In centres from Eastern Europe it was 120.3 +/- 51.2 min, and 20.4 +/- 11.9 min resp. Two adverse events were reported. Both patients had strong chest pain during ablation. These results are comparable with the literature data published. CONCLUSIONS: Irrigated tip catheters are effective and safe in ablation of common atrial flutter. This technology helps to accelerate and facilitate achievement of bi-directional isthmus block. Most of procedures were terminated to one hour in experienced centers in France as early as 2002. Procedures not exceeding one hour are feasible in case of spreading this method as method of first choice with gaining of experiences in centres of Middle and Eastern Europe.

Adult↗
PubMed1991

Clinical importance of coronary calcification detected by CT.

Coronary calcifications appear in advanced atheromatous lesions therefore fluoroscopy is useful for the detection of the atherosclerotic coronary artery disease (Aldrich et al., 1979). However, the detection of coronary calcification by fluoroscopy is difficult in the case of obesity or thick chest wall and also impaired by the background structures including bone and other intrathoracic calcifications. X-ray CT is more advantageous than fluoroscopy in the detection of coronary calcification. It can eliminate the interference from background structures and clearly demonstrates calcified sites of the coronary artery. Therefore, we investigated the clinical usefulness in the detection of coronary calcification with X-ray CT.

Adult↗
PubMed1989

[Differentiation of organ dose distribution during exposure to plain film and transillumination in relation to the path of the rays].

The analysis of present radiation exposure from exposure parameters with a computer program gives an orientation for the radiation burden to various organs of risk in dependence from geometric imaging parameters also for spot film radiographs taken under fluoroscopy. Recommendations for practical proceeding are derived. Considering the relation between fluoroscopy and spot film dose, minimum field size and optimum field location is important in fluoroscopy. With rare-earth-screens instead of conventional high speed screens a reduction of total dose by 27% can be achieved in conventional myelography, that was used as a model for our calculations.

Adult↗
PubMed1988

Echocardiography-guided endomyocardial biopsy. A 5-year experience.

The number of cardiac transplant procedures performed each year continues to increase and may exceed 1,600 procedures in 1987. In these patients, the diagnosis of rejection is obtained from serial endomyocardial biopsy. The absence of clinical symptoms associated with allograft rejection with cyclosporine therapy has necessitated a predetermined routine biopsy frequency that averages 10-15 biopsies per patient in the first posttransplant year. Traditionally, fluoroscopy has been used to guide the biopsy, but this technique has a number of negative features, including cumulative radiation exposure in the physician and the patient, limited portability, and the limited area of access (intraventricular septum) for biopsy. In contrast, echocardiography provides greater portability and flexibility for location of procedure performance, eliminates radiation exposure, provides important information about cardiac function, and safely allows biopsy of any area of the right ventricle, including the free wall and apex. We performed over 4,700 individual biopsies for evaluation of rejection in 58 patients who underwent orthotopic cardiac transplantation. Fluoroscopy was not required for any of the echocardiography-guided biopsies, and only two complications occurred in 4,700 biopsies. We propose, therefore, that echocardiography is a useful alternative or adjunct to fluoroscopy for guiding endocardial biopsy and is a technique that can be learned easily by anyone now performing biopsies.

Antilymphocyte Serum↗
PubMed1993

[Radiometric survey during hemodynamic studies with "Siemens Angioskop D" equipment].

PURPOSE: To provide data for professional specialized in these subjects, contributing to minimize their exposure radiation dosage. METHODS: We made a radiometric survey using a ionization chamber to check the exposure rate in several places in the examination's room to different operational conditions of X-ray equipment. RESULTS: The operational conditions on which we have gotten the highest scatter X-ray rate were: image intensifier with 17cm of diameter for left anterior oblique projection (45 degrees) and image intensifier with 27cm of diameter for perpendicular beam to the patient (0 degrees). During fluoroscopy and cinefilm mode we have got average reduction of 40% for scatter X-ray using the image intensifier of 27 cm of diameter. During the cinefilm the dose rates were 23 times bigger than the dose rate in fluoroscopy mode. CONCLUSION: An analysis of results show that the choice of X-ray entrance angle as well as the diameter of image's intensifier during the cinefilm and fluoroscopy mode change significantly the occupational exposure dosages. Considering that in this kind of procedure, physicians and assistants spent long time close to the patient, they should have special concern to observe the technical condition more appropriate as well as to make use of all protection devices to minimize the personnel dosage.

Cardiology↗
PubMed1996

[Transcatheter radiofrequency ablation in supraventricular tachycardia in children: immediate results and mid-term follow-up].

OBJECTIVES: The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation of supraventricular tachycardias due to a reentry circuit in a group of closely followed-up pediatric patients. PATIENTS: Forty-six pediatric patients (mean age 12.6 years, range 3-18) underwent a total of 48 radiofrequency ablation procedures for reciprocating supraventricular tachycardia. Thirty-nine had an orthodromic reentry tachycardia, 6 an atrioventricular node reentry tachycardia and 1 a permanent junctional reciprocating tachycardia. METHODS: To ablate the overt accessory pathways, the Kent potential (K) was identified and then the shortest A-K, and delta wave-K intervals were measured. The shortest V-A interval was identified for those concealed. For the left-sided accessory pathways, we used the retrograde transaortic approach in 10 procedures and the transseptal approach in 18. Atrioventricular node reentry tachycardia was ablated at the site where the slow-pathway electrogram was recorded. Follow-up clinical data, electrocardiogram, 24-hours Holter monitoring and transesophageal atrial stimulation were obtained and evaluated. RESULTS: Early: We performed a total of 48 procedures. Among 41 procedures performed in the 39 patients with accessory pathway, 38 were successful (92,6%). Mean fluoroscopy time was 31 +/- 18 min. For left sided accessory pathways, mean fluoroscopy time of procedures with retrograde approach was 45 +/- 10 min and with transseptal 23 +/- 12 min (p < 0.01). Ablation of slow-pathway in patients with intranodal reentry tachycardia was successful in 3/6 cases (50%). The patient with permanent junctional reciprocating tachycardia was successfully ablated. Late: All patients are alive and none was lost during the follow-up after a mean time of 12.9 months (range 5-33). Success at last follow-up was 100% in patients with an accessory pathway and 33% in patients with atrioventricular node reentry. In patient with permanent junctional reciprocating tachycardia, the arrhythmia appeared again one month after the procedure, thus a second successful attempt was performed. COMPLICATIONS: Major complications (6,5%) including a right femoral vein thrombosis (one patient), an hematoma without pulse loss (one patient) and a non-sustained monomorphic ventricular tachycardia (one patient). CONCLUSIONS: Our data show high efficacy of radiofrequency ablation in pediatric patients with accessory pathways. The risks are low at follow-up evaluation, but might be helpful a longer-term follow-up in order to evaluate the risk of a long fluoroscopy time and the arrhythmogenic effect of the scar.

Adolescent↗
PubMedDate not supplied

[The age of diagnostic radiologic equipment in Croatia].

The quality of health care also depends partly on technological equipment. Among the devices which diminish the quality of services if they are old, increasing at the same time the danger when used, are certainly those in radiodiagnostics. Besides, their age controls the dose of radiation to which patients and professional staff are exposed. The knowledge of the age of this equipment is the basis of the plans for further development. The aim of the study is to determine the age of each individual radiodiagnostic device in Croatian institutions. The assessment of each device was made by a qualified professional. The method of data collection was based on the uniform questionnaire which comprised radiodiagnostic devices older than ten years, classified according to type and location (primary health care center or hospital, in total 655 devices). Determination of the age index of generators and x-ray tubes older than seven years (according to the World Bank recommendation), included also mobile units (55 for fluoroscopy and 68 for radiography), devices for dental radiography, devices in private sector (118) and devices which are out of use but not officially blocked (88), which means in total 859 generators and 1111 x-ray tubes. In addition, the availability of image intensifiers for fluoroscopy and manufactures of all devices were determined. The results of the study reveal that in primary health care centers, out of 248 radiodiagnostic devices, 193 are older than ten years (77.8%), while 4 are of unknown age. In hospitals, out of 407 devices, there are 261 older than ten years (64.1%), while 46 are of unknown age (11.3%). Among devices for fluoroscopy, 97 out of totally 206 have no image intensifier (32%). These devices should be immediately excluded from utilization. The index of age above seven years, which is according to the recommendation of the World Bank the lifetime of devices, reveals that 859 generators out of totally 984 (91%) are too old to be used, while there are 1111 x-ray tubes out of totally 1206 (92%) which are in the same condition. Regarding the manufacturers, the ratio is also unfavourable, since 49.3% of devices have been manufactured by comparies whose technology and spare parts are now inaccessible (Elektronska industrija). Such unacceptable obsoleteness of the radiological equipment requires urgent renewal.

Croatia↗
PubMed1998

[Transthoracic needle aspiration biopsy. The diagnostic accuracy of pulmonary lesions].

We performed 91 transthoracic functions, under fluoroscopy, sonographically or by computed tomography control, at Clinic Hospital in Valencia. The procedures was performed with Chiba needle 22 gauges while the cytopathologist was present. Maximum number of needle passes was four. Malignant diagnosis has been obtained in 64.8% of cases, in 12 patients a benign diagnosis was obtained and confirmed, 13 cases were false negative and the specimen was insufficient for diagnosis in 7 (5 of them lesions had a diameter less than 2 cm). The study showed 82% for sensitivity, 100% for specificity and 85% for accuracy. The punction was guided by fluoroscopy in 49 patients, by sonography in 6 and by computed tomography control in 36. The accuracy diagnosis for fluoroscopy guidance was 96%. The complications were 9 (9.9%): Two patients presented minor hemoptysis resolved spontaneously, 6 patients showed minor pneumothorax and one patient was treated a cause of a large pneumothorax. We concluded that transthoracic biopsy is a simple and save technique that can provide a high diagnosis accuracy in patients with pulmonary pathology.

Biopsy, Needle↗
PubMed1997

Magnetic resonance imaging of the pediatric airway.

OBJECTIVE: To determine the role of magnetic resonance imaging (MRI) and how it relates to endoscopy as well as to other imaging modalities in the evaluation of pediatric airway disorders. DESIGN: A review study of children with various distal airway disorders over a 3-year period. Surgical procedures as well as all diagnostic imaging modalities were reviewed and analyzed with respect to clinical outcome. SETTING: Academic tertiary care children's hospitals. PATIENTS: Forty-nine children between the ages of 1 week and 14 years with the signs and symptoms of distal airway disorders. INTERVENTIONS: Forty-five of 49 children underwent airway endoscopy. Fourteen children also underwent fluoroscopy and 4 underwent echocardiography. When indicated, open surgical repair was performed and used to verify findings in 32 cases. RESULTS: Magnetic resonance imaging was the most accurate modality in defining extrinsic airway abnormalities. The findings of echocardiography were incorrect in 2 of 4 cases, and fluoroscopy, although accurate for tracheal narrowing and tracheomalacia, often could not elucidate that exact cause or missed left mainstem bronchial compression. Furthermore, tracheal narrowing to 50% or greater on MRI correlated 100% with the need for surgical intervention. CONCLUSIONS: Magnetic resonance imaging is a useful modality that has allowed us to accurately diagnose extrinsic pediatric tracheal abnormalities. In certain cases, MRI scans can be obtained prior to endoscopy. In those cases, definitive endoscopy and open repair are performed at the same procedure instead of at 2 separate procedures (ie, one for diagnostic endoscopy and the other for definitive repair).

Adolescent↗