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PubMed1993

[Colonoscopy without the aid of fluoroscopy. Results from a gastroenterological practice].

In Switzerland colonoscopy is usually performed with the aid of fluoroscopy. However, the advantages of fluoroscopy are uncertain and it involves much equipment. Accordingly, in 200 consecutive colonoscopies we attempted to work without reliance on fluoroscopy. In this way the cecum was reached in 92.5% of cases. Addition of the fluoroscope made it possible to reach it in a further 1.5%. It is concluded that in gastroenterologic practice colonoscopy can be performed without fluoroscopy since the success rate is essentially the same.

Adolescent↗
PubMed1993

Pelvic floor evaluation with dynamic fluoroscopy.

OBJECTIVE: To evaluate dynamic fluoroscopy of the pelvic floor for the study of women with pelvic floor disorders. METHODS: In a prospective, observational study in a tertiary care referral center, 30 women with prolapse beyond the introitus underwent comprehensive fluoroscopic imaging of the pelvic floor. RESULTS: Dynamic fluoroscopy of the pelvic floor was technically possible in all patients. Whereas the physical examinations appeared relatively similar in these patients, the fluoroscopic examination revealed distinct differences. Of the 30 women, 25 had a cystocele, 25 had a rectocele, and 26 had an enterocele. Eleven patients had their surgical plan modified accordingly. Pelvic floor fluoroscopy is not a test for urinary or fecal incontinence. However, incontinence was demonstrated objectively in ten women (eight with fecal incontinence, two with urinary incontinence). CONCLUSION: Dynamic fluoroscopy of the pelvic floor is a useful adjunct in the clinical evaluation of women with prolapse. This imaging can be used to individualize the operative approach to prolapse. It is superior to clinical examination for the detection of enterocele formation. In addition, it provides information regarding the emptying function of the rectocele, which is not obtainable on physical examination.

Adult↗
PubMed1999

Evaluation of sleep apnea syndrome with low-field magnetic resonance fluoroscopy.

The aim of this study was to assess the upper airway status of sleep apnea syndrome (SAS) patients with low-field MR fluoroscopy. Twenty patients with clinically diagnosed SAS underwent upper airway monitoring using MR fluoroscopy for 5 min while awake and for 30 min while asleep. A 0.064-T permanent-magnet MR imaging system was used for the study. No patients required any sedative drugs because of the very small gradient noise, except in one case. No occlusion was observed while patients were awake. Nine patients showed repeated occlusion at retropalatal (Rp) pharynx, whereas 11 demonstrated both simple Rp occlusion and combined retropalato-retroglossal (Rp + Rg) occlusions (complex occlusion). The mean frequency of occlusion in complex cases was significantly higher than that in simple Rp cases (p < 0.05). Low-field MR fluoroscopy was useful in determining the occlusion level while asleep in patients with SAS because of its quiet gantry and long-term monitoring capability. The MR fluoroscopy technique should prove to be a valuable clinical tool for the diagnosis and for determining the appropriate therapy in patients with SAS.

Adult↗
PubMed2004

CT-fluoroscopy guided interstitial brachytherapy with image-based treatment planning for unresectable locally recurrent rectal carcinoma.

PURPOSE: The aim of the study is to develop high-dose-rate (HDR) conformal interstitial brachytherapy by means of combined CT-fluoroscopy guidance with CT-based treatment planning for locally recurrent rectal carcinoma. METHODS AND MATERIALS: Brachytherapy needle insertion was guided with a helical CT scanner providing continuous fluoroscopy reconstruction. A video monitor placed adjacent to the CT gantry simultaneously allowed the operator to see the process of needle insertion. Final CT images were transferred by an online system to the treatment-planning computer, which reconstructed the implant needles and organ contours. The doses in planning target volume were normalized and geometrically optimized. The patients received a brachytherapy dose at 5 Gy twice daily with a hypofractionated accelerated schedule at a total dose of 30-50 Gy with or without external radiation therapy. Eighteen patients were treated with this procedure. RESULTS: Ten to thirty-six needles (average, 17.3) were successfully placed to the planning target volume in each patient. The average time for CT fluoroscopy was 357 seconds for each procedure. No accident was seen at needle insertion, but 2 patients developed incomplete peroneal nerve palsy after needle removal, but gradually recovered. CT-based treatment planning was faster and more accurate than projection reconstruction with conventional radiograms. Analysis of the dose volume histogram showed conformal dose distribution to the target, while avoiding normal structures. CONCLUSION: CT fluoroscopy guidance ensures safety and increases the accuracy of needle placement in brachytherapy. Conformal high-dose-rate (HDR) interstitial brachytherapy with CT-based treatment planning is a method worth considering for locally recurrent rectal cancer.

Adenocarcinoma↗
PubMed2004

Demonstrating the effect of theophylline treatment on diaphragmatic movement in chronic obstructive pulmonary disease patients by MR-fluoroscopy.

INTRODUCTION: The purpose of this study was to determine the increase in diaphragmatic excursion of patients with chronic obstructive pulmonary disease (COPD) treated with theophylline by MR-fluoroscopy which is an innovative method to demonstrate effectiveness of this treatment. MATERIALS AND METHODS: Investigations were performed on a 0.3 T open MR unit. MR-fluoroscopy images of 30 patients with COPD were obtained before and after theophylline treatment. Diaphragmatic movement values were recorded for evaluation. RESULTS: The response of the diaphragmatic movement in COPD patients treated with theophylline was evaluated by MR-fluoroscopy and an increase of 48% in diaphragmatic contractility was determined after the treatment. The increase in contractility was found to be parallel with respiratory function tests and clinical status. CONCLUSION: Diaphragmatic movement and response to the medical therapy in patients with COPD can be evaluated by MR-fluoroscopy method which can allow accurate measurements.

Adult↗
PubMed2002

Validation of fluoroscopy-based navigation in the hip region: what you see is what you get?

Fluoroscopy-based navigation systems can be used for internal fixation of intracapsular femoral neck fractures, with the object of optimizing positioning of the implant and reducing radiation exposure. With this technique, the virtual position and direction of a reamer can be simultaneously superimposed on anteroposterior (AP) and axial (AX) fluoroscopic images. However, surgeons have to rely on the accuracy of these systems, because the only intraoperative feedback on the true position of the reamer is the projection of a virtual reamer superimposed on two fluoroscopic images. The objective of this study was to evaluate the accuracy of the displayed position of the virtual reamer in relation to the true position of the instrument when using a fluoroscopy-based navigation system (medivision, Oberdorf, Switzerland). Secondary to this, the accuracy of the drill-channel measuring tool of the system was analyzed. The study was performed on 20 sawbones. To evaluate the position of the virtual reamer, an 8-mm Perspex bar was inserted in predefined drill channels in each sawbone. AP and AX fluoroscopic images of the sawbones with the Perspex bar were loaded into the workstation. The Perspex bar was then removed and exchanged for a navigated dynamic hip screw (DHS) reamer. The position of the Perspex bar in the images represented the true position of the reamer. Subsequently, the difference between the position of the virtual reamer and the Perspex bar was measured with a dedicated computer program. Drill-channel lengths measured with the system were compared with measurements obtained with a digital ruler. The mean difference in position of the Perspex bar and reamer at a predefined point was 0.90 mm (range: 0.00-3.21 mm) in 360 images. The mean difference in length measurements between the medivision system and the digital ruler was 1.00 mm (p = 0.01, SD =1.33). Reaming and measuring the screw channel of a DHS with a medivision fluoroscopy-based navigation system can be performed with an acceptable error margin.

Femoral Neck Fractures↗
PubMed1984

Joint fluoroscopy before arthrography: detection and evaluation of loose bodies.

Fluoroscopy before injection of contrast medium increased the usefulness and accuracy of arthrography in 14 of 22 patients with possible intra-articular loose bodies. Although loose bodies wedged between articular surfaces deep within the joint were immobile, a typical tumbling motion on fluoroscopy reliably identified most free-floating loose bodies. Fluoroscopy sometimes revealed abnormalities more clearly than the plain radiographs or arthrograms.

Ankle Joint↗
PubMed2006

Percutaneous iliosacral screw fixation of unstable pelvic injuries by conventional fluoroscopy.

OBJECTIVE: Closed reduction and retention of translatory unstable pelvic injuries (type C injuries), in order to restore the form and function of the posterior pelvis by percutaneous iliosacral screw osteosynthesis, using conventional fluoroscopy. INDICATIONS: Definitive treatment of the posterior pelvis in type C injuries (AO classification) with complete sacral fracture, sacroiliac joint (SI joint) dislocation, transiliac or transsacral dislocation fracture of the SI joint with insignificant small fragment and sacroiliac avulsion injuries which can be reduced almost anatomically in closed technique. CONTRAINDICATIONS: Poor general health, local soft-tissue damage, rotationally unstable type B pelvic injuries as well as type C injuries which cannot be reduced satisfactorily in closed technique. SURGICAL TECHNIQUE: Closed reduction, stab incision and percutaneous stabilization of the posterior pelvis by transiliosacral screw osteosynthesis, guided by fluoroscopy. POSTOPERATIVE MANAGEMENT: Partial loading of the injured side with 15 kg for 8-12 weeks with two underarm crutches. Implant removal 6-12 months after injury. RESULTS: 20 patients with a transforaminal sacral fracture consistent with a type C pelvic injury underwent screw fixation with fluoroscopy with 7.3-mm cannulated screws, placed in a transiliosacral position in the vertebral body of S1. The average preoperative displacement of 3.8 mm was decreased by closed reduction to 1.6 mm postoperatively. The average operating time was 55 min, the average screening time 2.22 min. Incorrect screw position with no consequences was observed in three patients; iatrogenic nerve damage was not found. All fractures healed within 3 months.

Adolescent↗
PubMed2003

[Fluoroscopy based surgical navitation vs. mechanical guidance system for percutaneous interventions. A controlled prospective study exemplified by distal locking of intramedullary nails].

The aim of this study was to directly compare mechanically based targetting and surgical navigation when applied for percutaneous osteosynthesis. The distal locking procedure of intramedullary nails was used as the clinical model for a controlled prospective study. A total of 50 patients were included in two groups. In group 1, the distal locking was done with a mechanical aiming device while in group 2 this was done using a fluoroscopy based surgical navigation system. The target parameters were the precision attained, the necessary operation and fluoroscopy times as well as the number and severity of intra-operative problems. The drill-bit failed to pass through the interlocking hole in one patient with mechanical guidance and in two patients with surgical navigation. The average procedure time for distal locking with mechanical guidance was 6.9 minutes compared with 37.6 minutes with surgical navigation. An additional 44 minutes were required before skin incision and after skin closure as setup time for the navigation system. There was no significant difference in the fluoroscopy time or in the number of intra-operative technical problems. Surgical navigation increased the demand for resources but failed to improve the precision of distal locking compared with mechanical guidance. Further clinical studies are required to determine to what degree these results, using a special model, relate to other applications.

Aged↗
PubMed2006

Radiation management and credentialing of fluoroscopy users.

During the last 15 years, developments in X-ray technologies have substantially improved the ability of practitioners to treat patients using fluoroscopically guided interventional techniques. Many of these procedures require a greater use of fluoroscopy and more recording of images. This increases the potential for radiation-induced dermatitis and epilation, as well as severe radiation-induced burns to patients. Many fluoroscope operators are untrained in radiation management and do not realize that these procedures increase the risk of radiation injury and radiation-induced cancer in personnel as well as patients. The hands of long-time fluoroscope operators in some cases exhibit radiation damage-especially when sound radiation protection practices have not been followed. In response, the Center for Devices and Radiological Health of the United States Food and Drug Administration has issued an Advisory calling for proper training of operators. Hospitals and administrators need to support and enforce the need for this training by requiring documentation of credentials in radiation management as a prerequisite for obtaining fluoroscopy privileges. A concerted effort on the part of professional medical organizations and regulatory agencies will be required to train fluoroscopy users to prevent physicians from unwittingly imparting serious radiation injuries to their patients.

Credentialing↗
PubMed2000

A multihospital survey of radiation exposure and image quality in pediatric fluoroscopy.

BACKGROUND: Traditionally, pediatric radiologists have been advocates of fluoroscopy systems that provide diagnostic images at the lowest possible radiation dose to the pediatric patient. Manufacturers of fluoroscopic equipment vary as to their claims of "low radiation" exposures. OBJECTIVES: To obtain comparative data on radiation exposure and image quality from four pediatric hospitals, across variants of fluoroscopic equipment (such as pulsed versus continuous fluoroscopy). MATERIALS AND METHODS: Images were acquired from phantoms that simulated the size of a 3-year-old child. Phantom results, both stationary and rotating dynamic, were evaluated for radiation exposure and for image resolution of high- and low-contrast objects. RESULTS: Radiation exposure from the four fluoro units varied widely; the lowest-dose selectable fluoro mode produced exposures varying between 34 and 590 mrads/min among the four fluoro units, and the highest-dose selectable fluoro mode produced 540-2,230 mrads/min. The lowest radiation exposures were produced by pulsed fluoro units, and the very lowest radiation exposure was produced by a fluoroscope that had been especially optimized for pediatric imaging. There was only a small variation in image quality among the hospitals for visualization of stationary objects. A wide variability was noted for detection of objects on the moving phantom. CONCLUSIONS: The variability in the number of detected objects was considerably smaller than the variability in radiation exposure. Pulsed fluoroscopy provides improved resolution for moving objects. Optimization of one hospital's fluoroscope especially for pediatric imaging produced the best ratio of image quality to radiation exposure.

Age Factors↗
PubMedDate not supplied

Better visualization of transbronchial biopsy using CT fluoroscopy.

PURPOSE: Computed tomography fluoroscopy (CTF) provides the capability for continuous CT imaging and has been increasingly used in interventional procedures. Our objective was to assess the usefulness of CTF in the monitoring of transbronchial biopsy procedures. METHODS: We evaluated nine patients in whom yield of "conventional" transbronchial biopsies had failed. CTF was performed on a Somatom Plus 4 Power scanner (CARE Vision CT, Siemens, Forchheim, Germany) using 120 kV, 50 mA at a frame rate of eight images per second on a matrix of 256 x 256. Image reconstruction was based on a partial scan with an acquisition time of 0.5 sec. The maximal time without interruption was 79 sec; after stopping for a few seconds a new period of 79 sec was available. The number of biopsies, procedure times, applied dose, and histologic results were documented. RESULTS: With CTF-guided transbronchial biopsy, the yield of the biopsies was improved. In seven patients biopsy yielded bronchial cancer; in one patient histopathologic examination showed tuberculosis. Only in one patient did CTF-guided transbronchial biopsy fail. The mean number of biopsies was four in each patient. Mean fluoroscopy time was 165 +/- 92 sec (range 111-272 sec) and mean procedure time was 800 +/- 302 sec (range 480-1081 sec). The applied dose ranged between 500 and 1224 mSv; the mean applied dose was 743 +/- 414 mSv. There were no fatal complications. CONCLUSION: Computed tomography fluoroscopy appears to facilitate visualization of transbronchial biopsy procedures, with the drawback of increased radiation exposure. To compare the "conventional" method versus CTF a randomized prospective study is necessary.

Aged↗
PubMed2006

A new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy.

The purpose of this study was to report a new technique for localization of hepatic tumors that are poorly visible with CT fluoroscopy. Forty-three hepatocellular carcinomas were not visible with CT fluoroscopy. A 22-gauge Chiba end-hole needle was inserted in the approximate location of a lesion estimated on the basis of anatomical landmarks demonstrated on both previous MR and CT images. We injected 3 ml of a mixture of nonionic contrast material and saline solution. Following the first injection, contrast solution filled the hepatic lesion in 29 of 43 cases. In 8 of 43 cases, contrast solution was distributed in the normal surrounding liver. In 7 of these 8 cases, repositioning allowed us to adjust the needle in the tumor. In the other 6 of 43 cases, contrast solution spread within capsule or pseudocapsule (pattern 3). In all 6 cases, repositioning allowed to adjust the needle in the tumor. This new technique allows an accurate localization of hepatic tumors that are poorly visible with CT fluoroscopy.

Adult↗
PubMed2001

MR-guided percutaneous drainage of abdominal fluid collections in combination with X-ray fluoroscopy: initial clinical experience.

The aim of this study was to examine the feasibility of a hybrid interventional MR system, which combines a closed bore magnet with a C-arm fluoroscopy unit for percutaneous drainage of abdominal fluid collections. During the past 2 years, we have performed four drainage procedures in four patients (mean age 47 years). Three patients had abscesses (psoas muscle, kidney, subphrenic location) and the fourth patient had a recurrent splenic cyst. All procedures were performed on an interventional MR system consisting of a 1.5-T ACS-NT scanner combined with a specially shielded C-arm. The drainages were guided by T1-weighted fast gradient-echo images, T2-weighted single-shot turbo spin-echo images or both. A standard 18 G (1.2 mm) nonferromagnetic stainless steel needle with a Teflon sheath was used for the punctures following which a 0.89 mm nitinol guidewire was inserted into the fluid collection. Thereafter, the patient was positioned in the immediate adjacent fluoroscopy unit and a drainage catheter was placed under fluoroscopic control. All drainage catheters were successfully placed into the fluid collections, as proven by fluid aspiration and resolution of the collection. The mean time needed for the entire drainage procedure (MR and fluoroscopy) was 110 min. No procedure-related complications occurred. It is feasible to perform drainage procedures on a closed-bore MR scanner. The multiplanar imaging capabilities of MR are particularly helpful for fluid collections in the subphrenic location.

Abdominal Abscess↗
PubMed2005

Percutaneous discography: comparison of low-dose CT, fluoroscopy and MRI in the diagnosis of lumbar disc disruption.

AIM: To compare the diagnostic accuracy of low-dose computed tomography (CT), magnetic resonance imaging (MRI) and fluoroscopy in percutaneous discography in patients scheduled for lumbar spondylodesis. MATERIAL AND METHODS: Within a prospective pilot study, 18 disc segments of 11 patients with radicular or pseudoradicular pain prior to anteroposterior spondylodesis were evaluated. After injection of a mixture of non-ionic iodine-containing contrast agent and gadolinium-based contrast medium into the disc spaces, all patients underwent conventional fluoroscopy, as well as low-dose CT and MRI. The occurrence of memory pain during contrast injection was recorded. CT, MRI and fluoroscopic images were analyzed independently by two readers blinded to the clinical findings. RESULTS: There was 100% agreement between CT and MRI discography in the detection, localization and grading of degenerative changes. In contrast, conventional fluoroscopy identified only 9 of the 12 abnormal segments. Memory pain following puncture was identified in 3 of the 12 affected segments. SUMMARY: Low-dose CT and MRI discography have a similar accuracy in the assessment of disc disruption and they are superior to fluoroscopic discography.

Adult↗
PubMed2006

Inserting pedicle screws in the upper thoracic spine without the use of fluoroscopy or image guidance. Is it safe?

Several studies have looked at accuracy of thoracic pedicle screw placement using fluoroscopy, image guidance, and anatomical landmarks. To our knowledge the upper thoracic spine (T1-T6) has not been specifically studied in the context of screw insertion and placement accuracy without the use of either image guidance or fluoroscopy. Our objective was to study the accuracy of upper thoracic screw placement without the use of fluoroscopy or image guidance, and report on implant related complications. A single surgeon inserted 60 screws in 13 consecutive non-scoliotic spine patients. These were the first 60 screws placed in the high thoracic spine in our institution. The most common diagnosis in our patient population was trauma. All screws were inserted using a modified Roy-Camille technique. Post-operative axial computed tomography (CT) images were obtained for each patient and analyzed by an independent senior radiologist for placement accuracy. Implant related complications were prospectively noted. No pedicle screw misplacement was found in 61.5% of the patients. In the remaining 38.5% of patients some misplacements were noted. Fifty-three screws out of the total 60 implanted were placed correctly within all the pedicle margins. The overall pedicle screw placement accuracy was 88.3% using our modified Roy-Camille technique. Five medial and two lateral violations were noted in the seven misplaced screws. One of the seven misplaced screws was considered to be questionable in terms of pedicle perforation. No implant related complications were noted. We found that inserting pedicle screws in the upper thoracic spine based solely on anatomical landmarks was safe with an accuracy comparable to that of published studies using image-guided navigation at the thoracic level.

Adolescent↗
PubMed2005

The use of virtual fluoroscopy in managing acute type II odontoid fracture with anterior single-screw fixation. A safe, effective, elegant and fast form of treatment.

BACKGROUND: The management of odontoid fractures represents both a clinical and a technical challenge due to the singular anatomy and biomechanics of the region. At present there is still much controversy as far as any form of management (surgical vs. conservative) is concerned and in any case there is not sufficient evidence to support a standardized form of treatment. This study was designed to further evaluate safety and efficacy of anterior odontoid single-screw fixation and to better determine the usefulness of Image Guided Surgery Virtual Fluoroscopy in treating such cases assessing also its advantages over traditional fluoroscopy and CT-guided frameless stereotaxy in the upper cervical spine surgery. METHODS: This was a retrospective review of ten patients presented during a short period of 18 months with acute traumatic Type II odontoid fractures. Nine underwent fixation within a mean of 3 days after injury, whereas a patient had to be operated upon on the 22nd day due to poor alignment with conservative treatment and ongoing instability. All patients postoperatively were fitted in a collar and then followed-up with serial clinical and radiographic examinations. FINDINGS: Radiological signs of fusion were seen in 10 cases (100%) (mean follow-up: 16 months). No complications occurred during the surgical procedure, nor were any instrumentation failures recorded; all patients remained neurologically intact. CONCLUSIONS: We believe that anterior odontoid screw fixation using Image Guided Surgery virtual fluoroscopy is a safe, effective, less time consuming and low x-ray exposure technique and we recommend this as the preferred treatment method for acute Type II odontoid fractures. Moreover, the use of image guided technology affords more precision, confidence and safety enabling the surgeon to approach the upper cervical spine in an easier and faster way.

Adult↗
PubMed1984

Diagnostic impact of thallium scintigraphy and cardiac fluoroscopy when the exercise ECG is strongly positive.

We studied 83 men, who had a chest pain syndrome, no prior history of myocardial infarction, and exercise-induced horizontal or downsloping ST segment depression greater than or equal to 0.2 mV. The 38 patients unable to complete Bruce stage II had a significant increased risk of coronary (0.97 vs 0.71) and multivessel (0.88 vs 0.61) disease (p less than 0.01) compared to the pretest risk; data obtained from exercise-reperfusion thallium scintigraphy and cardiac fluoroscopy did not alter the risk of coronary or multivessel disease. The 45 patients who had ST depression greater than or equal to 0.2 mV and a peak work capacity greater than or equal to Bruce stage III did not have a significant increased risk of coronary (0.76) or multivessel disease (0.44). When both exercise-reperfusion thallium scintigraphy and cardiac fluoroscopy were abnormal in this latter patient subgroup, the post-test risk of multivessel disease was increased from 0.44 to 0.82 (p less than 0.03); when both tests were normal, none of the patients had multivessel disease (p less than 0.03) and only 0.18 had coronary artery disease. Thus, cardiac fluoroscopy and exercise thallium scintigraphy increase the diagnostic content of the strongly positive exercise ECG, particularly in men who have a peak work capacity greater than or equal to Bruce stage III.

Angina Pectoris↗