Patient Selection for Minimally Invasive Spinal Surgery
Alexander R. Vaccaro, Christopher M. Bono in Minimally Invasive Spine Surgery, 2007
Fluoroscopy is utilized for almost all less invasive procedures. Some procedures, such as the placement of percutaneous pedicle screws, require a significant amount of fluoroscopy. The additive effects of fluoroscopy during occupational exposure to radiation can be significant for the surgeon and surgical team. For this reason, the surgeon should take steps to limit the effective radiation exposure to operative personnel. Modern, high-efficiency fluoroscopy equipment should be used because the radiation produced by these units is significantly less than that with older fluoroscopy units. Proper protective lead aprons with thyroid shield protection should be worn by the surgeon and staff in the operating room. Leaded glasses should be worn to protect the cornea. Steps should be taken to “cone down” or columnate the radiation beam so that only the necessary anatomy is visualized. Short “snapshots” rather than continuous fluoroscopy should be used when possible. The surgeon should stand when possible so that the radiation beam is directed away. The surgeon should keep his hands away from the fluoroscopy path during imaging. Proper dosimetry badges should be worn on the outside of the surgeon’s gown and checked regularly. When possible, the surgeon should step back when using fluoroscopy as the radiation dose drops dramatically as a function of distance from the source.
Motion of venous valves in humans—a new discovery
Dinker B. Rai in Mechanical Function of the Atrial Diastole, 2022
The data were collected by performing the following procedure.16 The procedure was performed in the X-ray suite under fluoroscopy on a tilt table under local anesthesia. An 18-gauge angio-catheter was introduced into the right internal jugular vein and through that a guidewire 0.032 inches in diameter and then advanced to the area of the right femoral vein. Along the guidewire, using the Seldinger technique a number 6-F size 100-cm-long catheter was introduced into the femoral vein. The guidewire was removed and the contrast medium was injected with a 60 mL syringe in small doses of 10 mL each. The motion in the form of opening and closing of these valves and their relationship to the cardiac cycle and postures were recorded in more than 150 patients.
Gastrointestinal tract and salivary glands
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A VFSS is a modification of the standard barium swallow examination and is used in the assessment and management of high dysphagia (oropharyngeal swallowing disorders). The VFSS is often described as the ‘gold standard’ for the assessment of dysphagia [14; 15], providing an assessment of both swallowing function and oro-pharyngeal structure. In many hospitals the VFSS service is delivered by a radiographer or radiologist working in conjunction with a speech and language therapist, who will be well-placed to direct the patient’s on-going care. An unsafe swallow (aspiration into the lungs) or an ineffective swallow may result in a risk of death, pneumonia, dehydration, malnutrition and psychosocial issues related to discomfort and difficulty eating and drinking. VFSS provides an objective baseline to which future examinations can be compared as a measure of improvement or deterioration of the underlying condition, enabling management strategies to be formulated. Where an ineffective swallow is identified, the speech and language therapist may trial a range of different positional modifications (e.g. head tilting and chin tucking) and eating modifications (e.g. texture changes and double swallow) with the patient while they swallow. Where these modifications are unsuccessful and the swallow is deemed unsafe, oral feeding may be withdrawn as a last resort. It is therefore essential that the radiology team do not stop the procedure prematurely (when a diagnosis is reached) but provide sufficient time to enable these management strategies to be tried and tested within the fluoroscopy room.
Contact force sensors in minimally invasive catheters: current and future applications
Published in Expert Review of Medical Devices, 2021
Weyland Cheng, Manye Yao, Bo Zhai, Penggao Wang
Fluoroscopy is commonly used to observe the catheter’s location within the body or to assess arterial and cardiovascular structures. However, radiation exposure to the patient and catheter operator can be undesirable consequences when using x-ray imaging. Although operators wear partly protective lead aprons during the procedure, radiation exposure to the head can increase the risk of cataracts, hematological malignancies, and neural tumors [10]. Moreover, constantly wearing heavy lead aprons can lead to the development of chronic back pain and orthopedic injuries [10]. Therefore, minimizing operation time and fluoroscopy duration is necessary for maximizing safety for both the patient and operator. Magnetic resonance (MR) angiography is another option for visual feedback. Yet, drawbacks such as high expense, shielding requirements, and prohibition of using ferromagnetic materials can limit its usage [11].
Fluoroscopy guided percutaneous biopsy in combination with bronchoscopy and endobronchial ultrasound in the diagnosis of suspicious lung lesions – the triple approach
Published in European Clinical Respiratory Journal, 2020
Jatinder Singh Sidhu, Geir Salte, Ida Skovgaard Christiansen, Therese Marie Henriette Naur, Asbjørn Høegholm, Paul Frost Clementsen, Uffe Bodtger
It could be argued, that non-diagnostic bronchoscopy and EBUS should not be followed by F-TTNAB but by more modern sampling guided by electromagnetic navigation bronchoscopy (ENB) and radial ultrasound probe [1,13]. However, in many centres – especially in non-Western countries – these techniques are not available due to the substantial costs for single-purpose equipment. Fluoroscopy is used in several disciplines of medicine and is readily available even in low-income countries. The sampling of peripheral lung lesions guided by CT or fluoroscopy normally requires referral to a radiologist [16], which will cause a delay in the diagnostic workup. A combined, same-day invasive triple approach aiming at both diagnosis and staging will speed up the process. The equipment for fluoroscopy is routinely available in the operating room of the pulmonologist, since it is used when performing transbronchial lung biopsies [13].
Safety, long-term outcomes and predictors of recurrence following a single catheter ablation procedure for atrial fibrillation
Published in Acta Cardiologica, 2019
Michael Efremidis, Konstantinos P. Letsas, Stamatis Georgopoulos, Nikolaos Karamichalakis, Konstantinos Vlachos, Louiza Lioni, George Bazoukis, Athanasios Saplaouras, Antigoni Sakellaropoulou, Angelos Michael Kolokathis, Aikaterini Rokiza, Aikaterini Anagnostou, Kosmas Valkanas, Antonios Sideris
The study enrolled a total of 520 patients (mean age 57.08 ± 11.33 years old, 354 males). The baseline clinical, echocardiographic, biochemical and procedural data of the study cohort are depicted in Table 1. Of the total population, 356 patients (68.5%) underwent catheter ablation for PAF and 164 (31.5%) for NPAF. In the NPAF group, there were 143 (27.5%) patients with persistent AF and 21 (4%) patients with long-standing persistent AF. There were no procedure-related deaths, while 11 patients (2.1%) experienced complications. The mean duration of the procedure was 199.57 ± 47.9 min and the mean fluoroscopy time was 15.41 ± 10.75 min. Specifically, cardiac tamponade, managed with pericardiocentesis, occurred in three patients (0.6%), while five patients (1%) suffered a transient ischaemic attack (TIA). Complications associated with vascular access (two femoral arteriovenous fistulas and one pseudoaneurysm) occurred in three patients (0.6%).
Related Knowledge Centers
- Anatomy
- Physiology
- Heart
- X-Ray
- Medical Imaging
- Surgeon
- Swallowing
- Medical Diagnosis
- Radiology
- Interventional Radiology