Efficacy of portable X-ray in identifying retained suture needles in ophthalmologic cases

Abstract

To evaluate the role and efficacy of portable X-ray in reliably identifying retained suture needles in ophthalmologic surgical cases. Ophthalmologic 10-0 nylon suture needles were placed into 10 of 20 porcine eyes positioned within the orbit of a human skull. Portable, plain film radiographs were taken of all eyes with a C-arm fluoroscopy machine. The films were reviewed by six ophthalmologists and six radiologists who were blinded to the presence or absence of needles, as well as the number of needles used in the protocol. The sensitivity and specificity of identifying retained suture needles by plain film radiographs were then analysed based on the results of the physicians' interpretations of the films. The overall sensitivity and specificity for physicians reviewing radiographs with suspected intraoperative suture needles were 54 and 77%, respectively. When looking separately at radiologists reviewing the films, the sensitivity was 57% and the specificity was 87%. Ophthalmologists reviewing the films identified retained needles less reliably with a sensitivity of 51% and a specificity of 67%. Significant controversy exists regarding the reliability and utility of plain film radiography in identifying intraocular foreign bodies. This study demonstrates that the use of plain film radiographs to rule-out the presence of an intraocular surgical needle is neither a sensitive nor specific imaging modality.