Duration Of Fluoroscopy Time Research Articles

A comparative cadaveric study for percutaneous scaphoid fixation: robotic vs freehand.

To compare the robotic-assisted and the traditional freehand percutaneous scaphoid fixation in number of guidewire attempts, duration of fluoroscopy time, amount of radiation dose, and screw centrality. Twenty cadaveric specimens were randomized into either the robotic or freehand group. The scaphoids in both groups were fixed by either the same attending or resident from our hand surgery department. The operation duration, amount of radiation from intraoperative fluoroscopy, total fluoroscopy time, and the number of guidewire attempts were documented and compared. Postoperatively, all the specimens had a computed tomography (CT) scan performed, and the difference in the final position of the screw and the central axis of the scaphoid was examined. In the robotic group, all the guide wires were satisfactorily positioned within a single attempt, while the median number of attempts in the traditional freehand group was 18 (quaternion 14-65). This also meant that the surgeon in the robotic group experienced significantly lower radiation exposure dose and time as compared to the freehand group. There were no significant differences in the final screw position as compared to the central axis of the scaphoid in both groups. Although there was no difference in surgeon performance in the robotic group, the operative time for the attending was significantly lower as compared to the resident in the freehand group. Robotic-assisted surgery for scaphoid fracture fixation is superior to the traditional freehand method as it facilitates accurate screw placement with lower radiation exposure and fewer guide wire attempts.

P19 Mid-term results of coronary intervention with directional coronary atherectomy compared with conventional stenting for LMT related lesion - a single center experience

Abstract Background The technology of percutaneous coronary intervention (PCI) has dramatically advanced and now patients can get various treatment options for left main trunk (LMT) lesion. On the other hand, Directional Coronary Atherectomy (DCA) has appeared again on the stage of PCI as a technique of debulking plaques. Purpose of this study was to compare procedural and mid-term outcomes between DCA and conventional stenting for LMT related lesions. Methods We extracted cases treated with PCI for LMT related lesion and retrospectively examined backgrounds of patients, postprocedural events and whether dual antiplatelet therapy (DAPT) had been stopped or not. In order to rule out selection bias, conventional stenting cases were collected in the era prior to starting DCA treatment. In this study, we defined Major Adverse Cardiovascular Events (MACE) as cardiovascular death, restenosis in the target lesions and acute coronary syndrome (ACS). Results From April, 2014 to September, 2017, consecutive 85 patients underwent LMT stenting. Fifty-four patients enrolled in the non-DCA group excluding patients post CABG, treated with rotablator, with ACS and unexpected incidental LMT stenting. From May, 2016 to September, 2018, consecutive 26 cases underwent DCA (DCA group), in whom 15 cases were treated with the Drug Coating Balloon (DCB) subsequent DCA. The purposes of DCA were to avoid LMT stent or stent to other lesions and plaque reduction. In terms of patient’s characteristics, there was no significant difference in sex, BMI, coronary risk factors. Renal function was significantly better in DCA group than non-DCA group (eGFR 69.0 vs 59.5 ml/min/1.73m2; p = 0.028), and the amount of contrast medium used (124 vs 94 ml; p = 0.003) and duration of fluoroscopy time (47.7 vs 35.8 minutes; p = 0.007) were significantly greater in the DCA group than non-DCA group. However, there was no significant difference in incidence of periprocedural complications (0 vs 7 cases, p = 0.09), all cause of death (0 vs 8(14.8%); p = 0.161(Log-Rank)) and MACE (2(7.7%) vs 11(20.1%); p = 0.261(Log-Rank)) between the two groups. In addition, DAPT had been significantly stopped earlier in DCA group than non-DCA group (9(36%) vs 13(24.1%) cases; <0.0001(Log-Rank))(Figure). Conclusions LMT stenting has a high risk for the fatal event in case of in-stent-restenosis and it makes difficult to stop DAPT in any case even at other surgical treatments. The appropriate plaque debulking by DCA can avoid deploying stents in LMT, shorten stent length and shorten DAPT duration. Hence, DCA is very effective for patients ahead of other surgeries. Although the procedure with DCA needs more contrast medium and longer fluoroscopy time, DCA will be a good option for treatment in LMT related lesion for appropriate cases. New DCA might be useful and safe enough for treating LMT related lesion. DCB may also contribute to the improvement of outcomes in treatment with DCA. Abstract P19 Figure

The Influence of Resident Level of Training on Fluoroscopy Time in Pediatric Supracondylar Humeral Fractures Treated with Closed Reduction and Percutaneous Pinning.

ObjectiveThe purpose of this study was to evaluate the effect of resident level of training on fluoroscopy duration in pediatric supracondylar humeral fractures treated with closed reduction and percutaneous pinning (CRPP).MethodsAfter classifying the surgeons according to their seniorities, the duration of fluoroscopy time of 80 patients with extension type III supracondylar fractures during reduction and pinning was recorded.ResultsThe time duration of reduction procedures was similar in all groups with respect to the surgical experience; however, time durations of percutaneous pinning procedures were found statistically different between groups (p=0.042).ConclusionSurgical experience is very important in the management of supracondylar humeral fractures in children, especially in percutaneous pinning rather than closed reduction.

2D projection-based software application for mobile C-arms optimises wire placement in the proximal femur – An experimental study

PurposeA new software application can be used without fixed reference markers or a registration process in wire placement. The aim was to compare placement of Kirschner wires (K-wires) into the proximal femur with the software application versus the conventional method without guiding. As study hypothesis, we assumed less placement attempts, shorter procedure time and shorter fluoroscopy time using the software. The same precision inside a proximal femur bone model using the software application was premised. MethodsThe software detects a K-wire within the 2D fluoroscopic image. By evaluating its direction and tip location, it superimposes a trajectory on the image, visualizing the intended direction of the K-wire. The K-wire was positioned in 20 artificial bones with the use of software by one surgeon; 20 bones served as conventional controls. A brass thumb tack was placed into the femoral head and its tip targeted with the wire. Number of placement attempts, duration of the procedure, duration of fluoroscopy time and distance to the target in a postoperative 3D scan were recorded. ResultsCompared with the conventional method, use of the application showed fewer attempts for optimal wire placement (p=0.026), shorter duration of surgery (p=0.004), shorter fluoroscopy time (p=0.024) and higher precision (p=0.018). Final wire position was achieved in the first attempt in 17 out of 20 cases with the software and in 9 out of 20 cases with the conventional method. ConclusionsThe study hypothesis was confirmed. The new application optimised the process of K-wire placement in the proximal femur in an artificial bone model while also improving precision. Benefits lie especially in the reduction of placement attempts and reduction of fluoroscopy time under the aspect of radiation protection. The software runs on a conventional image intensifier and can therefore be easily integrated into the daily surgical routine.

Su1616 Prospective Evaluation of Predictors of Increased Patient Radiation During ERCP: the Stanford ERCP Radiation Safety (Sers) Study

The use of fluoroscopy during ERCP exposes patients to ionizing radiation with the potential for deleterious health consequences. Therapeutic ERCP is associated with a 2-5 fold greater patient radiation exposure, than diagnostic ERCP, with radiation exposure levels approaching those of CT scans of the abdomen. Endoscopists now have the ability to control modifiable factors on the fluoroscopy table, including the fluoroscopy frame rate, degree of magnification, collimation and imaging geometry, all of which can modulate the radiation dose received, over the same duration of Fluoroscopy Time.

Initial Experience with Catheter Ablation Using Remote Magnetic Navigation in Adults with Complex Congenital Heart Disease and in Small Children

The improved outcomes and increased availability of surgery for congenital heart disease (CHD) over the last three decades have created a small but steadily increasing subset of patients with unique needs: children and adults with complex arrhythmias in the setting of structural cardiac abnormalities. Radiofrequency catheter ablation (RFCA) in these patients, and in small children with normal cardiac anatomy, is effective but challenging. An understanding of specific anatomical and electrophysiological characteristics of these patients and the technical challenges in addressing them are critical to the success of this therapy. Tools specifically designed for intracardiac diagnosis and therapy in anatomically complex and/or small hearts remain scarce. We report single-center results from an ongoing registry of all patients with congenital heart disease and all children with complex arrhythmias in which the Magnetic Navigation System (MNS) was used. Included in this report are 12 patients with CHD in whom 17 tachyarrhythmias were treated, and 11 pediatric patients with normal cardiac anatomy who each had a single arrhythmia. The procedures' duration and the duration of fluoroscopy time as well as arrhythmia recurrence rates were comparable to those found in previous reports of procedures performed in adults with structurally normal hearts, and the incidence of complications was quite low. In patients with complex congenital malformations, retrograde mapping of the pulmonary venous atrium was feasible, eliminating the need for puncture of the atrial septum, or surgically placed baffle in many cases. Moreover, the design of the catheter eliminated the need for multiple mapping and ablation catheters. Our findings suggest that RFCA using the MNS for arrhythmias after surgery for congenital heart disease and in pediatric patients is safe and effective.