Fluoroscopy Research Articles

Safety and Feasibility of Interventional Hybrid Fluoroscopy and Nuclear Imaging in the Work-up Procedure of Hepatic Radioembolization.

Purpose To evaluate the safety and feasibility of a novel hybrid nuclear and fluoroscopy C-arm scanner to be used during the work-up procedure of hepatic radioembolization. Materials and Methods In this prospective first-in-human clinical study, 12 participants (median age, 67 years [range: 37-78 years]; nine [75%] male, three [25%] female) with liver tumors undergoing work-up for yttrium 90 radioembolization were included (ClinicalTrials.gov NCT06013774). Work-up angiography and technetium 99m-macroaggregated albumin injection were performed in an angiography suite equipped with a hybrid C-arm that could simultaneously perform fluoroscopy and planar nuclear imaging. Technetium 99m-macroaggregated albumin was injected under real-time hybrid imaging, followed by in-room SPECT imaging. Safety and feasibility were studied by assessing adverse events, technical performance, additional x-ray radiation dose, and questionnaires completed by radiologists and technologists. Results No adverse events were attributed to the hybrid C-arm scanner. The additional x-ray radiation dose was low (median, 19 Gy · cm2; minimum: 12 Gy · cm2; maximum: 21 Gy · cm2 for participants who completed all imaging steps). The interventional personnel considered use of the hybrid C-arm scanner safe and feasible, although the additional time spent in the intervention room was considered long (median, 64 minutes; minimum: 55 minutes; maximum: 77 minutes for participants who completed all imaging steps). Conclusion Use of the hybrid C-arm scanner during the work-up procedure of hepatic radioembolization was found to be safe and feasible in this first-in-human clinical study. Keywords: Angiography, Fluoroscopy, Interventional-Vascular, Radionuclide Studies, Radiosurgery, Gamma Knife, Cyberknife, SPECT, Instrumentation, Physics, Technical Aspects, Technology Assessment Supplemental material is available for this article. Published under a CC BY 4.0 license. Clinical trial registration no. NCT06013774.

Safety and efficacy of brachial approach for coronary angiography and percutaneous coronary intervention

Abstract Background There are many feasible ways to reach the coronary arteries through a percutaneous technique. Till now, the most commonly used approach is the radial artery approach because it has the lowest risk of known vascular adverse events. However, it could not be an option in some situations as congenital radial artery hypoplasia and radial artery spasm. In these cases, the second most common access is the femoral artery access. The current literature over the brachial artery access is controversial. Our study's objective is to verify the brachial artery approach's effectiveness and safety. Methods We studied 300 patients who underwent elective coronary angiography and percutaneous angioplasty in our institution with failed radial access between August 2022 and February 2023. They were classified into two groups; 150 patients in a group with brachial access and 150 in a group with femoral access. Baseline clinical and demographic traits of all enrolled patients were obtained from hospital records and the cardiovascular risk factors were identified. Venous blood samples, resting 12-lead electrocardiogram and transthoracic echocardiography were done before the coronary angiography. Access, procedural and fluoroscopy times were recorded. Doppler evaluations of both brachial and femoral arteries were done the day after the procedure. All patients were examined carefully immediately after the procedure and before discharge to assess any complications. Results Our data showed that no statistically significant difference between the studied groups regarding the cardiovascular risk factors, demographic, clinical and laboratory characteristics. Left brachial access was used more frequently than left femoral access (32.7% vs. 22.7%, p= 0.05), but no significant difference regarding right sided or bilateral access. Procedure time, fluoroscopy time, and contrast volume did not differ significantly (p=0.19, 0.06 and 0.1 respectively). However, brachial group had shorter access time (2.6 ±1.1 vs. 3.4 ± 0.7 minutes, p=0.05) and shorter hospital stay (3.5 ± 1.1 vs. 5.9 ± 1.3 days, p<0.001). Regarding complications, both major and minor complications were significantly lower in the brachial arm (p=0.04 and 0.05, respectively). Conclusion Brachial artery access is a safe, efficient alternative and non-inferior to the femoral route for coronary intervention whenever radial access is not an option.

Regional variations of mechanical responses of IVD to 7 different motions: An in vivo study combined with FEA and DFIS

The abnormal mechanical behaviour of a lumbar intervertebral disc (IVD) is commonly recognized as a direct indicator of intervertebral disc degeneration (IDD). However, current methods cannot evaluate the patient-specific mechanical performance of an IVD in vivo during movement. This study establishes a patient-specific (PS) model that combines the kinematics parameters of the lumbar spine obtained with a dual fluoroscopic imaging system (DFIS) and a finite-element (FE) method for the first time to reveal the mechanical behaviours of IVDs in vivo under seven motions. Three healthy participants were recruited for this study. CT images were obtained to create finite-element models of L3-L5 spine segments. Meanwhile, participants were required to take specific positions including upright standing, flexion, extension, left and right lateral bending, as well as left and right axial torsion in the DFIS. The in vivo kinematic parameters, calculated by registering the CT images with images obtained with DFIS, were considered as loading conditions in FE simulations. Significant differences of von Mises stresses and principal strains were found between PS model and GN model which employing a generalized moment as loading conditions, former resulting in up to 76.74 % lower strain than the GN model. Also, considerable differences were observed for five anatomical regions of the IVD (L3-L5). Under all motions, the stress in the centre region (nucleus pulposus) was the lowest, while the stress in the posterior region was the highest in extension motion. Therefore, activities such as stretching with an extension, should be avoided by patients with a herniated disc, in which the posterior region was the herniation site. The PS model combining in vivo kinematics and FE simulations shows the potential in the design and assessment of patient-specific implants.

A new method to evaluate fluoroscopic system collimator performance.

Fluoroscopy uses collimators to limit the radiation field size. Collimators are often evaluated annually during equipment performance evaluations to maintain compliance with regulatory and/or accreditation bodies. A method to evaluate and quantify fluoroscopy collimator performance was developed. A radiation field and displayed image measurement device consisting of radiopaque rulers and radiochromic film strips was placed on the x-ray source assembly exit window to evaluate fluoroscopy collimator performance. This method was used to evaluate collimator performance on 79 fluoroscopic imaging systems including fixed C-arms, mobile C-arms, mini C-arms, and radiographic fluoroscopic systems. The excess length (EL), excess width (EW), and sum EL + EW of the radiation field relative to the displayed image were measured and compared to the limits specified in 21CFR1020.32. Four systems exceeded these limits. Placing the radiation measurement device at the x-ray source assembly exit window relative to the image receptor cover increased the film exposure rate by a factor up to 14.6. The time required to set up and complete the fluoroscopy collimator performance measurements using this method ranged from 5 to 10 min. This method provides an easily implemented quantitative measure of fluoroscopy system collimator performance that satisfies regulatory and accreditation body requirements.

Comparative Analysis of Transradial and Transfemoral Approaches in Transarterial Radioembolization for Liver Tumors: A Systematic Review and Meta-Analysis.

Transarterial radioembolization (TARE) is a minimally invasive therapy combining embolization and radiation for cancer treatment. This meta-analysis compares radiation exposure, quality of life, and safety of the transradial (TRA) versus transfemoral (TFA) approaches in TARE for liver tumors. We searched PubMed, SCOPUS, Cochrane, EMBASE, and Web of Science for studies comparing TRA versus TFA in TARE for liver tumors. Our primary outcomes focused on various measures of patient radiation exposure, including procedure time, fluoroscopy time, air kerma, and dose-area product (DAP). For secondary outcomes, we evaluated safety parameters, such as overall pain experienced during the procedure, pain in the recovery room post-procedure, the incidence of adverse events, and the impact on quality of life. Study quality was assessed using Cochrane's ROB 2 tool for RCTs and the Newcastle-Ottawa scale for observational studies. Data analysis was conducted with REVMAN 5.4.1 software. Six studies, comprising one RCT and five cohort studies with 1,209 patients, underwent comprehensive analysis. The aggregated findings revealed a significant reduction in procedure duration associated with TRA (MD =- 6.30, 95% CI [- 9.88, - 2.73], P = 0.005). However, no statistically significant differences were found between TRA and TFA groups concerning fluoroscopy time, recovery time, air kerma, DAP, pain in the recovery room, overall pain during the procedure, quality of life measuring mental health and physical function or adverse events. TRA and TFA showed comparable results in TARE for liver tumors, but TRA offered a shorter procedure time. Further RCTs with larger samples are needed to confirm these findings. Future studies should assess long-term efficacy for a more complete evaluation.

Impact of operative position on rotational alignment after intramedullary nailing of trochanteric fractures: a comparative analysis of lateral decubitus versus supine position.

Fixation of trochanteric fractures with an intramedullary nail in a non-physiological position can cause poor functional outcomes. The aim of this study is to evaluate the effect of intraoperative patient position on rotational alignment in intramedullary nail fixation of trochanteric fractures. The femoral rotational alignment of 84 trochanteric fracture patients who underwent intramedullary nailing was measured by computed tomography (CT) images. Patients were divided into two groups: the supine position on the fracture table (FT) (Group 1, n = 42) and the lateral decubitus (LD) position (Group 2, n = 42). Femoral malrotation angles were measured and divided into three subgroups: insignificant, significant,andexcessive.The number of intraoperative fluoroscopy images, preparation time, surgery time, and anesthesia time in both groups were compared. The malrotation degrees of patients in Group 1 ranged from 17° external rotation (ER) to 57° internal rotation (IR), with a mean of 10° IR. Of the patients in Group 1, 27 were insignificant, 5 were significant, and 10 were in the excessive subgroup. The malrotation degrees of patients in Group 2 ranged from 33° ER to 47° IR, with a mean of 11° IR. Of the patients in Group 2, 21 were insignificant, 12were significant, and 9 were in the excessive subgroup. There was no statistically significant relationship between patient position and malrotation angle. The number of intraoperative fluoroscopy images, preparation time, and anesthesia time were statistically lower in Group 2. There was no statistically significant difference between Group 1 and Group 2 in terms of surgery time. Intramedullary nailing in the LD position is a reliable and practical surgical method in the treatment of femoral trochanteric fractures since there is no need for the use of a FT, the surgeon is exposed to less radiation, there is no risk of complications related to the traction of the FT, and there is a shorter operation time.

Effects of Parallax and Distortion in Total Ankle Arthroplasty.

Surgeons rely on intraoperative fluoroscopy to assist in placement of implant components during total ankle arthroplasty (TAA). Parallax alters the direction of an object when viewed from two different points, resulting in image distortion. The purpose of this study was to evaluate parallax/distortion in intraoperative fluoroscopic images during TAA. A retrospective review of all TAAs performed by two surgeons (R.W.M. and B.S.) from August 2019 to April 2023 were reviewed. Intraoperative fluoroscopic anteroposterior (AP) ankle views were evaluated for any obvious parallax image distortion. Cases with obvious parallax distortion were included for angular evaluation of AP intraoperative fluoroscopic and first postoperative plain films. The tibia was marked at 2-centimeter intervals to create zones from the proximal stem of the implant. The anatomical axis of the tibia (AAT) was drawn at the mid-diaphysis. The anatomic lateral distal tibial angle (aLDTA) and anatomic axis deviation (AAD) were measured for each zone. A total of 22 TAAs were performed during the study period. Four cases were excluded due to inadequate imaging, leaving a total of 18 TAAs for review. We found 6 of 18 (33.3%) cases had obvious parallax distortion. We found the average aLDTA was 90.9° (84°-101°). At the most proximal tibial zone, the average aLDTA was 94° (91°-101°). We found the average AAD was 4.7 (0.5-17.2) mm. The AAD ranged from 0.5 to 17.2 mm lateral to 0.8 to 8.2 mm medial. Postoperative plain film radiographs displayed a normal aLDTA and an AAT centered within the ankle joint. Parallax can distort the appearance of the tibia on fluoroscopic images. Deviation from the normal aLDTA and anatomical axis should be anticipated. Surgeons should be aware of the potential impact of parallax and ways to mitigate these effects.

Space Radiology: Emerging Nonsonographic Medical Imaging Techniques and the Potential Applications for Human Spaceflight.

Space medicine is a multidisciplinary field that requires the integration of medical imaging techniques and expertise in diagnosing and treating a wide range of acute and chronic conditions to maintain astronaut health. Medical imaging within this domain has been viewed historically through the lens of inflight point-of-care ultrasound and predominantly research uses of cross-sectional imaging before and after flight. However, space radiology, a subfield defined here as the applications of imaging before, during, and after spaceflight, will grow to necessitate the involvement of more advanced imaging techniques and subspecialist expertise as missions increase in length and complexity. While the performance of imaging in spaceflight is limited by equipment mass and volume, power supply, radiation exposure, communication delays, and personnel training, recent developments in nonsonographic modalities have opened the door to their potential for in-mission use. Additionally, improved exam protocols and scanner technology in combination with artificial intelligence algorithms have greatly advanced the utility of possible pre- and postflight studies. This article reviews the past and present of space radiology and discusses possible use cases, knowledge gaps, and future research directions for radiography, fluoroscopy, computed tomography, and magnetic resonance imaging within space medicine, including both the performance of new exam types for new indications and the increased extraction of information from exams already routinely obtained. Through thoughtfully augmenting the use of these tools, medical mission risk may be reduced substantially through preflight screening, inflight diagnosis and management, and inflight and postflight surveillance.

More is less: image enhancement technology reduces radiation exposure during anterior lumber interbody fusion

BACKGROUND CONTEXTFluoroscopy and radiation exposure occur during anterior lumbar interbody fusion (ALIF). Image enhancement technology is available that can potentially reduce radiation exposure. PURPOSEThe purpose of this study is to evaluate radiation exposure and fluoroscopy times comparing standard fluoroscopy (FL) with a low dose image enhancement platform (LD). STUDY DESIGNRetrospective review of prospectively maintained database. PATIENT SAMPLEConsecutive patients undergoing ALIF with either standard fluoroscopy or low dose image enhancement technology. OUTCOME MEASURESRadiation dispersion and fluoroscopy times in ALIF patients with standard fluoroscopy and low dose image enhancement technology. METHODSA retrospective review of a prospective database on consecutive patients who have undergone ALIF, stratified into 2 groups: subjects with standard fluoroscopy (FL), and low dose fluoroscopy with image enhancement technology (LD). RESULTSA total of 487 ALIF patients were included (FL: 372 vs. LD: 115). LD patients were significantly older (66 vs. 60 years), with more deformity cases (28% vs. 12%), and less degenerative cases (71% vs. 87%), all p<.05; no differences in sex, BMI, or the number of levels operated on between groups. Fluoroscopy time (sec) was significantly higher in LD (51.4 vs. 45.5), with a statistically significant reduction in radiation (mGy) compared to FL (23.3 vs. 48.2), both p<.05. Furthermore, the results showed that radiation dispersion is increasingly reduced as fluoroscopy time increases in LD compared to FL (12%, 56%, and 65% reduction in radiation dispersion for fluoroscopy time <30 sec, between 30 to 60 sec, and >60 sec, respectively). CONCLUSIONSThe use of low dose fluoroscopy with image enhancement technology significantly reduces the cumulative dose of radiation during ALIF compared to standard dose fluoroscopy. Also, radiation dispersion increasingly decreases as fluoroscopy time increases using low dose image enhancement technology. Low dose image enhancement technology improves the safety profile of ALIF for patients and operating room staff.

Clinical usability and efficacy of a robotic bone fracture reduction system: A pilot animal study

Challenges in minimally invasive surgeries, such as intramedullary nailing for long bone fractures, include radiation overexposure for patients and surgeons, potential malreduction, and physical burden on surgeons in maintaining the reduction status. A robotic bone fracture reduction system was developed in this study to address these problems. The system consists of a hexapod with six degrees of freedom, with a fracture reduction device and a master device. This study aimed to evaluate the novel system in a preclinical setting. The length of the six axes in the system can be adjusted to precisely control the length, angle, and rotation so that no additional traction is required. Fluoroscopic images can be remotely examined to reduce the risk of radiation exposure for surgeons. In this study, alignment accuracy and radiation exposure were measured using 32 bovine bone fracture models, and these surgical outcomes were compared to those of conventional manual surgery to verify the clinical usability and effectiveness of the system. The alignment accuracy was assessed by analyzing length, angulation, and rotation. The four surgeons participating in this study were divided into two groups (expert and novice) according to their clinical experience. All parameters in robotic surgery significantly decreased by approximately 4 mm and 8° on average (p≤0.05) compared to conventional surgery. The mean radiation exposure in robot-assisted surgery was 0.11 mSv, showing a significant decrease compared to conventional surgery (p<0.05). Reduction accuracy was higher in robotic surgery performed by the novice group than in conventional surgery performed by the expert group; however, standard deviation values were inversed. In conclusion, the bone fracture reduction robot system increased the alignment accuracy through precise control while reducing radiation exposure in surgeons, as the surgery was performed remotely. The use of this system is predicted to improve the accuracy and reproducibility of the surgery and the safety of medical staff.11Abbreviations: CT, computed tomography; FRD, fracture reduction device; FRMD, fracture reduction master device; SD, standard deviation

Kinematic Interactions Between Bones, Patellar Tendon, And Cartilage Surfaces During Cycling By Three-dimensional Fluoroscopic Imaging

Kinematic Interactions Between Bones, Patellar Tendon, And Cartilage Surfaces During Cycling By Three-dimensional Fluoroscopic Imaging

Validation of the Lift-Off Screw Technique in Patients Undergoing Corrective Osteotomy for Malunited Distal Radius Fractures

The purpose of this study was to validate the clinical accuracy of the lift-off screw (LOS) technique for volar tilt correction (VTC) in patients undergoing corrective osteotomy for dorsally angulated distal radius fracture malunions. We conducted a retrospective review of 23 patients with dorsally angulated distal radius fracture malunions treated with corrective osteotomy using the LOS technique. The LOS equation Ls= [tan(Tc) ∗ Lp+ C]/[cos(⍬s)] and standardized intraoperative fluoroscopic images were used to determine and compare the calculated and clinical VTC and final volar tilt. Correlations between the LOS length and the clinical VTC were calculated, as well as between the desired VTC and the correction accuracy. Preoperative volar tilt ranged from-6° to-50° (mean=-22.9° ± 10.6°). The calculated VTC was 32.7° ± 9.4°, and the clinical VTC achieved was 25.8° ± 9.3°. The difference between the clinical and calculated correction was-6.9°, with an average postoperative clinical volar tilt of 2.8° ± 5.7°, compared with a calculated volar tilt of 9.7° ± 4.4°. There was a moderately strong positive correlation between LOS screw length and clinical VTC achieved, and a moderately weak negative correlation between the desired amount of correction and the accuracy of the correction. The LOS technique is a reproducible method to plan the amount of sagittal plane correction during corrective osteotomy surgery for dorsally angulated distal radius fracture malunions. We demonstrate that this technique underestimates the clinical correction achieved by an average of 7°, with larger deformities experiencing greater undercorrection. Undercorrection of volar tilt during corrective osteotomy should be anticipated by surgeons and considered in future implant and cutting guide designs. Therapeutic IV.

A retrospective comparative study of robot-assisted unilateral biportal endoscopic lumbar decompression and fusion surgery versus percutaneous endoscopic lumbar decompression and fusion surgery.

The objective of this study is to illustrate the advantages of robot-assisted unilateral biportal endoscopy in lumbar decompression fusion and internal fixation surgery. According to the different surgical methods, we divided the 26 patients into 2 groups, robot-assisted unilateral biportal endoscopy for lumbar interbody fusion (R-ULIF) group and percutaneous endoscopic lumbar decompression and interbody fusion (Endo-LIF) group, with a 1:1 ratio. Gender, disease course, lesion site, fluoroscopy times, operative time, blood loss, postoperative hospital stay, screw placement success rate, fusion rate, complications rate, postoperative pain visual analog scale (VAS) (The VAS score is used only to evaluate pain in the lower back and legs.) Oswestry Disability Index (ODI) (The ODI score can serve as a reference indicator for evaluating the effectiveness of treatment for patients with low back pain, and has good responsiveness in assessing patients with chronic low back pain), and MacNab (The MacNab standard is divided into 4 levels: excellent, good, fair, and poor, which can be used to evaluate the therapeutic efficacy of certain spinal surgeries) standard efficacy evaluation were analyzed and compared between the 2 groups. All patients successfully completed the surgery. Compared with the Endo-LIF group, the R-ULIF group had fewer fluoroscopy procedures, less intraoperative blood loss, and shorter postoperative hospital stay (P < .05). The VAS scores and ODI scores of both groups significantly decreased at all-time points (P < .05). The ODI scores of the R-ULIF group were better than the Endo-LIF group at 1 month and 3 months after surgery (P = .017/P = .047), but there was no statistically significant difference between the groups before surgery and 1 week after surgery (P > .05). The efficacy was evaluated using the MacNab criteria at 6 months after surgery. The R-ULIF group has an excellent and good rate of 84.6%, while the Endo-LIF group has an excellent and good rate of 76.9% (P = 1.000). Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has shown short-term clinical efficacy in the treatment of lumbar disc herniation combined with lumbar instability, surpassing endoscopic lumbar interbody fusion surgery. Robot-assisted unilateral biportal endoscopy for lumbar interbody and fusion surgery has demonstrated high success rate in screw placement, minimal radiation exposure, less intraoperative blood loss, shorter hospital stay, and thus deserves further clinical promotion.

Suspected Intramural Spread of Dye during Transaortic Celiac Plexus Rhizolysis in Patient of Intra-abdominal Malignancy

Abstract Chronic abdominal pain from either primary or metastatic lesions is a substantial source of discomfort for patients receiving therapy or palliative care for abdominal cancers. A minimally invasive pain intervention, such as celiac plexus rhizolysis, may be needed to treat individuals whose pain is resistant to pharmaceutical therapy. Although celiac plexus rhizolysis is an effective and relatively safer technique, fatal complications such as aortic pseudoaneurysm or dissection are possible. Here, we present a case report where regular monitoring of intermittent fluoroscopic images, timely identification, and management prevented aortic dissection during transaortic celiac plexus rhizolysis.

Three-Dimensional Printing Technology Based on Digital Orthopedics: 5-Point Positioning Point-Contact Pedicle Navigation Template in the Case of Scoliosis and Complex Pedicle.

Imperfect fitting of the navigation template leads to prolonged surgery time and increased blood loss. These problems have not been effectively addressed in previous research. This study explores the efficacy of a novel 5-point positioning point-contact pedicle navigation template in complex pedicle situations in scoliosis. This study employed a retrospective controlled design. From November 2019 to November 2023, 28 patients with scoliosis and complex pedicle were selected and underwent scoliosis correction surgery. A 5-point positioning point-contact pedicle navigation template was used intraoperatively to guide pedicle screw placement. Matched with 56 historical cases as a control group. The analysis included screw placement time, screw placement bleeding volume, fluoroscopy frequency, manual repositioning frequency, screw placement accuracy and grade, screw placement complications, and main curve correction rate. Continuous variables were compared using the independent samples t-test. Categorical data were analyzed with the chi-square test. All 28 patients successfully underwent surgery, with a total of 268 pedicle screws placed. The surgery duration ranged from 220 to 410 min, with an average of (283.16 ± 51.26) min. Intraoperative blood loss ranged from 630 to 1900 mL, with an average of (902.17 ± 361.25) mL. Pedicle screw placement time ranged from 60 to 130 min, with an average of (85.24 ± 24.65) min. Pedicle screw placement bleeding volume ranged from 40 to 180 mL, with an average of (76.47 ± 42.65) mL. Fluoroscopy frequency ranged from 3 to 7 times, with an average of (4.31 ± 1.14) times. Manual repositioning frequency ranged from 0 to 2 times, with an average of (0.46 ± 0.58) times. Pedicle screw placement grades: Grade I: 237 screws; Grade II: 25 screws; Grade III: 6 screws; Grade IV: 0 screws. There were no screw-related complications. The correction rate ranged from 46% to 68%, with an average of (55.83 ± 9.22)%. Compared to the experienced screw group, the differences in screw placement time, screw placement bleeding volume, fluoroscopy procedures, and manual redirections were statistically significant (p < 0.05). The 5-point positioning point-contact pedicle navigation template features a claw-like structure that securely adapts to various deformed vertebral facet joints, avoiding drift phenomena and ensuring accurate screw placement. Its pointed contact structure with the lamina of the spine avoids extensive and complete detachment of posterior structures, reducing blood loss, surgery time, and trauma. Predesigned pedicle screw entry points and directions reduce fluoroscopy frequency and surgery time.

Coccygeal Nerve Blockade vs. Impar Ganglion Blockade in Coccydynia: A Randomised Clinical Trial.

Background and objective Coccydynia is a condition that causes pain around the coccyx, severely limiting functionality. Interventional treatment options are available for cases that do not respond to conservative treatment. Coccygeal nerve block (CnB) is a novel method for treating coccydynia. This study compared the efficacy of CnB and ganglion impar block (GiB) and aimed to evaluate the efficacy of CnB in treating coccydynia. Methods The 12-week results of 56 patients were analysed. One group underwent ultrasound (US)-guided CnB, while the other group underwent fluoroscopy (FL)-guided GiB. Pain intensity was assessed using the numerical rating scale (NRS), and functionality was assessed using the PARIS Coccydynia Functionality Questionnaire. Evaluations were conducted before treatment, as well as four and 12 weeks after treatment. Results The baseline median NRS score was eight in both groups, while at week 12, it was three in the CnB group and 2.5 in the GiB group. The median PARIS score at baseline was seven in the CnB group and 6.5 in the GiB group, while at week 12, it was four and three, respectively.At week 12, compared to baseline, both the CNB and GiB groups showed statistically significant improvements in NRS and PARIS scores (p<0.001). When comparing the two groups, no significant difference was observed in the NRS and PARIS scores before and four and 12 weeks after treatment. No serious adverse events were observed in any patient. Conclusions Coccydynia is sometimes refractory to treatment. In our study, we found that CnB, a method recently used in the treatment of coccydynia, was as effective as GiB, which has been used for a long time, and we found no evidence of superiority. The lack of radiation exposure due to its US-guided application, the superficial course of the coccygeal nerves and the low depth of needle penetration make it easier to perform. These advantages suggest that it will be a preferable method in the treatment of coccydynia.

Neph-ex: a 3D printed interventional radiology training tool for nephrostomy exchange.

Fluoroscopic guided procedures are a mainstay for interventional radiology (IR) procedures. Practice is needed for the novice to interpret fluoroscopic images and simultaneously perform the procedure hands-on as well as control the foot pedal to screen. We describe the development of a training simulation model which simulates the human kidney, ureter, and bladder. Stereolithography (SLA) 3D print technology using SLA resin and Anycubic SLA printer were employed. A plastic tubing was used to connect the 3D printed kidney and bladder as the ureter. This simulation model permits fluoroscopic guided filling of "pelvicalyceal system" with contrast as well as ureteric stenting, guidewire, and drainage catheter manipulation. Effectiveness of the model to attain skills for nephrostomy exchange and ureteric stenting was obtained via questionnaire from trainees prior to and after utilizing the model. The 3D printing simulation model of the kidney, ureter, and bladder system enables trainees to perform nephrostomy exchange, nephrostogram, and antegrade stenting. Participants felt more confident to perform the procedures as they were more familiar with the procedure. Besides that, participants felt their wire and catheter manipulation skills have improved after using the simulation model. Neph-ex simulation model is safe and effective for hands-on training in improving proficiency of fluoroscopy-guided nephrostomy exchange and antegrade ureteric stenting. As of our knowledge, there are no commercially available simulation models for fluoroscopic guided nephrostomy exchange and ureteric stent deployment. No article on nephrostomy exchange simulation model has been published before.

Development of the humeral head offset index for control of humeral torsion

BackgroundControl of humeral torsion can present a challenge, especially intraoperatively during closed reduction and fixation of humeral shaft fractures or 2-part surgical neck fractures of the proximal humerus. The objective of this study is to develop and validate an indirect method for the assessment of humeral torsion using an index that is linearly correlated with rotational arm position and can be derived from only a single plain radiographic image of the proximal humerus.MethodsThe Humeral Head Offset Index (HHOI) is calculated as the ratio of the medial and lateral offset of the humeral head measured from the outer cortices of the shaft on a plain radiographic or fluoroscopic image. The relationship of HHOI with humeral torsion was first verified on a sawbone model with radiopaque characteristics under fluoroscopic control. Different degrees of retroversion were simulated through manual rotation of the humerus with a digital protractor in 5° increments until 40° internally rotated and then in 5° increments until 40° externally rotated from the neutral position. The same procedure was subsequently performed digitally on Digitally Reconstructed Radiographs (DRRs) from computed tomography (CT) dataset of the sawbone. Next, the HHOI index was applied to eight randomly selected patients with total humerus CT using the same method. Spearman’s rho was calculated for the bivariate analysis of correlation between the simulated degree of retroversion and the HHOI. Strength of correlation was classified according to Koo and Li. Interrater and intrarater reliability of three blinded observers with repetition of measurement after three months were analyzed by assessing the intraclass correlation coefficient (ICC).ResultsBoth in the sawbone model and in DRRs, we demonstrated a high to very high significant linear correlation between simulated retroversion and the HHOI. ICC values demonstrated excellent interrater reliability and excellent intrarater reliability for measurement of the HHOI.ConclusionsThe HHOI is a new, simple, reliable index that has a linear relationship to the rotation of the humerus and can therefore allow an indirect control of humeral torsion in comparison to the contralateral side.

Multifaceted biomedical applications of bismuth oxide-doped bioactive glass: Synthesis challenges, characterization and potential clinical implications

Herewith, the present work reports a facile synthesis method of Bi2O3 doped 70 SiO2.30CaO binary bioactive glass system termed as modified Bi-BG (acronymed as mBi-BG) that indicates successful incorporation of Bi3+ into the silicate glassy network, on prior complex formation of the precursor bismuth nitrate salt with acetyl acetone to address the rapid decomposition rate of precursor bismuth nitrate. The binary bioactive glass composition as above mentioned (70 SiO2.30CaO) is named as BG/Control. The synthesis methodology addresses inherent challenges encountered in traditional sol-gel derived bismuth oxide incorporated bioactive glass (Bi-BG) synthesis wherein yellow coloured bismuth oxide gets separated from the glassy network as confirmed by XRD phase analysis. Next, mBi-BG (modified Bi-BG) was synthesized via modifying the sol gel method by introducing a chelating agent acetyl acetone to stabilize the precursor Bi (NO3)3 salt, and was characterized using XRD, FTIR, FESEM-EDX. TG-DSC and BET isotherm. In vitro bioactivity studies illustrate the formation of hydroxyapatite crystals on mBi-BG surface indicating its potential for bone repair and regeneration. Additionally, mBi-BG exhibits significant effect against Staphylococcus aureus (gram-positive) bacterial strain, highlighting its utility in preventing bacterial infections at surgical sites. Radiographic imaging of mBi-BG reveals excellent radiopacity comparable to human bone, rendering it suitable for image-guided surgeries and fluoroscopic procedures. In summary, mBi-BG emerges as a versatile biomaterial with enhanced bioactivity, antibacterial efficacy and radiopacity, thereby offering novel avenues in medical treatment modalities and patient care.

Hallux Dorsal Curvature of the Distal Phalanx and Its Possible Implications for the Dorsal Osteophyte.

Background and Objective: The dorsal osteophyte on the distal phalanx of the first toe (hallux) is a reactive bony protrusion that may be associated with pathologies such as onychocryptosis or pincer nail. This study aims to describe and analyze the correlation between three novel measurements-dorsal osteophyte height (HDO), distal phalangeal hyperextension (DPHA), and distal phalangeal curvature (DCDP)-and to evaluate the impact of minimally invasive surgery on the dorsal osteophyte using fluoroscopic data. Materials and Methods: A total of 125 fluoroscopic images were analyzed. Baseline measurements for the variables were compared between groups. The key variables included distal phalanx curvature, distal phalanx hyperextension, and dorsal osteophyte height. Results: The analysis revealed statistically significant differences in the main group effect for distal phalanx curvature (F [2, 122] = 7.54, p < 0.001), distal phalanx hyperextension (F [2, 122] = 28.90, p < 0.001), and dorsal osteophyte height (F [2, 122] = 13.64, p < 0.001). Significant correlations were found between distal phalanx curvature and distal phalanx hyperextension, as well as between distal phalanx hyperextension and dorsal osteophyte height. However, no significant correlation was observed between distal phalanx curvature and dorsal osteophyte height. Conclusions: The findings suggest that minimally invasive dorsal osteophyte surgery effectively restores the distal phalanx to normal conditions, as indicated by the variables studied.