Fluoroscopy Group Research Articles

Conventional fluoroscopy-guided versus zero-fluoroscopy catheter ablation of supraventricular tachycardias

PurposeThe aim of this study was to evaluate the safety and efficacy of zero-fluoroscopy (ZF) catheter ablation (CA) for supraventricular tachycardias (SVT).Methods584 consecutive patients referred to our institution for CA of SVT were analysed. Patients were categorised into two groups; zero-fluoroscopy (ZF) group and conventional fluoroscopy (CF) group. The ZF group was further divided into two subgroups (adults and paediatric). Patient characteristics, procedural information, and follow-up data were compared.ResultsThe ZF group had a higher proportion of paediatric patients (42.2% vs 0.0%; p < 0.001), resulting in a younger age (30.9 ± 20.3 years vs 52.7 ± 16.5 years; p < 0.001) and lower BMI (22.8 ± 5.7 kg/m2 vs 27.0 ± 5.4 kg/m2; p < 0.001). Procedure time was shorter in the ZF group (94.2 ± 50.4 min vs 104.0 ± 54.0 min; p = 0.002). There were no major complications and the rate of minor complications did not differ between groups (0.0% vs 0.4%; p = 0.304). Acute procedural success as well as the long-term success rate when only the index procedure was considered did not differ between groups (92.5% vs 95.4%; p = 0.155; 87.1% vs 89.2%; p = 0.422). When repeated procedures were included, the long-term success rate was higher in the ZF group (98.3% vs 93.5%; p = 0.004). The difference can be partially explained by the operators' preferences.ConclusionThe safety and efficacy of ZF procedures in adult and paediatric populations are comparable to that of CF procedures.

Lumbar zygapophyseal joints injections under ultrasound guidance an alternative to fluoroscopy guidance in the management of low back pain

Ultrasound-guided injections are an alternative to evaluate in the management of low back pain associated with osteoarthritis of the lumbar facet joints: it eliminates the risk of ionizing radiation for both the patient and the practitioner. This study aims to compare the short-term clinical efficacy of lumbar facet joints injections between ultrasound-guided injections and fluoroscopy-guided injections. Observational, retrospective, single-center study. Patients received one or two lumbar zygapophyseal joints injections under fluoroscopy or ultrasound and a follow-up consultation at one month. Data from 54 patients was collected. The median of the evolution of VAS at one month was − 30 mm [−50.0; −20.0] in the ultrasound group and – 29.5 mm [−47.0; −15.0] (p < 0.001) in the fluoroscopy group with no statistically significant difference between the two groups (p = 0.835). There were no injection-related complications in either group during the follow-up. The percentage of patients who stopped NSAIDs was not statistically significant between the two groups (p = 1.00). Injections of corticosteroids of lumbar facet joints under ultrasound guidance significantly reduced pain after one month, with no difference found between the two techniques. Ultrasound-guided injections are reliable, accessible and a safe alternative that should be preferred over those under fluoroscopy.

Lumbar nerve root blocks using MRI - the effectiveness and safety of ultrasound/MRI fusion image guidance.

To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks.We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance.Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient's satisfaction, complications and the duration of the procedures. Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group.The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399).At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups.The patient's satisfaction scores were similar for both groups.The procedure by the two guidance methods took a similar time to perform.There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. Fusion imaging guidance provides the same outcome as fluoroscopic guidance.Fusion imaging guidance avoids the need for ionising radiation.

A comparison of robot-assisted and fluoroscopy-assisted kyphoplasty in the treatment of multi-segmental osteoporotic vertebral compression fractures.

Osteoporotic vertebral compression fracture (OVCF) has become a major public health issue that becomes more pressing with increasing global aging. Percutaneous kyphoplasty (PKP) is an effective treatment for OVCF. Robot-assisted PKP has been utilized in recent years to improve accuracy and reduce complications. However, the effectiveness of robot-assisted PKP in the treatment of multi-segmental OVCF has yet to be proved. This study was designed to compare the efficacy of robot-assisted and conventional fluoroscopy-assisted multi-segmental PKP. A total of 30 cases with multi-segmental OVCF between April 2019 and April 2021 were included in this study. Fifteen cases were assigned to the robot-assisted PKP group (robot group) and 15 cases to the conventional fluoroscopy-assisted PKP group (conventional fluoroscopy group). The number of fluoroscopic exposures, fluoroscopic dose, operation time, cement leakage rate, visual analog scale (VAS) score, vertebral kyphosis angle (VKA), and height of fractured vertebral body (HFV) were compared between the 2 groups. The number of fluoroscopic exposures, fluoroscopic doses, and cement leakage rates in the robot group were lower than in the conventional fluoroscopy group (P<0.05) while the operative time in the robot group was longer than in the conventional fluoroscopy group (P<0.05). VAS score and VKA were decreased and HFV was increased after surgery in both groups (P<0.05). Therefore, robot-assisted PKP for the treatment of multi-segmental OVCF can reduce the number of fluoroscopic exposures, fluoroscopic doses, and cement leakage compared to conventional treatment. As such, robot-assisted PKP has good application prospects and is potentially more effective in the treatment of multi-segmental OVCF.

Efficacy, Safety, and Cost-Effectiveness of Intracavitary Electrocardiography-Guided Catheter Tip Placement for Totally Implantable Venous Access Port

Intracavitary electrocardiography (IC-ECG) has been extensively used for locating the catheter tip of the central venous access devices (CVADs) with favorable safety and accuracy. We aimed to evaluate the efficacy, safety, and cost-effectiveness of IC-ECG-guided catheter tip placement for totally implantable venous access port (TIVAP) by comparing with the standard fluoroscopy method. A total of 231 patients who underwent TIVAP implantation from September 2019 to April 2021 were enrolled in the retrospective study. Fluoroscopy and IC-ECG were conducted intraoperatively to confirm the position of catheter tips. Demographic characteristics, surgical data, the catheter tip position, complication rate, and incidence, cost of procedures, and indwelling time were compared between the two groups. Univariate and multivariate analyses were used to identify the risk factors of TIVAP-related complications. There was no significance between the fluoroscopy group and the IC-ECG group in terms of the rate of ideal position (P=0.733). Nine patients (3.9%) developed TIVAP-related complications. Complication rates and incidence were similar in the fluoroscopy group and the IC-ECG group (3.1% and 0.114/1000 catheter days vs. 4.4% and 0.105/1000 catheter days). The Kaplan-Meier curve showed that there was no significant difference in indwelling time between the 2 groups (Log Rank P=0.634). Binary logistic regression analysis showed that body mass index (BMI) was an independent risk factor for TIVAP-related complications (OR=1.334, 95%CI: 1.139 - 1.563, P < 0.001). The IC-ECG group was less costly than the fluoroscopy group (¥9928 ± 362 vs. ¥11762 ± 431, P < 0.001). IC-ECG-guided catheter tip placement for TIVAP is feasible, safe, and cost-effective, with high accuracy, low risk of complications, and lower cost. It may be considered as an alternative to the standard fluoroscopy method for catheter tip placement of TIVAP.

Accuracy of cup placement using computed tomography-based navigation system in total hip arthroplasty through the direct anterior approach

BackgroundThis study aimed to elucidate the accuracy of cup placement with the computed tomography (CT)-based navigation system (CTN) in the direct anterior approach (DAA)-total hip arthroplasty (THA) in the supine position compared with the mechanical cup alignment guide (MG) or the fluoroscopy (FS). MethodsA total of 171 hips of 156 patients undergone primary THA were classified into the following three groups (the MG group: 63 hips, the FS group: 58 hips, the CTN group: 50 hips). Comparing the preoperative planning with postoperative CT measurement by three-dimensional templating software, the accuracy of cup placement was investigated in the three groups. ResultsThere were significant differences in the mean absolute error of radiographic inclination (RI) between the MG group (4.4° ± 3.2°) and the CTN group (2.8° ± 2.5°) (p = 0.01). The mean absolute error of radiographic anteversion (RA) also showed significant differences between the CTN group (2.8° ± 1.9°) and the MG group (5.8° ± 4.7°) (p = 0.0001) or the FS group (4.8° ± 4.1°) (p = 0.02). Regarding the cup center position, the mean absolute error of vertical position from preoperative planning was the smallest in the CTN group (1.8 ± 1.4 mm) compared with those in other groups (MG: 3.3 ± 3.2 mm, p = 0.007, FS: 3.2 ± 3.0 mm, p = 0.017). ConclusionThe CTN guarantees accurate cup placement in the DAA-THA in the supine position compared with the MG and FS groups.

727 Robotic Assisted Versus Fluoroscopic Guided Approach in Pedicle Screw Insertion: A Systematic Review and Meta-Analysis

Abstract Aim The robotic assisted surgery has become prevalent in most of the surgical subspecialty. The adaption of such technique in spine surgery has resulted in minimising several issues encountered with fluoroscopic guided approach. The aim of this study is to compare the outcomes of robotic assisted approach and fluoroscopic guided approach in pedicle screw insertion. Method PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched from its inception until November 2020. All the studies comparing robotic assisted surgery and fluoroscopic guided approach in pedicle screw insertion were included for quantitative and qualitative analysis. Results Twenty-eight studies enrolling 2105 patients (robotic group: 1027, fluoroscopic: 1078) and total screws of 8668 screws (robotic group: 4217, fluoroscopic group: 4451) were eligible for inclusion, these studies consisted of 19 observational studies, 7 randomised controlled trials (RCTs) and 2 cadaveric study. Robotic assisted approach was associated with significantly higher accuracy (Grade A+B) (OR = 2.34; P &amp;lt; 0.0001) and distance between pedicle and screw (MD: 1.69; P = 0.001), lower incident of facet joint violation (OR = 0.22; P &amp;lt; 0.00001), screw revision (OR = 0.38; P = 0.009), intraoperative blood loss (MD: -116.95; P = 0.0006), shorter pedicle screw placement time (MD: -4.66; P &amp;lt; 0.00001), radiation exposure time (MD:-5.27; P = 0.0001), radiation dose (MD:-22.30; P = 0.0002) and postoperative hospital stay (MD: -0.79; P = 0.02) compared to fluoroscopic guided approach. There was no significant difference in operative time and wound infection. Conclusions In this meta-analysis, robotic assisted approach is more effective in achieving better clinical outcomes compared to fluoroscopic guided technique in pedicle screw insertion. However, future adequately powered RCTs are warranted to generate standardised outcomes.

Radiation dose of fluoroscopy-guided versus ultralow-dose CT-fluoroscopy-guided lumbar spine epidural steroid injections.

Compare radiation dose of lumbar spine epidural steroid injections (ESIs) performed under fluoroscopy guidance and ultralow-dose CT-fluoroscopy guidance. Retrospective review of consecutive lumbar ESIs performed using fluoroscopy, between May 2017 and April 2019, and using ultralow-dose CT-fluoroscopy, between August 2019 and February 2021, was performed. Ultralow-dose CT-fluoroscopy technique omits a planning CT scan, utilizes CT-fluoroscopy, and minimizes radiation dose parameters. Patient characteristics (age, sex, height, weight, body mass index (BMI)), procedural characteristics (anatomic level, type of ESI, procedure time, pain reduction, complications, trainee participation), and radiation dose were compared. Chi-square tests and two-sample t-tests were performed for statistical analysis. One hundred and forty-seven patients (mean age 55.8 ± 16.7; 85 women) underwent ESIs using fluoroscopy. Sixty-six patients (mean age 60.9 ± 16.7; 33 women) underwent ESIs using ultralow-dose CT-fluoroscopy. The effective dose for the fluoroscopy group was 0.30mSv ± 0.34, compared to 0.15 mSV ± 0.11 for ultralow-dose CT-fluoroscopy (p < 0.001). The average age in the CT-fluoroscopy group was older (p = 0.04), and there was more trainee participation in the fluoroscopy group (p < 0.001); otherwise there was no statistically significant difference in patient or procedural characteristics between the conventional fluoroscopy group and the ultralow-dose CT-fluoroscopy group. There was no statistically significant difference in immediate post-procedure pain reduction between the groups (p = 0.16). Four intrathecal injections occurred only in the fluoroscopy group, though this difference was not significant (p = 0.18). Ultralow-dose CT-fluoroscopy technique for image-guided lumbar spine ESIs can lower radiation dose compared to fluoroscopy-guided technique.

Rationale and Study Design for Evaluating the Efficacy and Safety of Intracardiac Echocardiography-Guided Minimal-Fluoroscopy Ablation in Patients with Paroxysmal Atrial Fibrillation: A Non-Inferior, Multi-Center, Prospective Randomized Controlled Trial (PAF-ICE Trial)

Abstract The feasibility and safety of intracardiac echocardiography (ICE)-guided catheter ablation for atrial fibrillation (AF) using a minimal/zero-fluoroscopy approach have recently been reported. This approach helps to reduce ionizing radiation exposure and orthopedic complications resulting from using lead aprons. The objectives of this planned prospective, multicenter randomized controlled trial (RCT) (paroxysmal AF (PAF)-ICE trial; ChiCTR2000033624) are to evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF and the impact on occupational hazards among lab staff. Patients will be randomized in a 1:1 ratio to 2 groups: minimal fluoroscopy group (n = 216) and traditional approach group (n = 216). In the minimal fluoroscopy group, an ICE catheter will be used for geometry/anatomic construction, transseptal puncture, catheter tracking, and effusion monitoring. Pulmonary vein isolation (PVI) will be performed using an open-irrigated radiofrequency SmartTouch Surround Flow or SmartTouch catheter (Biosense Webster, Diamond Bar, California, USA), and confirmed by a multipolar Lasso or PentaRay catheter (Biosense Webster). In the traditional approach group, an ICE catheter will not be used. Transseptal puncture will be performed under fluoroscopic guidance, with all geometries constructed by mapping the catheters. The primary efficacy endpoint is freedom from AF recurrence (without antiarrhythmic medications) at 12 months after ablation. Other endpoints include duration of lead apron use, measures of intra-procedural efficiency, and peri-procedural complications. This RCT will evaluate the efficacy and safety of ICE-guided minimal-fluoroscopy ablation in patients with PAF, also evaluate the benefits to lab staff (regarding reducing occupational hazards) related to this “minimal/zero-fluoroscopy” and “leadless” mode.

Accuracy of Pedicle Screw Placement Using Intraoperative CT-Guided Navigation and Conventional Fluoroscopy for Lumbar Spondylosis.

BackgroundTranspedicular screws are a common adjunct for lumbar spine fusion. Accurate screw placement to prevent neurological injury has been the subject of many studies. The adoption of spine neuronavigation has shown a significant decrease in screw malposition morbidity. We aim to evaluate the accuracy of pedicle screw insertion using intraoperative CT-guided navigation in lumbar spondylosis.MethodsWe reviewed a prospective registry-based cohort study. This included patients who underwent transpedicular screws insertion for lumbar spondylosis under intraoperative CT-guided navigation (iCT-Nav) and compared it to another group operated using conventional fluoroscopy (FS) over one year. In addition, the correlation between clinical outcome using the visual analog scale (VAS) and short 12 physical component scores (SF-12 PCS) and hospital stay was reported.ResultsFifteen patients were included in the iCT-Nav group compared to 42 patients in the FS group. The median age of the iCT-Nav group was 59.3 years old (27-76 years) versus 45 years old (20-60 years) in the FS group. The number of screws was 98 in the iCT-Nav group and 252 screws in the FS group. Based on more than 2-mm breach increments measured on CT images, lumbar pedicular screw placement accuracy was 100% in the iCT-Nav group and 86.9% in the FS group. None of the patients in the iCT-Nav group had to undergo any postoperative revisions. On the other hand, two patients of the FS group developed new postoperative symptoms related to displaced screws and required readmission and revision surgery.ConclusionIn a commonly performed pedicular fixation in lumbar spondylosis, iCT-Nav has been shown to improve the accuracy of pedicle screw placement, hospital stay, and functional outcomes compared to FS.

Does intraoperative 3D navigation improve SpineJack vertebral augmentation in thoracic and lumbar compression fracture?

IntroductionThe aim of this retrospective study was to evaluate the effect of navigation on the positioning of the SpineJack implant in the treatment of thoracic and lumbar compression fractures. MethodsBetween January 2018 and December 2019, all patients operated on for thoracic or lumbar fracture using the SpineJack device in stand-alone were included in this single-center study. The positioning of the SpineJack implant was analyzed on axial CT views by measuring the angle between the axis of the pedicle and the axis of the final implant. The relationships between implant positioning and the use of navigation or fluoroscopy, pedicle dimensions and levels of injury were analyzed. Surgical time, radiation exposure, radiological findings and complications were assessed. ResultsOne hundred patients were included, for 103 fractured vertebrae and a total of 205 implants, 148 placed under standard fluoroscopy and 57 with the Surgivisio navigation system. For pedicle diameters≥5mm (165 implants), the positioning of the implant relative to the axis of the pedicle was significantly better in the navigation group: 2°±1.4° (range, 0–7°) in the fluoroscopy group versus 1.2°±1.1° (range, 0–5°) in the navigation group (p=0.04). There were no significant differences in reduction of vertebral kyphosis angle or mean operating time. Dose area product (DAP) was significantly higher with navigation: 4.43Gy.cm2 versus 0.47Gy.cm2 (p<0.001) and dose to the surgeon significantly lower: 0.5 versus 1.6μSv (p<0.001). No difference was found regarding complications. Subgroup analysis showed significantly greater operative time and patient irradiation in the fluoroscopy group when pedicle diameter was less than 5mm. ConclusionThis study demonstrates the interest of navigation for positioning the SpineJack implant with respect to the pedicle axis in vertebrae with pedicle diameter≥5mm. This study also confirmed the reliability of navigation and lower radiation dose to the surgeon, regardless of the fracture level. Navigation reduced operating time and patient irradiation for vertebrae with pedicle diameter<5mm. Level of evidenceIV; retrospective study.

Ultrasound Versus Fluoroscopy for Stellate Ganglion Block: A Cadaveric Study.

Post-Traumatic Stress Disorder (PTSD) is a common psychiatric disorder. Recent investigations have demonstrated effectiveness of Stellate Ganglion Blocks (SGB) for reducing symptoms associated with PTSD. Both fluoroscopic guided and ultrasound guided SGB have been described and are regularly used in clinical practice. This study sought to evaluate differences in block performance when comparing fluoroscopic versus ultrasound guided SGB. Cadaveric Pilot Study. Academic Research Laboratory. Ten Soft-Cured Human Cadavers. Ten soft-cured human cadavers were used after being at room temperature for 3 hours. Fluoroscopic and ultrasound guided injections were both performed on each cadaver, randomized to left or right sidedness. In total, 7 mL of omnipaque and methylene blue (5:1) was injected in each side. Injectate spread was assessed by measuring vertebral body spread under fluoroscopy. Successful staining of the sympathetic trunk was assessed under cadaveric dissection, with visualization of the sympathetic trunk stained with methylene blue. Ultrasound guided injections resulted in successful staining in 9 of 10 injections, while 6 of 10 for fluoroscopic guidance (P = .3034). The average spread in the ultrasound group was 4.0 compared with 5.2 for the fluoroscopic group (P =.088). In the four fluoroscopic guided injections which failed to stain, the injection occurred posterior to the prevertebral fascia. In the single ultrasound guided block that failed to stain, the injection was in the carotid sheath. While there appeared to be a trend favoring ultrasound guidance, no statistical significance was achieved. This was likely due to this being a limited pilot study. Numerous limitations exist in cadaveric studies, and future investigations should be completed to further study this comparison. That said, the use of the SGB may provide significant relief for patients suffering with PTSD.

A minimally fluoroscopic approach in AVNRT ablation reduces radiation exposure and number of RF applications without compromising safety, effectiveness and procedural time

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Radiofrequency ablation (RF) of atrioventricular nodal reentry tachycardia (AVNRT) using conventional fluoroscopy is associated with a significant radiation exposure to both patients and operators. 3D electro-anatomical mapping systems (EAMS) can reduce radiation exposure, but specific clinical studies on their use in AVNRT ablation still lack. Purpose The aim of this study was to determine if EAMS use in AVNRT ablation can reduce radiation exposure and to analyse its effects on clinical and procedural outcomes. Methods We selected 277 patients who underwent AVNRT RF ablation in a single center in Belgium between July 2015 and November 2019 and performed a retrospective analysis of 136 and 141 patients who respectively and consecutively underwent AVNRT ablation with a conventional fluoroscopic approach (Conventional group) and a minimally fluoroscopic approach using a 3D electro-anatomical mapping system to guide the procedure (Minimal fluoroscopy group). Conventional fluoroscopy was used in both groups to confirm AVNRT induction to avoid costs related to the use of EAMS catheters in case of non-induction. We compared radiation dose, acute success/complication rates, procedural time and the number/time of RF applications in both groups. Results Radiation dose in the minimal fluoroscopy group was significantly lower compared to the conventional group (1179 vs. 2686 mgray.cm2, p &amp;lt; 0,0001) and fluoroscopic time was shorter (2,5 vs. 8,6 minutes, p &amp;lt; 0,0001). Procedural time (70 vs. 69 min, p = NS) and acute success rate (99% vs. 98%, p = NS) were not significantly different in the minimal fluoroscopy group compared to the conventional group, and no complications were observed in both groups. The number of RF applications was significantly lower when EAMS was used (6,2 ± 4,8 vs. 8,6 ± 7,6 RF application, p = 0,01) while the RF application time was not significantly different (56,8 ± 51,2 1 vs. 65,3 ± 86 seconds, p = NS). Conclusion AVNRT catheter ablation using a minimally fluoroscopic approach with 3D electro-anatomical mapping systems reduces radiation exposure without compromising safety, effectiveness and procedural time. EAMS use is associated with a reduction in the number of RF applications suggesting a higher precision and stability of ablation catheters during RF application.

A novel \u201cthree-dimensional-printed individual guide template-assisted percutaneous vertebroplasty\u201d for osteoporotic vertebral compression fracture: a prospective, controlled study

BackgroundConventional percutaneous vertebroplasty (PVP) are mainly guided by C-arm fluoroscopy, and it usually leads to excessive X-ray radiation exposure to patients, surgeons, and anesthetists. Moreover, multi-time fluoroscope may prolong the operation time. 3D-printed template could help minimize fluoroscopy shot times and fluoroscopy dosage during operation, and shorten operation time. We perform this study to compare the efficacy and accuracy of PVP assisted by “three-dimensional printed individual guide template” versus conventional PVP.MethodPatients who suffered acute painful single segment osteoporotic vertebral compression fracture(OVCF) needed operative treatment were randomly assigned into three-dimensional printing individual guide template-assisted percutaneous vertebroplasty group (group A) or conventional PVP guided by C-arm fluoroscopy group (group B) at a 1:1 ratio. Fluoroscopy times for puncture points (FTPP), total radiation dosages (TRD), total fluoroscopy time (TFT), and total operation time (TOT) were recorded as the main evaluation factors to evaluate the two operation procedures.ResultsA total of 36 acute painful single segment OVCF patients were successfully operated on, and each group has 18 patients. None of the patients presented symptomatic complications. The surgical success rate in group A was 94.4%(17/18), one patient in the group A was failed and then operated by conventional procedure. FTPP (1.8 ± 0.8 in group A vs 5.2 ± 1.9 in group B, P < 0.05), TRD (4.9 ± 0.9 mGy vs 7.9 ± 1.6 mGy, P < 0.05), TFT (16.7 ± 2.9 vs 26.6 ± 5.3, P < 0.05), and total operation time (19.4 ± 2.4 min vs 27.8 ± 4.0 min, P < 0.05) were presented statistically difference in the two groups. The incidence of cement leakage occurred in group A (3/18, 16.7%) was less than that occurred in group B (7/18, 38.9%) (P > 0.05).ConclusionsCompared with the conventional PVP, “three-dimensional-printed individual guide template-assisted PVP” could minimize fluoroscopy shot times during operation and fluoroscopy dosage, shorten operation time, and is a more precise and feasible operation method.Trial registrationThe present study was registered with the Chinese Clinical Trial Registry (ChiCTR) (http://www.chictr.org.cn), and its registration no. is ChiCTR1900024283.

Ultrathin bronchoscope combined with virtual bronchoscopic navigation and endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions with or without fluoroscopy: A randomized trial.

BackgroundTransbronchial lung biopsy (TBLB) is usually performed to obtain a definitive diagnosis for peripheral pulmonary lesions (PPLs). Ultrathin bronchoscopy combined with virtual bronchoscopic navigation (VBN) and radial endobronchial ultrasound (R‐EBUS) are generally considered appropriate diagnostic methods for PPLs; however, they have not yet been explored in combination with fluoroscopy. Therefore, the present prospective randomized controlled trial determined the role of fluoroscopy in ultrathin bronchoscopy combined with VBN and R‐EBUS for the diagnosis of PPLs.MethodsPatients with potentially malignant PPLs were enrolled in the study and randomized into fluoroscopy or nonfluoroscopy groups. In both groups, a 3.0‐mm outer and 1.7‐mm internal diameter ultrathin bronchoscope was used for transbronchial lung biopsy combined with R‐EBUS and VBN. In addition, the fluoroscopy group (FG) underwent fluoroscopy, while the nonfluoroscopy group (NFG) did not.ResultsA total of 126 patients were enrolled and randomized in the study. Among them, 120 patients (60 in the NFG and 60 in the FG) were analyzed. The mean lesion sizes were 26.3 ± 11.4 mm and 29.0 ± 11.3 mm in the NFG and FG, respectively. The diagnostic yield was 73.3% (44/60) in the NFG and 81.7% (49/60) in the FG without statistically significant difference (p = 0.38). No obvious complications occurred in either group.ConclusionsUltrathin bronchoscope combined with VBN and R‐EBUS without fluoroscopy is a feasible and safe diagnostic method for PPLs.

C-Arm-Free Anterior Correction for Adolescent Idiopathic Scoliosis (Lenke Type 5C): Analysis of Early Outcomes and Complications

Computer-assisted spinal surgery as a technique for reducing radiation exposure to the operating staff and the complications of spinal deformity are receiving considerable attention. However, no technical reports have described the technique for navigating anterior correction of adolescent idiopathic scoliosis without C-arm fluoroscopy. The purpose of this study was to evaluate the efficacy and safety of this new C-arm-free anterior correction for scoliosis. This study investigated 38 consecutive patients with Lenke type 5C curves who underwent selective lumbar or thoracolumbar fusion, comprising 26 patients with conventional anterior correction surgery, and 12 patients with C-arm-free navigation surgery. The 2 groups were evaluated immediately postoperatively and at the 2-year follow-up. No vascular injuries, screw malpositioning, or major complications were associated with the surgical procedure in either group. Correction rates of the lumbar curve were satisfactory with no significant difference between groups (mean, 82.6% ± 5.7% vs. 80.7% ± 10.2%, respectively). However, mean time for fluoroscopy in group C was 133 ± 9.5 seconds (P < 0.0001). No significant differences in intraoperative blood loss (642 ± 123 mL vs. 731 ± 222 mL, respectively) or surgical time (251 ± 13 min vs. 301 ± 38 min, respectively) were seen between groups. Mean final follow-up Scoliosis Research Society Outcomes Questionnaire (SRS-22) was also excellent for both group C (4.2 ± 0.19) and group N (4.3 ± 0.20). C-arm-free anterior correction offers safe, effective surgery for adolescent idiopathic scoliosis. The advantage of this new technique is no radiation exposure for medical staff at centers performing large numbers of spinal procedures.

Computed tomography versus fluoroscopic guided-sacroiliac joint injection: a prospective comparative study

BackgroundThere are limited data discussing long-term pain relief and comparability of different image-guided sacroiliac joint (SIJ) injection. This study compared CT and fluoroscopic-guided SIJ injections regarding statistically and clinically significant differences in numeric pain reduction, radiation doses, and patient’s satisfaction.MethodsA prospective study conducted on 52 patients who met specific inclusion criteria of SIJ pain. A mixture of 1 ml of 40 mg methylprednisolone acetate diluted in 2 ml of lidocaine 2% was injected under either CT or fluoroscopic guidance. Numeric rating score (NRS) and Oswestry disability index (ODI) were assessed and recorded for each patient before procedure and one-week, and one-, three-, six-, and 12-months after procedure. The results were compared between both groups.ResultsAnalysis of NRS one-month post-procedure showed a significant decrease from baseline in both groups: 12.5% in CT group (p = 0.002) and 9.5% in fluoroscopic group (p = 0.006). No significant difference in NRS between two groups at one- and three-months post-procedure (p = 0.11 and 0.1, respectively). There was a significant difference in NRS between two groups at six- and 12-months post-procedure (p = 0.001 and < 0.0001, respectively). Comparison of ODI at six-month post-procedure revealed that both groups had a statistically significant improvement (p < 0.0001). There was a significant difference in ODI between two groups at six-months post-procedure (p = 0.01).ConclusionsCT-guided SIJ injection compares favorably with fluoroscopic guidance and offers statistically and clinically significant long-term pain relief. The use of dose reduction protocol in CT is important for decreasing the radiation dose.

The Impact of Intraoperative Image-Guidance Modalities and Neurophysiologic Monitoring in the Safety of Sacroiliac Fusions.

Study Design:Retrospective observational cohort.Objective:A review of efficiency and safety of fluoroscopy and stereotactic navigation system for minimally invasive (MIS) Sacroiliac (SI) fusion through a lateral technique.Methods:Retrospective analysis of an observational cohort of 96 patients greater than 18 years old, that underwent MIS SI fusion guided by fluoroscopy or navigation between January 2013 and April 2020 with a minimum of 3 months follow-up. Intraoperative neuromonitoring (IONM) with a variable combination of electromyography (EMG), somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) was also utilized.Results:The overall complication rate in the study was 9.4%, and there was no difference between the fluoroscopy (10.1%), and navigation groups (8%). Neurological complication rate was 2.1%, without a significant difference between both intraoperative guidance modality groups (p = 0.227). There was a significant difference between the modalities of IONM used and the occurrence of neurological injury (p = 0.01).The 2 patients who had a neurological complication postoperatively were monitored only with EMG and SSEP, but none of the patients (n = 76) in which MEPs were utilized had neurologic complication. The mean pain improvement 3 months after surgery was greater in the navigation group (2.44 ± 2.72), but was not statistically different than the improvement in the fluoroscopy group (1.90 ± 2.07) (p = 0.301).Conclusions:No difference in the safety of the procedure was found between the fluoroscopy and the stereotactic navigation techniques. The contribution of the IONM to the safety of SI fusions could not be determined, but the data indicates that MEPs provide the highest level of sensitivity.

The Impact of Fluoroscopy During Percutaneous Nerve Evaluation on Subsequent Implantation of a Sacral Neuromodulator Among Women With Pelvic Floor Disorders: A Randomized, Noninferiority Trial

To evaluate whether percutaneous nerve evaluation (PNE) without fluoroscopy is inferior to fluoroscopy use in women undergoing trials of sacral neuromodulation (SNM) for pelvic floor disorders (PFDs). In an unblinded noninferiority trial, women undergoing PNE were randomized to fluoroscopy or no fluoroscopy. The primary outcome was "success" and defined as implantation of the permanent SNM device within three months of PNE. At an expected 40% success and a 30% noninferiority threshold, 33 participants in each group were needed for 80% power (α = 0.05). Univariate analyses and a logistic regression model adjusting for univariate variables associated with the primary outcome were performed. From April 2016 to December 2018, 74 participants underwent PNE of which 36 underwent PNE with fluoroscopy and 38 without. The fluoroscopy group had less baseline mean daily voids compared to the no fluoroscopy group (10.79 ± 6.48 vs. 16.21 ± 10.05, p = 0.01). PNE performed without fluoroscopy had similar success (18/38, 47.4%) compared to fluoroscopy (21/36, 58.3%), meeting our noninferiority definition (difference 10.9%, 90% CI -8% to 30%, p = 0.049). In a logistic regression model adjusting for age, Charlson comorbidity index, stage of prolapse, and number of baseline voids per day, trial success was still similar between the two groups (adjOR 1.82, 95% CI 0.52 to 6.94, p = 0.36). PNE performed without fluoroscopy is noninferior to PNE with fluoroscopy use for the outcome of SNM device implantation within three months among women undergoing therapy for PFDs.

Abstract 16072: Clinical Outcomes of Catheter Ablation for Left Ventricular Summit/intramural Premature Ventricular Contractions Comparing Conventional vs. Fluoroless Techniques

Introduction: Radiofrequency catheter ablation (CA) is the preferred treatment for premature ventricular contractions (PVCs). Ionizing radiation has major side effects for both patients and personnel in the electrophysiology laboratory. Fluoroless procedures are routinely performed for atrial fibrillation and simple PVC cases. Nonetheless, left ventricular (LV) summit/intramural PVCs cases are more challenging and clinical outcomes and complications have been poorly studied in this category with the use of fluoroless ablation. Hypothesis: We aimed to compare acute, long-term success rate and complications between fluoroless procedures versus standard approach for left ventricular (LV) summit/intramural PVCs. Methods: We conducted a retrospective analysis of patients who underwent PVC ablation under fluoroscopy and non-fluoroscopy at two institutions. Results: A total of 41 cases were enrolled (male: 61%; mean age: 55 ). Twenty-five cases underwent ablation under fluoroscopy whereas 16 underwent non-fluoroscopy ablation. Acute success was seen in 88% of non-fluoroscopy cases compared to 87.5% in the fluoroscopy group ( p = 0.9). The PVC recurrence at 12 months was similar between both groups (non-fluoroscopy: 15% vs Fluoroscopy: 18%) ( p = 0.9). No complications occurred in any group. Conclusions: Fluoroless CA is an emerging technique in the treatment of LV summit/intramural PVCs that appears to have similar clinical outcomes and complications compared to conventional fluoroscopic procedures.