Fluoroscopy Research Articles

A systematic review of the effectiveness of leaded glasses for ensuring safety among healthcare professionals in fluoroscopy.

Currently, there is an increase in procedures across various clinical specialties involving the use of ionising radiation. The primary objective of this systematic review is to analyse and compare the existing literature regarding the effectiveness of leaded glasses for healthcare professionals. Comprehensive literature searches were conducted for relevant studies published between 2018 and 2023 using the Scopus, PubMed, and Web of Science databases according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. After the complete text screening, 11 articles were deemed suitable for inclusion in the review. Leaded glasses significantly reduce eye radiation exposure, with studies showing shielding effects ranging from 10 % to 88,9 %, depending on the configuration and thickness of the glasses. For instance, lightweight glasses achieved a shielding effect of 61.4 %, while thicker lead equivalents (≥0.5 mm) offered up to ninefold dose reductions. Studies also noted the importance of lateral shielding and ergonomic designs for optimal protection. Leaded glasses significantly reduce eye lens doses but are most effective when combined with other protective measures. Factors such as head orientation, procedural complexity, and operator movement influence their performance. The findings underscore the need for standardised guidelines on protective eyewear use and further research under real-world clinical conditions. It is essential to ensure the proper use of leaded glasses to minimize the risks of ionising radiation for healthcare professionals in fluoroscopy procedures.

HKA angle exceeding 5 degrees is strongly associated with lateral patellar translation beyond 2 mm: surgical recommendations for avoiding adverse effects on the patellofemoral joint after OWHTO

PurposePrevious studies reported that anterior knee pain (AKP) occurs with an incidence of 32% after opening-wedge high tibial osteotomy (OWHTO). However, the biomechanical effects of this procedure on patellofemoral joints (PFJs) remain unclear. We aimed to quantify the changes in the kinematics and cartilage conditions of the PFJ during stair climbing before and after OWHTO.MethodsWe recruited 15 patients who underwent unilateral OWHTO. All patients performed continuous stair climbing under the surveillance of a dual fluoroscopic imaging system to determine accurate 6-degree-of-freedom (6-DOF) PFJs and 3D hip-knee-ankle (HKA) angles before and 6 months after OWHTO. The volume penetration centres between the patellar and femoral cartilage models were defined as contact centres. Eleven of these patients underwent quantitative T2 relaxation MRI to determine whether and how PFJ cartilage degeneration progressed.ResultsAfter OWHTO, patella valgus (mean − 3.73°, P = 0.02) and internal rotation (mean 3.14°, P = 0.03) increased compared with the preoperative conditions during the stair climbing motion. In addition, the patellae of OWTHO knees were located more laterally after surgery (1.56 ± 2.24 mm, P = 0.02) at knee flexion. Moreover, lateral shifts in the contact patterns of both the medial and lateral patellar facets together with increased T2 values (207.10 ± 21.84 ms, P = 0.04) of the lateral patella cartilage were found after surgery. Finally, the lateral patellar shift increased with decreasing varus 3D-HKA after surgery (R= -0.79, P < 0.001). Therefore, controlling 3D-HKA may be helpful in limiting lateral patellar shift.ConclusionOWHTO changed the patellofemoral kinematics and contact patterns during stair climbing, especially the lateral patellar shift, which may lead to degeneration of the PFJ cartilage. Avoiding overcorrection of the HKA angle beyond 5 degrees of valgus reduces lateral patellar translation, which may help prevent AKP. Additional clinical studies are necessary to validate these biomechanical findings and clarify their impacts on patient outcomes.

Accuracy of a Superficial Landmark of the Recurrent Branch of the Median Nerve and Anatomical Features of Transverse Muscle Fibres Observed During Carpal Tunnel Release.

Background: Surgeons use anatomical landmarks like the scaphoid tubercle, pisiform, trapezial tubercle and hook of hamate, along with Kaplan cardinal line (KCL) to avoid injury to the recurrent motor branch (RMB) of the median nerve during carpal tunnel release. The presence of transverse muscle fibres (TMF) overlying the transverse carpal ligament (TCL) may suggest proximity of the RMB, but their anatomical relationship is unclear. In this study, we evaluated the accuracy of anatomical landmarks to the RMB, TMF origin and insertion, and examined the relationship between TMF presence and RMB running patterns. Methods: We dissected 30 hands from 16 fresh-frozen cadavers. After marking the superficial landmarks, we made a skin incision to confirm the presence of TMF and examined their origins and insertions. We then opened the carpal tunnel, dissected the RMB and recorded each position on a coordinate system using a fluoroscopic imaging system. Results: TMF were observed in 18 hands (60%): 13 were continuous with the abductor pollicis brevis (APB), 2 were continuous with the superficial head of the flexor pollicis brevis (FPB) and 3 were continuous with both. The bifurcation point of the RMB was significantly located 4.5 mm ulnar and 7.5 mm proximal to the superficial landmark at the median. The RMB was classified according to Poisel classification: 24 (80%) were of the extraligamentous type, 4 (13%) of the transligamentous type, 1 (3%) of the preligamentous type and 1 (3%) of the subligamentous type. Amongst these, the transligamentous/preligamentous/subligamentous types are at high risk for RMB injury during TCL incision. No significant association existed between TMF presence and these high-risk RMB types.. Conclusions: The actual RMB may be located ulnar and proximal to the superficial landmark, indicating that surgeons should be cautious about RMB damage even in the absence of TMF.

Intra-Vertebral Contrast Phlebography During Balloon Kyphoplasty: A Cautionary Tale of Using Antegrade Inferior Vena Cavogram in Preventing Pulmonary Cement Embolism

Pulmonary embolism of cement is considered a catastrophic complication of kyphoplasty. Considering the predilection of thoracic and upper lumbar levels as well as the role of valveless vertebral plexus and abdominal caval system, we report the utility of performing an intra-osseous phlebography in the fractured vertebral body visualized through lateral view fluoroscopic cine-images to assess the direct contrast efflux towards the Inferior Vena Cava (IVC). The flow patterns of anterior external vertebral venous plexus and its tributaries are shown using schematic diagrams and fluoroscopic images. Stepwise technique of this perivertebral venogram is discussed as well as recognition of confounding paravertebral/ radiculomedullary arterial anatomy. The new venous channels opening up after balloon inflation are highly likely to be the surrogate pathways for cement embolization to the heart and pulmonary artery. This simple additional imaging step (“antegrade inferior vena cavogram”) helps to avoid anterior venous plexus extravasation of cement towards the IVC, using bipedicular contrast lavage and sequential injection using different viscosities. This article also highlights the management of pulmonary embolism using interventional radiology as well as open surgical methods. The article also eludes into some alternate vertebral augmentation device strategies to achieve complete obviation of cement extravasation as well.

Does Orthopaedic Resident Pelvis Fluoroscopy Knowledge improve with testing with a Novel Pelvis Model and Educational website?

We tested whether residents would improve in fluoroscopy knowledge and ability after using an inexpensive novel pelvis model and educational website. Twenty-four orthopaedic residents were recruited from three United States residency programs and randomised into two groups with equal numbers of juniors and seniors. The OrthoAcademy group received educational materials from a website ( www.theorthoacademy.com ), whereas the control group did not. Survey scores, radiograph scores, number of fluoroscopic images taken, and overall radiation exposure were compared (1) between control and OrthoAcademy groups and (2) between junior and senior residents. Both groups had higher radiograph scores at the second round of testing than at the first (P =.004). The OrthoAcademy group had higher post-test than pre-test knowledge survey scores (P =.045), whereas the control group did not (P =.54). However, the OrthoAcademy group did not have higher radiograph scores between tests (P =.15), whereas the control group did (P =.01). Junior residents had higher second-round than first-round radiograph scores (P =.005) and survey scores (P =.006), whereas senior residents did not (P =.24 radiograph scores) (P =.30 survey scores). Testing residents with this novel pelvis model improved the quality of the fluoroscopic images obtained by the residents, especially juniors. This study highlighted the need for more accessible resources for residents to learn about obtaining these images.

Deep Learning-Based Detection of Malignant Bile Duct Stenosis in Fluoroscopy Images of Endoscopic Retrograde Cholangiopancreatography.

The accurate distinction between benign and malignant biliary strictures (BS) poses a significant challenge. Despite the use of bile duct biopsies and brush cytology via endoscopic retrograde cholangiopancreaticography (ERCP), the results remain suboptimal. Single-operator cholangioscopy can enhance the diagnostic yield in BS, but its limited availability and high costs are substantial barriers. Convolutional Neural Network (CNN)-based systems may improve the diagnostic process and enhance reproducibility. Therefore, we assessed the feasibility of using deep learning to differentiate BS using fluoroscopy images during ERCP. We conducted a retrospective review of adult patients (n=251) from three university centers in Germany (Leipzig, Dresden, Halle) who underwent ERCP. We developed and evaluated a deep learning-based model using fluoroscopy images. The performance of the classifier was evaluated by measuring the area under the receiver operating characteristic curve (AUROC) and we utilized saliency map analyses to understand the decision-making process of the model. In cross-validation experiments, malignant BS were detected with a mean AUROC of 0.89 ± 0.03. The test set of the Leipzig cohort demonstrated an AUROC of 0.90. In two independent external validation cohorts (Dresden, Halle), the deep learning-based classifier achieved an AUROC of 0.72 and 0.76, respectively. The artificial intelligence model's predictions identified plausible characteristics within the fluoroscopy images. By using a deep learning model, we were able to discriminate malignant BS from benign biliary conditions. The application of artificial intelligence enhances the diagnostic yield of malignant BS and should be validated in a prospective design.

Single-View Fluoroscopic X-Ray Pose Estimation: A Comparison of Alternative Loss Functions and Volumetric Scene Representations.

Many tasks performed in image-guided procedures can be cast as pose estimation problems, where specific projections are chosen to reach a target in 3D space. In this study, we construct a framework for fluoroscopic pose estimation and compare alternative loss functions and volumetric scene representations. We first develop a differentiable projection (DiffProj) algorithm for the efficient computation of Digitally Reconstructed Radiographs (DRRs) from either Cone-Beam Computerized Tomography (CBCT) or neural scene representations. We introduce two innovative neural scene representations, Neural Tuned Tomography (NeTT) and masked Neural Radiance Fields (mNeRF). Pose estimation is then performed within the framework by iterative gradient descent using loss functions that quantify the image discrepancy of the synthesized DRR with respect to the ground-truth, target fluoroscopic X-ray image. We compared alternative loss functions and volumetric scene representations for pose estimation using a dataset consisting of 50 cranial tomographic X-ray sequences. We find that Mutual Information significantly outperforms alternative loss functions for pose estimation, avoiding entrapment in local optima. The alternative discrete (CBCT) and neural (NeTT and mNeRF) volumetric scene representations yield comparable performance (3D angle errors, mean ≤ 3.2° and 90% quantile ≤ 3.4°); however, the neural scene representations incur a considerable computational expense to train.

Clinical application of intramedullary nail fixation assisted by locking plates in segmental tibia fractures: A retrospective study.

It is unclear whether small plates are needed for augment fixation to provide a more stable mechanical environment in segmental fractures of the tibia treated with intramedullary nail. The purpose of this study was to investigate the efficacy of intramedullary nailing combined with locking plates in the treatment of segmental fractures of the tibia. This study included 41 patients with segmental tibia fractures between January 1, 2018 and January 1, 2023. Eighteen patients were treated with an intramedullary nail assisted by a locking plate (combination group), and 23 patients were treated with an intramedullary nail without a plate (nail group). The perioperative parameters of all patients were recorded, and clinical efficacy was evaluated during follow-up. The operation time was shorter but the incision was longer in the combination group (P < .05). The numbers of fluoroscopy procedures and the time to union were shorter in the combination group (P < .05). The rate of malunion in the nail group (4, 17.4%) was significantly greater than that in the combination group (0, 0%). At the last follow-up, no statistically significant differences in walking ability were detected. Our results suggest that a locking plate combined with an intramedullary nail for segmental tibial fractures may require a longer surgical incision, but it has significant advantages such as a shorter operative time and time to union, a shorter fluoroscopy time, and a lower rate of malunion and nonunion. Intramedullary nail fixation assisted by a locking plate is an effective method for treating segmental fractures of the tibia.

FBG‐driven simulation for virtual augmentation of fluoroscopic images during endovascular interventions

AbstractEndovascular interventions are procedures designed to diagnose and treat vascular diseases, using catheters to navigate inside arteries and veins. Thanks to their minimal invasiveness, they offer many benefits, such as reduced pain and hospital stays, but also present many challenges for clinicians, as they require specialized training and heavy use of X‐rays. This is particularly relevant when accessing (i.e. cannulating) small arteries with steep angles, such as most aortic branches. To address this difficulty, a novel solution that enhances fluoroscopic 2D images in real‐time by displaying virtual configurations of the catheter and guidewire is proposed. In contrast to existing works, proposing either simulators or simple augmented reality frameworks, this approach involves a predictive simulation showing the resulting shape of the catheter after guidewire withdrawal without requiring the clinician to perform this task. This system demonstrated accurate prediction with a mean 3D error of 2.4 1.3 mm and a mean error of 1.1 0.7 mm on the fluoroscopic image plane between the real catheter shape after guidewire withdrawal and the predicted shape. A user study reported an average intervention time reduction of 56 when adopting this system, resulting in a lower X‐ray exposure.

The impact of ureteral access sheaths on radiation exposure in the ureterorenoscopic treatment of urolithiasis.

Ureteral access sheaths (UAS) are widely used in the endoscopic treatment of urolithiasis. In modern medicine, radiation exposure from diagnostics and therapy is increasing; however, the impact of UAS on procedure duration, fluoroscopy time, and radiation exposure is still uncertain. This retrospective study included 1,026 patients who received ureterorenoscopic treatment for urolithiasis between 2016 and 2018 at a large academic center. Patients were dichotomized according to the use of UAS, and propensity score matching was performed based on age, BMI and stone size. Patient demographics, stone size, radiographic density, perioperative complications, and postoperative outcome were assessed. Procedure time and radiation exposure, recorded as the fluoroscopy time and area dose product, were analyzed. In total, 300 patients were successfully matched to the cohort with UAS (n=150) and the cohort without UAS (n=150). Patients' demographics were similar for age, gender, BMI and ASA score (each p>0.05). Median stone size was 8mm and 7.5mm in the cohort with and without UAS (p=0.335). Procedure time showed no differences between the two cohorts (p=0.749). Fluoroscopy time and area dose product were significantly lower in patients treated with the use of UAS (p=0.004; p<0.001). The use of a UAS does not prolong operation time in patients with equivalent stone burden. In addition, the use of a UAS reduces fluoroscopy time and radiation exposure. In the future, to reduce radiation exposure to the patient and medical staff, the use of a UAS should also be considered for limited stone disease.

Open window mapping with extended early meets late algorithm vs. conventional mapping for accessory pathway ablation.

Catheter ablation of accessory pathway is the treatment of choice for patients with symptomatic Wolff-Parkinson-White (WPW) syndrome. Accessory pathway (AP) identification relies on point-by-point mapping, raising the need for more precise and efficient methods. High-density open window mapping (OWM) combined with the extended early meets late (EEML) algorithm, utilizing 3D electroanatomic mapping systems, is a promising alternative. However, its role in clinical practice lacks comprehensive investigation, necessitating a comparison with conventional mapping. A prospective cohort study of patients referred for AP ablation evaluated the OWM strategy, comparing it with a retrospective cohort using conventional mapping. Procedure variables, including radiofrequency (RF), fluoroscopy, mapping and procedure times along with total mapping points were compared. Long-term recurrence rates were assessed. 42 patients in the OWM group and 34 in the conventional group were included. The OWM strategy exhibited a significantly lower total mapping time (p = 0.030) despite acquiring more points (p < 0.001) than the conventional group. OWM was associated with reduced fluoroscopy time (12.0 (9.0-16) vs. 19 (11-30) minutes, p = 0.009) and RF time (p = 0.021). Long-term recurrence rates were comparable between groups (7.1% OWM vs. 17.7% conventional mapping, p = 0.284). At a median follow-up of 16.2 (4.6-39.4) months there were not significant differences in recurrence-free survival (p = 0.509). OWM with the EEML algorithm is a feasible tool for precise AP location and ablation, associated with less fluoroscopy time, RF time, and total mapping time. Long-term recurrence rates were similar to conventional mapping. Prospective studies are warranted for further validation.

Exploring the Relationship Between Foot Position and Reduced Risk of Knee-Related Injuries in Side-Cutting Movements

Background: Knee-related injuries often result from poor movement patterns that destabilize the joint and increase stress on knee structures. Understanding the influence of foot positioning on knee biomechanics is critical for identifying high-risk movement patterns and preventing injuries. Methods: Twenty healthy male participants performed side-cutting movements at three different foot progression angles. One participant’s data were used to develop and validate a knee finite element model with high-speed dual fluoroscopic imaging (DFIS). Combined with a musculoskeletal analysis, the model simulated internal knee loads under various foot-positioning conditions. Results: The analysis revealed that, as the external foot progression angle increased, the ankle plantarflexion decreased, while the ankle internal rotation and knee valgus moments increased. Higher stress concentrations were observed on the ACL, lateral meniscus, lateral tibial cartilage, and medial collateral ligament, particularly at the femoral–tibial ACL attachments. Conclusion: The findings suggest that a toe-out foot position elevates the risk of knee injuries by increasing stress on key structures, whereas a toe-in position may enhance joint stability, reduce the ACL injury risk, and promote favorable muscle activation patterns.

Impact of a Prototype 29:1 Ratio Grid on Image Quality and Radiation Dose in Abdominal Angiography

Objectives The aim of this study was to evaluate the impact of a prototype grid with a 29:1 ratio (r29) and a 15:1 (r15) grid on the image quality (IQ) and radiation dose in abdominal angiography. Materials and Methods Six typical abdominal angiographic image scenarios were created in 4 pigs. Polymethylmethacrylate and aluminum plates were used to add 10 cm of patient equivalent thickness to simulate different body types. Fluoroscopic images were acquired with a source-to-image receptor distance of 120 cm. Tantalum- and iron-specific acquisition protocols at different IQ levels were acquired. IQ of radiation dose equivalent image pairs, created with the r29 and r15 grids, respectively, was quantitatively evaluated using contrast-to-noise ratio (CNR) measurements. Differences in radiation dose were estimated using the dose-weighted CNR. Two blinded readers compared IQ of these images using a Likert scale. In a second step, the readers selected pairs of the r29 and r15 images with subjectively equivalent IQ. Radiation doses were then compared. Results Compared with the r15 grid, the r29 grid images achieved similar CNR at an average of 26% (±12%) lower radiation dose at a mean patient equivalent thickness of 26 cm and 36 cm. Both readers noted a significant increase in IQ (P &lt; 0.001) for dose equivalent images, whereas the interobserver agreement was 0.59. For the selected IQ equivalent images, a radiation dose reduction of 38% (±17%; P &lt; 0.001, interobserver agreement 0.92) was noted when using the r29 grid. Conclusions The use of an r29 grid at a large source-to-image receptor distance can significantly improve the IQ compared with the r15 grid at the same radiation dose in abdominal angiography or can reduce radiation dose while preserving IQ.

Management of ERCP-related perforation: a large multicenter study.

Perforation is a rare but serious adverse event associated with endoscopic retrograde cholangiopancreatography (ERCP). There is no consensus to guide clinicians in the management of ERCP-related duodenal perforations, making it difficult to determine whether surgical or endoscopic treatment is optimal. The present study retrospectively evaluated the characteristics and clinical outcomes of patients who experienced ERCP-related duodenal perforations according to the mechanism of injury. This study evaluated the incidence of ERCP-related duodenal perforations among the 51,957 patients who underwent ERCP at 21 tertiary care hospitals in Japan between April 2017 and March 2022. ERCP-related duodenal perforations were categorized according to the Stapfer classification system. Serious adverse events, length of stay (LOS), and mortality associated with ERCP-related duodenal perforations were evaluated according to the mechanism of injury, time of diagnosis, and treatment modality. Of the 51,957 patients who underwent ERCP, 58 (0.12%) experienced ERCP-related duodenal perforations. The mean LOS was 27.1 days and the mortality rate was 2%. LOS (P = 0.031) and time to healing (P = 0.009) were significantly shorter in patients who underwent endoscopic than surgical treatment. Multivariate Cox regression analysis showed that endoscopic treatment (P = 0.017) and intraprocedural diagnosis (P = 0.019) were independently associated with a good clinical course. Diagnosing a perforation during the ERCP procedure can prevent serious complications. Fluoroscopic and endoscopic images should be carefully reviewed. Endoscopic management should be the treatment of choice for patients diagnosed with perforation during ERCP procedures.

Experimental study on dissipative characteristics of cathode plasma of coaxial magnetically insulated transmission lines based on microwave interferometry

Flash x-ray radiography is an important diagnostic in hydrodynamic experiments to provide fluoroscopic imaging of fast-moving dense targets. In order to obtain multiple images of an object at different times in an experiment, a flash x-ray accelerator is required to output multiple pulses. For the induction voltage adder (IVA) multi-pulse accelerator, it is important to study the effect of the cathode plasma generated by the front pulse in magnetically insulated transmission lines (MITLs) on the transmission of the subsequent pulses. In this paper, a coaxial MITL experimental platform based on the “QiangGuang-I” accelerator is established to study the dissipation characteristics of the cathode plasma, and its working condition is similar to that of MITLs in typical IVA accelerators. In the experiment, a stable magnetic insulation is formed in the coaxial MITL, and the current loss along the line can be ignored. The microwave interferometer is used to measure the evolution of cathode plasma density over time for hundreds of microseconds after the pulse disappears. The measurement results of microwave interference show that the line-averaged density of the plasma in the anode–cathode gap is above 1 × 1018 m−3, and the time for the plasma density to decrease to 1 × 1016 m−3 is about 600 μs. The expansion velocity of the plasma after a pulse is much lower than that during the pulse. In addition, the dissipation characteristics of the cathode plasma with different electrical parameters of the pulses are compared and analyzed.

The Dreaded Cholangiogram: Fluoroscopic Findings for Timely Diagnosis

Abstract This study presents the fluoroscopic image of hilar cholangiocarcinoma (Klatskin tumor) in a young adult male with accelerated hypertension. The image captures the characteristic biliary obstruction at the hepatic hilum, underscoring the diagnostic value of fluoroscopy in identifying biliary tract malignancies. It aims to highlight the importance of timely imaging for management decisions in such cases.

Evaluation of the true lateral fluoroscopic projection for the relation of the S1 recess/foramen to safe corridors in transiliac-transsacral screw placement in human cadaveric pelves

IntroductionPercutaneous screw fixation is a widely used treatment for posterior pelvic ring injuries. Transiliac-transsacral screw fixation has demonstrated superior biomechanical properties over bilateral sacroiliac screws, particularly in the minimally displaced bilateral sacral fractures. Screw placement under fluoroscopic control is still common, while CT navigation is gaining popularity. However, the accurate placement of screws within a safe zone is essential to avoid neurovascular complications.MethodsAn anatomical study using human cadaveric pelves was conducted to assess radiological landmarks and determine a safe zone in relation to the S1 recess/foramen for transiliac-transsacral screw placement.ResultsFourteen pelves were evaluated. Ten pelves were classified as having a satisfactory corridor for screw placement, while four were deemed to have an impossible or high-risk corridor. A safe zone was defined based on the diagonal bisector of the S1 vertebral body, ICD and anterior cortex.DiscussionThe study findings suggest that lateral fluoroscopic projection can determine a safe entry point for screw placement. Understanding the anatomy and landmarks on lateral fluoroscopic images is crucial for successful screw placement and avoiding complications.ConclusionThe S1 body diagonal is consistently located anterior to the S1 recess in lateral fluoroscopic projections, providing a potential safe corridor for transiliac-transsacral screw placement at the S1 level in nondysmorphic pelves. Further research is needed to confirm these findings with CT imaging and evaluate the technical feasibility of screw placement.

Intraoperative angulation of the C-arm for X-ray of each curved surface of the femoral neck wall: a cadaveric study.

C-arm fluoroscopy is the main method assisting surgical reduction and internal fixation of the femoral neck, as traditional anteroposterior and lateral fluoroscopy is insufficient for visualizing the irregular anatomical structure of the femoral neck. We analysed the anatomy of the femoral neck to ascertain the optimal position and angle of the C-arm for adequate visualization of the femoral neck during fluoroscopy. The femoral neck was divided into anterior, posterosuperior and posteroinferior surfaces. These surfaces and the coronal plane of the femur formed the anterior surface coronal angle (ACA), posterosuperior surface coronal angle (PSCA) and posteroinferior surface coronal angle (PICA), respectively. Three angles of 32 dried femoral samples were measured. In the aluminium model, steel wires penetrated the femoral neck wall, whereas, in the wire model, three Kirschner wires penetrated the femoral neck wall. The C-arm was rotated 5° for a 0°-180° fluoroscopic view of each curved surface. Each specimen was imaged, totalling 111 frames. The optimal angle for fluoroscopic imaging of each surface was ascertained, and fluoroscopic features of the Kirschner wire penetrating the femoral neck cortex at three different angles on fluoroscopy and anteroposterior and lateral radiographs were observed. The femoral neck is irregularly shaped and cylindrical, with the anterior surface longer than the posteroinferior surface. The ACA, PSCA and PICA were 31 ± 4.589°, 67.813 ± 5.052° and 168.688 ± 3.206°, respectively. The optimal angles for visualizing the anterior, posterosuperior and posteroinferior surfaces of the steel wire aluminium foil model under fluoroscopy were 30.781 ± 5.464°, 67.969 ± 3.721°, and 167.813 ± 4.319°, respectively. There was no significant difference in the measurements of the corresponding surface coronal angles (P > 0.05). Kirschner wires penetrating the femoral neck wall were difficult to visualize on traditional anteroposterior and lateral films. Increasing the angle to 30°, 70° or 170° for fluoroscopy allowed clear visualization of Kirschner wires penetrating the femoral cortex. Traditional anteroposterior and lateral fluoroscopic views are insufficient for clear visualization of the true structure of the femoral neck. Additionally, increasing the angle to 30°, 70° or 170° for fluoroscopy allows observation of the fracture reduction quality from the anterior surface, posterosuperior surface and posteroinferior surface of the femoral neck and the damage to the corresponding cortical bone caused by internal fixation. Level II.

Comparative Analysis of Real-World Clinical Outcomes of a Novel Pulsed Field Ablation System for Pulmonary Vein Isolation: The Prospective CIRCLE-PVI Study.

Background: Pulsed field ablation (PFA) represents a novel non-thermal approach for treating atrial fibrillation (AF) through pulmonary vein isolation (PVI). By utilizing irreversible electroporation, PFA creates lesions with minimal impact on adjacent tissues. This study investigates the procedural outcomes and safety of a novel circular PFA catheter in comparison to an established PFA system in a real-world clinical setting. Methods: This prospective, single-center study enrolled 125 consecutive patients with symptomatic paroxysmal or persistent AF undergoing first-time PVI with PFA at Ulm University Heart Center. Twenty-five patients underwent PFA PVI using a novel PFA system (PulseSelectTM, Medtronic, Dublin, Ireland) which incorporates a new circular catheter design and additional features such as ECG-triggered energy application and phrenic nerve capture testing. In comparison, 100 patients were treated using the established PFA system (FarapulseTM, Boston Scientific, Marlborough, MA, USA). Results: Acute PVI was achieved in 100% of the patients. Procedure duration, total left atrial (LA) time and fluoroscopy time remained comparable between both groups. The total number of energy deliveries was higher with the novel circular PFA catheter (34.0 vs. 32.0; p < 0.001). No procedure-related complications, including pericardial tamponade, phrenic nerve injury, atrial-esophageal fistula, vascular complications, embolisms, malignant cardiac arrhythmias, or coronary spasms were observed. Conclusions: The novel and the established PFA systems demonstrated comparable results in terms of procedure duration, fluoroscopy time, and LA time. In the hands of experienced operators, the novel circular PFA system enables an effective, consistent, and safe approach to successful PFA PVI.

Spinal navigation with AI-driven 3D-reconstruction of fluoroscopy images: an ex-vivo feasibility study

BackgroundWith the increasing number of surgeries utilizing spinal instrumentation, three-dimensional surgical navigation aims to improve the accuracy of implant placement. However, its widespread clinical adaption has been hindered by factors such as high radiation exposure and interference with standard surgical workflows.MethodsX23D is a novel AI-based fluoroscopy reconstruction technique that generates a 3D anatomical model of the spine from only four fluoroscopy images. Based on this technology, we developed a prototype for the surgical navigation of pedicle screws placement of the lumbar spine, visualizing the 3D-reconstructed spine anatomy and the surgical drill position in real-time. An ex-vivo study was conducted to compare the accuracy of the X23D-based navigation approach with fluoroscopy-aided freehand instrumentation. Five board-certified surgeons placed pedicle screws on six human torsi within a realistic surgical environment. Breach rate, site and extent (Gertzbein-Robbins) were evaluated in postoperative CT scans, as well as execution time, radiation dose, and user experience. Specimens, operating side, and surgeon were randomised.ResultsForty-nine pedicle screws (n = 24 × 23D, n = 25 2D-fluoroscopy) were evaluated, with six breaches occurring in the control group, one of which was considered clinically significant (medial breach grade C). Five breaches with one clinically significant breach were observed in the X23D group. Breach rate, execution time for each lumbar level (X23D 167 s vs. control 156 s), radiation dose (X23D 33.26 mGy vs. control 49.5 mGy), and user experience did not reveal significant differences (p > 0.05) between the groups.ConclusionsSpinal navigation using the X23D-based approach shows promise and performs well in a realistic surgical ex-vivo setting. With further refinements, its accuracy is expected to match clinical-grade navigation systems while reducing radiation dose.