Improve Patient Safety Research Articles

The Effect of Implementing 3S (SIND, SINO, SINI)-based Orthopedic Nursing Care Instrument in Improving Nursing Service Quality and Patient Safety in Indonesia Hospital

Along with the increasing of orthopedic disorders incidence, the provision of orthopedic nursing care in Indonesia is also increasing. The Indonesian National Nurses Association (INNA) has published nursing care standards as a reference for nurses in providing nursing care and standardizing nursing care terminologies. Standard-based orthopedic nursing care instruments have been developed, but their effectiveness has not been investigated in improving the quality of nursing services and patient safety. This study aimed to identify the effect of the application of 3S-based Orthopedic Nursing Care (3S-ONC) on the quality of nursing services and patient safety. Descriptive quantitative analysis using a quasi-experimental method with a pretest and posttest with control group design, involving 106 respondents (53 control, 53 intervention), recruited by purposive sampling technique. In the intervention group, nurses provided nursing care by applying the 3S-based Orthopedic Nursing Care (3S-ONC) instrument. The study showed that in both groups, most of the nurses were in the early adult category, dominated by female sex and most of them had professional education level. There were significant differences in the quality of nursing services (p 0.046; α 0.05) and patient safety (p 0.000; α 0.05) between the intervention group and the control group after the application of the 3S-ONC instrument. The 3S-ONC instrument can improve the quality of nursing services and the safety of patients with orthopedic disorders in hospitals.The 3S-ONC instrument can be considered for the development of a paper-based or computer-based nursing care documentation system to further improve the quality of nursing services and patient safety in healthcare facilities, especially in hospital.

Application of the bow-tie analysis to improve patient safety - a lesson learned from clinical practice.

This study aimed to assess the risk management of drug safety in an operating theater setting within a hospital-based treatment facility.

Human errors in emergency medical services: a qualitative analysis of contributing factors

BackgroundThe dynamic and challenging work environment of the prehospital emergency care settings creates many challenges for paramedics. Previous studies have examined adverse events and patient safety activities, but studies focusing on paramedics’ perspectives of factors contributing to human error are lacking. In this study, we investigated paramedics’ opinions of the factors contributing to human errors.MethodData was collected through semi-structured individual interviews (n = 15) with paramedics and emergency medical field supervisors in Finland. The data was analyzed using inductive content analysis. Consolidated criteria for reporting qualitative research were used.ResultsContributing factors to human errors were divided into three main categories. The first main category, Changing work environment, consisted of two generic categories: The nature of the work and Factors linked to missions. The second main category, Organization of work, was divided into three generic categories: Inadequate care guidelines, Interaction challenges and Challenges related to technological systems. The third main category, Paramedics themselves, consisted of four generic categories: Issues that complicate cognitive processing, Individual strains and needs, Attitude problems and Impact of work experience.ConclusionVarious factors contributing to human errors in emergency medical services (EMS) settings were identified. Although many of them were related to individual factors or to the paramedics themselves, system-level factors were also found to affect paramedics’ work and may therefore negatively impact patient safety. The findings provide insights for organizations to use this knowledge proactively to develop their procedures and to improve patient safety.

Examining clinical pharmacist interventions and identifying opioid medication-related issues in patients with cancer.

Opioid medications are crucial for managing pain among patients with cancer. Yet, inappropriate prescribing and medication issues can compromise patient safety and quality of care. Clinical pharmacists play a significant role in optimizing opioid therapy and addressing issues related to opioid medication use. This study aimed to examine clinical pharmacist interventions and identify opioid medication-related issues in patients with cancer. We conducted a retrospective observational study at Shaukat Khanum Memorial Cancer Hospital and Research Center in Lahore, Pakistan, conducting a chart review from 1st July 2021 to 31st December 2021. Out of 10,534 opioid medication orders, we documented a total of 974 interventions based on our inclusion criteria. Tramadol and morphine accounted for most of these interventions, comprising 49.27% (n = 475) and 40.04% (n = 386), respectively. Regarding clinical significance, 41.70% (n = 406) were deemed significant, while 37.36% (n = 365) were somewhat significant. The majority of interventions, i.e., 54.05% (n = 521), primarily aimed at optimizing patient outcomes, followed by a secondary aim of improvements in communication, i.e., 25.52% (n = 246). This study establishes the evaluation of clinical pharmacist interventions on opioid medication use in patients with cancer, an issue particularly in oncology settings in Pakistan. The findings emphasize the crucial role of clinical pharmacists in addressing issues related to opioid issue medications, thus improving patient safety and optimizing opioid use for patient well-being.

Potential harms resulting from patient–clinician real-time clinical encounters using video-based telehealth: A making healthcare safer rapid evidence review

Objectives To review the evidence on harms associated with patient–clinician real-time encounters using video-based telehealth and determine the effectiveness of any related patient safety practices (PSPs), which are interventions, strategies, or approaches intended to prevent or mitigate unintended consequences of healthcare delivery and improve patient safety. Methods We searched PubMed, EMBASE, and Cochrane to identify eligible studies published from 2012 to 2022, supplemented by grey literature search. Outcomes of interest included adverse events and other specified harms (i.e., preventable hospitalizations, inappropriate treatment, missed or delayed diagnoses, duplication of services, privacy breaches). Findings Our search retrieved 7155 citations, of which 23 studies (including six randomized controlled trials [RCTs]) were eligible for review. Fourteen studies reported on adverse events or unintended effects of telehealth conducted in diverse settings. Adverse events such as death, reoperation, infection, or major complications were infrequent in both telehealth and usual care groups. Thirteen studies examined preventable hospitalizations or emergency department (ED) visits and reported mixed findings. Of the six RCTs, three showed no difference in risk of hospitalization or ED visits for telehealth compared to usual care and three showed reduced risk for patients receiving telehealth. We found no studies on the effectiveness of PSPs in reducing harms associated with real-time telehealth. Conclusions Telehealth was not inferior to usual care in terms of hospitalizations or ED visits. No studies evaluated a specific PSP. More research is needed to improve understanding of harms associated with real-time use of telehealth and how to prevent or mitigate those harms.

Enhancing operating room efficiency and patient outcomes: The impact of preoperative neuraxial ultrasound in cesarean deliveries

BackgroundThe operating room (OR) is a pivotal financial hub in modern healthcare, accounting for up to 40 % of hospital costs and generating 60–70 % of revenue. Optimizing OR efficiency is crucial for financial sustainability, patient safety, OR throughput, and satisfaction among patients, surgeons, and staff. ObjectiveThis Quality Improvement (QI) project aims to evaluate whether pre-procedure neuraxial ultrasound can enhance obstetric OR efficiency by reducing the time and attempts needed for epidural placement. The secondary objective is to assess improvements in patient comfort, safety, and satisfaction. MethodsConducted at a tertiary hospital in Miami from January to March 2022, the study included 98 parturients undergoing elective cesarean delivery. Patients were randomized into two groups: one receiving preoperative ultrasound (n = 49) and the other not (n = 49). Key metrics recorded included patient demographics, procedural times, number of attempts, pain scores, and patient satisfaction. ResultsThe ultrasound group demonstrated significant improvements in OR efficiency: shorter epidural placement times (median 9 vs. 13 min, p < 0.001), fewer attempts (median 1 vs. 2, p < 0.001), reduced anesthesia ready times (median 22 vs. 31 min, p < 0.001), and decreased total OR times (median 122 vs. 140 min, p = 0.004). Patients in the ultrasound group reported less back pain (median score 0 vs. 1, p < 0.001) and higher satisfaction (median score 10 vs. 9, p < 0.001). ConclusionPreoperative neuraxial ultrasound significantly improves OR case duration and enhances patient outcomes in obstetric anesthesia. While the study's single-site data and lack of blinding are limitations, the findings support larger, multi-institutional studies to confirm these benefits and explore further efficiency improvements.

Evaluation of the Level of Nurses' Awareness of Fungal Infections in Zahedan Educational Hospitals

Background: Hospital-acquired fungal infections are becoming an increasingly significant cause of morbidity, mortality, and healthcare costs. Nurses play a pivotal role in preventing and managing these infections, yet their knowledge levels often remain unevaluated. Objectives: This study aimed to assess the knowledge of nursing staff in educational-medical hospitals in Zahedan, Iran, regarding fungal infections in 2023. Methods: This descriptive, cross-sectional study was conducted among nurses in three educational hospitals (Khatam Al Anbia, Ali ebn Abitaleb, and Bu Ali) in Zahedan. A total of 342 nurses with at least one year of work experience were included using convenience sampling. Data were collected using a two-part questionnaire: A demographic information form and a researcher-made questionnaire assessing knowledge about fungal infections across four domains—epidemiology, prevention, diagnosis, and treatment. Data were analyzed using SPSS software, with a P-value of less than 0.05 considered significant. Results: The mean age of participants was 40.70 ± 8.36 years, with an average work experience of 237.85 ± 133.02 months. Of the 342 nurses, 52.92% were female. The mean total awareness score was 12.63 ± 4.53 out of 25. Overall, 19.30% had very low awareness, 52.05% had low awareness, 26.32% had moderate awareness, and only 2.34% had high awareness. In the epidemiology domain, 69.30% had very low or low knowledge. For prevention, 61.11% showed very low or low awareness. In diagnosis, 61.40% had very low or low knowledge, and in treatment, 63.45% demonstrated very low or low awareness. No significant differences were found based on work experience, gender, age, educational level, or hospital affiliation (P &gt; 0.05). Conclusions: The study reveals a critical knowledge deficit among nursing staff in Zahedan regarding fungal infections. Over 70% of nurses demonstrate low or very low overall awareness, a trend consistent across all evaluated domains. This systemic issue underscores the urgent need for comprehensive, targeted educational interventions, ongoing professional development, and institutional policy changes to enhance nurses' competency in managing fungal infections. Such measures are crucial for improving patient safety, reducing infection rates, and ultimately saving lives.

Interprofessional education interventions for healthcare professionals to improve patient safety: a scoping review.

Patient safety incidents, such as adverse events and medical errors, are often caused by ineffective communication and collaboration. Interprofessional education is an effective method for promoting collaborative competencies and has attracted great attention in the context of patient safety. However, the effectiveness of interprofessional education interventions on patient safety remains unclear. This scoping review aimed to synthesize existing studies that focused on improving patient safety through interprofessional education interventions for healthcare professionals. Six databases, including Medline (via PubMed), Embase, Cochrane Library, CINAHL (via EBSCO), Scopus and Web of Science, were last searched on 20 December 2023. The search records were independently screened by two researchers. The Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies was used for quality appraisal. The data were extracted by two researchers and cross-checked. Finally, a narrative synthesis was performed. The protocol for this scoping review was not registered. Thirteen quasi-experimental studies with moderate methodological quality were included. The results revealed that the characteristics of current interprofessional education interventions were diverse, with a strong interest in simulation-based learning strategies and face-to-face delivery methods. Several studies did not assess the reduction in patient safety incidents involving adverse events or medical errors, relying instead on the improvements in healthcare professionals' knowledge, attitude or practice related to patient safety issues. Less than half of the studies examined team performance, based primarily on the self-evaluation of healthcare professionals and observer-based evaluation. There is a gap in applying newer tools such as peer evaluation and team-based objective structured clinical evaluation. Additional evidence on interprofessional education interventions for improving patient safety is needed by further research, especially randomized controlled trials. Facilitating simulation-based interprofessional education, collecting more objective outcomes of patient safety and selecting suitable tools to evaluate teamwork performance may be the focus of future studies.

Could breaks reduce general practitioner burnout and improve safety? A daily diary study.

Rates of burnout are currently at record high levels, and GPs experience higher burnout than many other specialties. Organisational interventions may reduce burnout, but few studies have investigated these in primary care. The current study investigated whether breaks, both with and without social interactions, were associated with burnout and patient safety perceptions in GPs. A within-subjects, interval contingent, quantitative daily diary design. UK GP practices. Participants completed questionnaires at baseline measuring demographic variables, burnout and patient safety perceptions. They then completed a questionnaire in the evening each day for a week which captured whether they had taken a break that day, whether it involved a positive social interaction, burnout (comprising subscales of disengagement and exhaustion), positive and negative affect and patient safety perceptions. The data were analysed using hierarchical linear modelling to assess same-day and next-day associations. We included 241 responses from 58 GPs for analysis. Taking at least one break (involving any or no social interactions) was associated with lower disengagement that day and lower exhaustion the next day. Taking at least one break involving a positive interaction was associated with 1) lower disengagement, exhaustion, overall burnout and negative affect on the same day, as well as higher positive affect and improved perceptions of patient safety, and 2) lower exhaustion and improved patient safety perceptions on the next day. Organizing daily team or practice breaks where staff can socialise may help to reduce burnout and improve perceptions of patient safety.

A crucial step towards a safer healthcare system: Embracing the WHO surgery checklist in Pakistan.

Mistakes happen. We all make mistakes that makes us human. But when a surgeon makes mistake, it costs lives. Being surgeon, a little negligence might make catastrophic incidents happen. An unintentionally retained needle in the abdominal cavity or surgery of a normal limb instead of faulty gall bladder can have serious consequences not only for the patient and the patient-physician relation but also for the healthcare system. Such negligence events have become common in Pakistan. In Faisalabad, it was reported that a patient with gall stones was mixed up with a patient of limb surgery having the same name that led to inappropriate surgical procedures performed on both.[1] In Abbottabad, an incident was reported where the patient had to undergo an arm surgery but an eye surgery was performed in a private hospital. [2] Everyone blamed the surgeon and the health care system but no one dared to dig into the cause. Why are such childish mistakes happening? And if happened once how is this being repeated? How could a surgeon, a practically learned man make such non-sense? The answer to all these questions lies in the WHO Surgical Safety Checklist. “Safe Surgery Save Lives” was initiated by the World Health Organization (WHO) in 2007 in order to alleviate the number of such unwanted events encountered in the surgical procedures. For the purpose of improving patient safety with least of the resource utilization, WHO came on board with safety checklist in 2008.[3] The WHO 19-item checklist is based on advocating safety checks and a good communication among surgery team members during perioperative periods. It also contains a time-out procedure. In Pakistan, in spite of the great effectiveness, the time-out is either not practiced or is done by some junior, and not by the operating surgeon at the preoperative time. A time-out is a short interval before incision during which it is confirmed that the patient on the surgery bed is the correct one, the procedure to be performed on it is exact and at the required part of body either marked or unmarked.[4] The surgeon should be present at the time-out and all members should guarantee the correct patient, procedure and site. Patient participation in the time-out process is also advised. Majority of the patients show great compliance and satisfaction for participating in the time-out procedure. ---Continue

Nurses' burnout and patient safety culture: The moderating effect of structural empowerment.

To identify correlations among job burnout, structural empowerment, and patient safety culture (PSC), and to explore the potential moderating effect of structural empowerment on the associations between burnout and PSC. The study used a cross-sectional survey design. Convenient sampling was employed. We conducted an anonymous online survey in January 2024 among nurses employed at hospitals in three regions of China. Job burnout, structural empowerment, and perceptions of PSC were assessed. A total of 1026 useable surveys were included in the analyses. Descriptive statistics were performed using SPSS software. A latent structural equation modeling approach using Mplus software was used to analyze the moderating effect. The proposed hypothetical model was supported. Job burnout had a strong direct negative effect on structural empowerment and PSC. Structural empowerment had a significant moderating effect on the relationship between job burnout and PSC. The empirically validated moderation model and study results suggest that managers of healthcare organisations can improve patient safety and care quality by fostering empowerment and providing sufficient support to clinical nurses. The findings of this study suggest that providing more support, resources, and information is likely to be effective in weakening the detrimental impact of job burnout on PSC. This study provides insights into the possible approaches that may improve patient safety. To control the impact of nurses' burnout on care quality, nurse managers should increase empowerment as well as staff nurse engagement. We have adhered to relevant EQUATOR guidelines and conducted an observational study, following the STROBE checklist. During the data collection phase of this study, clinical caregivers participated in completing the online survey.

Reuse of Adverse Effect Reports from the French National Agency of Medicines: A Visual Analytic Tool to Improve Patient Safety.

Adverse drug reaction are defined as "harmful or unpleasant reaction, resulting from an intervention related to the use of a medicinal product". In France, adverse effects due to medicines are reported to the French National Agency of Medicines (ANSM) by the healthcare professionals or consumers. The objective of this study was to implement a tool that facilitates the utilization of ANSM reports by synthesizing information to effectively inform prescribers and users. We focused on 3 psychotropic classes: antidepressants, antipsychotics and anxiolytics. We extracted relevant data from the ANSM website through a webscraping process, based on the names of molecules in these 3 classes: antidepressants, antipsychotics, and anxiolytics. We implemented a web interface with R Shiny that provides three panels: (i) a presentation of the active ingredient with the fewest reports for a selected adverse effect category, (ii) the adverse reactions for a selected active ingredient ranked in descending order, and (iii) a comparison of two active ingredients where, for each adverse effect, the active ingredient with the fewest reported adverse drug events (ADEs) is displayed. Our application allows for synthesizing information to effectively inform prescribers and users. In the ANSM existing interface, molecules can only be viewed one by one, and the ratio needs to be calculated manually, making it difficult to compare molecules. It is important to note that this is not a prescription assistance device but rather for informational purposes. In the future, the application may be expanded to include other categories of molecules. Finally, the indicators provided by our tool could be compared to those from other pharmacovigilance databases.

Quality and Patient Safety Improvement Is Never Finished

A survey of the NEJM Catalyst Insights Council finds that organizations where respondents report high quality and patient safety outcomes are doing something different than their peers.

Determinants of clinical nurses’ patient safety competence: a systematic review protocol

IntroductionPatient safety has become a fundamental element of healthcare quality. However, despite the ongoing efforts of various organisations, patient safety issues remain a problem in the healthcare system. Given the...

Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy

This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies. A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression. Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR= 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR= 22.69, P <0.001), central venous pressure monitoring (AOR= 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR= 4.44, P <0.001), and venous catheterisation (AOR= 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR= 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR= 6.13, P < 0.001). This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.

Digital Guardians: The Role of Technology in Preventing Adverse Drug Events in Community Pharmacies

These adverse drug events, also known as ADEs, are a major cause for concern in the healthcare industry since they are a contributor to morbidity, mortality, and increased healthcare expenditures. Community pharmacies, which serve as the primary point of contact for a large number of patients, play an essential part in the process of identifying and preventing adverse drug reactions (ADEs). The implementation of technology in these contexts presents a number of interesting options that have the potential to improve patient safety and drug management capabilities. Within the context of community pharmacy, this research investigates the impact that various technological improvements have had on the prevention and monitoring of adverse drug reactions (ADEs). Telepharmacy, clinical decision support systems (CDSS), automated dispensing systems, and electronic health records (EHRs) are some of the key technologies that are mentioned. Through this analysis, the benefits, challenges, and future directions of technology-driven pharmacovigilance in community pharmacies are highlighted. Additionally, the review emphasises the necessity of continuous innovation and adaptation in order to enhance patient outcomes and the efficiency of healthcare.

A Literature Review of Human Resource Management in Improving Performance in Health Services

Patient safety is a critical concern in healthcare, and the development and maintenance of patient safety culture are influenced by various human resource factors. This literature review aims to investigate the relationship between human resource factors and safety culture in hospital settings. The study uses a comprehensive literature search using PubMed and Science Direct, focusing on studies conducted from 2020 to 2024 with inclusion criteria based on national journals with an appropriate research scope. The review synthesizes existing research to provide valuable insights into the relationship between human resource factors and patient safety culture within the healthcare environment. The preliminary conceptual framework integrates four main factors: communication, leadership, work procedures, and human factors, providing a comprehensive guide to understanding and improving patient safety culture within the healthcare environment. The review concludes that effective communication, strong and committed leadership, clear work procedures, and the crucial role of human factors are key elements in shaping patient safety culture within the healthcare environment. The findings highlight the interconnectedness of these factors and their collective influence on the safety climate within healthcare organizations. This study contributes to the understanding of how human resource management practices can be utilized to enhance patient safety culture and patient outcomes in hospital environments.

Student Engagement in Patient Safety and Healthcare Quality Improvement: A Brief Educational Approach.

Achieving optimal patient safety (PS) remains a challenge in healthcare. Effective educational methods are critical for improving PS. Innovative teaching tools, like case-based learning, augmented reality, and active learning, can help students better understand and apply PS and healthcare quality improvement (HQI) principles. This study aimed to assess activities and tools implemented to improve PS and HQI education, as well as student engagement, in medical schools. We designed a two-week course for fourth-year medical students at the Autonomous University of Guadalajara, incorporating Fink's taxonomy of significant learning to create engaging activities. The course featured daily synchronous and asynchronous learning, with reinforcement activities using tools, like augmented reality and artificial intelligence. A total of 394 students participated, with their performance in activities and final exam outcomes analyzed using non-parametric tests. Students who passed the final exam scored higher in activities focused on application and reasoning (p = 0.02 and p = 0.018, respectively). Activity 7B, involving problem-solving and decision-making, was perceived as the most impactful. Activity 8A, a case-based learning exercise on incident reporting, received the highest score for perception of exam preparation. This study demonstrates innovative teaching methods and technology to enhance student understanding of PS and HQI, contributing to improved care quality and patient safety. Further research on the long-term impact is needed.

Prevalence and causes of medication transcription errors among hospitalized patients: An observational study and survey of nurses at a faith-based hospital in Cameroon

Medication errors are a leading cause of death globally; with the burden on resource-limited countries more than double that in high-income countries. Errors can occur at all stages of the medication use process; however, there is limited information on medication transcription errors (MTEs) among hospitalized patients in Africa. This study sought to determine the prevalence and types of MTEs and to assess nurses&amp;rsquo; perceptions of the likely causes of MTEs within the pediatric and general wards at a faith-based hospital in Cameroon. A prospective chart review of medication orders transcribed for patients admitted from April 1 to April 30, 2021, was conducted. Data analyzed included patient demographics, prevalence and types of MTEs, medication classes involved in MTEs, and nurse&amp;rsquo;s perceptions of the causes of MTEs. A total of 578 medication orders were reviewed for 75 patients, of whom 40 (53%) were female, and 30 were admitted to the pediatric ward. The results revealed that 38 MTEs were recorded, with 47% occurring on the medication administration sheet and dispensing cards. The most frequent MTEs were the omission of new and stop medication orders, involved in 28.9% and 26% of all MTEs, respectively. Antibacterials for systemic use were involved in the majority (55.3%) of MTEs. Illegible prescriptions (90.7%), distractions (87.0%), and high workload (77.8%) were ascribed as the most likely causes of MTEs. In conclusion, MTEs are common and pose a potential risk of patient harm in hospitalized patients. The adoption of a computerized provider order entry system could eliminate illegible prescriptions, reduce transcription processes, and alleviate workload, thereby improving patient safety.

Automatic localization of anatomical landmarks in head cine fluoroscopy images via deep learning.

Fluoroscopy guided interventions (FGIs) pose a risk of prolonged radiation exposure; personalized patient dosimetry is necessary to improve patient safety during these procedures. However, current FGIs systems do not capture the precise exposure regions of the patient, making it challenging to perform patient-procedure-specific dosimetry. Thus, there is a pressing need to develop approaches to extract and use this information to enable personalized radiation dosimetry for interventional procedures. To propose a deep learning (DL) approach for the automatic localization of 3D anatomical landmarks on randomly collimated and magnified 2D head fluoroscopy images. The model was developed with datasets comprising 800000 pseudo 2D synthetic images (mixture of vessel-enhanced and non-enhancement), each with 55 annotated anatomical landmarks (two are landmarks for eye lenses), generated from 135 retrospectively collected head computed tomography (CT) volumetric data. Before training, dynamic random cropping was performed to mimic the varied field-size collimation in FGI procedures. Gaussian-distributed additive noise was applied to each individual image to enhance the robustness of the DL model in handling image degradation that may occur during clinical image acquisition in a clinical environment. The model was trained with 629370 synthetic images for approximately 275000 iterations and evaluated against a synthetic image test set and a clinical fluoroscopy test set. The model shows good performance in estimating in- and out-of-image landmark positions and shows feasibility to instantiate the skull shape. The model successfully detected 96.4% and 92.5% 2D and 3D landmarks, respectively, within a 10mm error on synthetic test images. It demonstrated an average of 3.6±2.3mm mean radial error and successfully detected 96.8% 2D landmarks within 10mm error on clinical fluoroscopy images. Our deep-learning model successfully localizes anatomical landmarks and estimates the gross shape of skull structures from collimated 2D projection views. This method may help identify the exposure region required for patient-specific organ dosimetry in FGIs procedures.