Needle Placement Research Articles

Optimal patient positioning for spinal anesthesia using a visual aid in cesarean section patients: A randomized control trial.

Spinal anesthesia is the safest technique of anesthesia in parturients for cesarean section. Usually, patients are instructed verbally to acquire the ideal position for spinal anesthesia, but there can be difficulty in attaining the best position if patients fail to understand the verbal command, which will lead to detainment in accomplishing the technique and increased possibility of patient's dissatisfaction. Hence, in our study, we hypothesized that using photographs with verbal commands would reduce the time taken for spinal needle placement, reduce the total number of skin pricks, and improve the success at the first attempt. One hundred and eleven pregnant women undergoing elective cesarean section were divided into Group C (only verbal instructions were given) and Group V (visual aid and verbal instructions were given). Time taken for successful spinal needle placement was noted in seconds and summarized in terms of median and interquartile range. Number of skin punctures, intervertebral spaces attempted, and first-pass success were determined in terms of percentage. Pearson's Chi-square test was used to compare the above parameters between the two groups. There was significant reduction in the time taken for spinal needle placement in Group V compared to the control group. There was significant improvement in first-pass success rate and reduction in the number of skin pricks and intervertebral spaces attempted in Group V. Use of visual aid with verbal commands helps in better understanding of positioning, thus improving the first-pass success significantly. It also reduces the duration for successful spinal needle placement, number of skin pricks, and intervertebral spaces attempted.

Posterior intra-articular hip injections: a pilot study investigating a new approach.

The purpose of this study was to investigate a novel posterior intra-articular hip injection approach while discussing the clinical pearls for methodology, accuracy, and associated adverse events. The goal was to investigate if this approach could potentially be used in those where the typical anterior access would be challenging. 10 adults (age > 18years) who were referred to a tertiary outpatient clinic for hip injection due to hip osteoarthritis or femoral acetabular impingement with labral tearing to a single academic sports medicine clinic. Patients were placed in prone position. Posterior structures were identified using a curvilinear transducer. A 22 gauge 3.5-6-inch spinal needle was advanced in-plane to the transducer towards the hip capsule at the head-neck junction of the femur from inferolateral to superomedial. A fluoroscopic arthrogram was obtained to evaluate needle placement accuracy. Location of the needle, direction of contrast flow, the rate of conversion to an anterior portal, and adverse events were analyzed. A fluoroscopic arthrogram was obtained after the first attempt in nine patients (90%). One patient (10%) was converted to the anterior approach due to inability to obtain the expected arthrogram. Two patients (20%) demonstrated mild adverse events. Ultrasound-guided posterior approach hip injection is accurate and without serious adverse events in our study. The posterior approach can be considered as an alternative approach for patients who cannot tolerate or may have technical difficulty with an anterior approach.

Exploring software navigation tools for liver tumour angiography: a scoping review.

Liver cancer presents a growing global health concern, necessitating advanced approaches for intervention. This review investigates the use and effectiveness of software navigation in interventional radiology for liver tumour procedures. In accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, a scoping review was conducted of the literature published between 2013 and 2023 sourcing articles through MEDLINE, Scopus, CINAHL and Embase. Eligible studies focused on liver cancer, utilised cone-beam computed tomography (CBCT), and employed software for intervention. Twenty-one articles were deemed eligible for data extraction and analysis. Categorised by type, software applications yielded diverse benefits. Feeder detection software significantly enhanced vessel identification, reducing non-target embolisation by up to 43%. Motion correction software demonstrated a 20% enhancement in image quality, effectively mitigating breathing-induced motion artefacts. Liver perfusion software facilitated efficient tumour targeting while simultaneously reducing the occurrence of side effects. Needle guide software enabled precise radiofrequency ablation needle placement. Additionally, these software applications provided detailed anatomical simulations. Overall, software integration resulted in shorter procedures, reduced radiation exposure and decreased contrast media usage. This scoping review highlights the innovative yet relatively underexplored role of software navigation for liver tumour procedures. The integration of software applications not only enhances procedural efficiency but also bolsters operator confidence, and contributes to improved patient outcomes. Despite the current lack of uniformity and standardisation, these software-driven advancements hold significant promise for transforming liver tumour interventions. To realise these benefits, further research is needed to explore the clinical impact and optimal utilisation of software navigation tools in interventional radiology.

Efficacy of Lateral View Needle Placement for Sacroiliac Joint Injections.

Sacroiliac joint (SIJ) pathology is typically diagnosed and treated with fluoroscopy-guided intraarticular injections. Most practitioners use only an anteroposterior (AP) or oblique view. Although injection into the periarticular space may yield adequate pain relief, intraarticular needle placement is imperative to identify SIJ pathology and plan future management. This study highlights the importance of obtaining an additional lateral view during fluoroscopy to better evaluate SIJ disease. A retrospective review of 38 patients who underwent fluoroscopy guided SIJ injection was conducted, for which IRB approval was granted by the MetroWest Medical Center Institutional Review Board. Patient demographics (age, sex, BMI) and pre- and post-operative numerical rating scale (NRS) scores were collected, and initial needle location was reviewed. Patients were placed into groups according to initial needle location. Statistical analysis was conducted using a Mann-Whitney U-test with significance defined as p < 0.05. The 21 females and 17 males had a mean age and BMI of 70.5 years and 27.8 kg/m2, respectively. Thirty-one patients had initial intraarticular needle placement confirmed with lateral arthrogram, and 7 patients had initial periarticular needle placement, requiring needle readjustment in lateral confirmatory view. Both groups had similar demographic characteristics. No statistically significant differences were found between the two groups' mean NRS score improvement (p=0.108). Using only the AP or oblique view during needle placement results in miss rates of nearly 20% while adding a lateral view can lower miss rates to near 0%. While pain relief may be adequate in either case, proper diagnosis and future management relies upon accurate needle placement.

Design of Automated Needle Placement Machine with a Printed Circuit Board Composite Board Fixture

Design of Automated Needle Placement Machine with a Printed Circuit Board Composite Board Fixture

A Comparison of Precision and Safety using Three Recognized Ultrasound-Guided Approaches to Cervical Medial Branch Blocks: A Cadaver Study

BACKGROUND: Ultrasound (US) guidance is widely used for needle positioning for cervical medial branch blocks (CMBB) and radiofrequency ablation, however, limited research is available comparing different approaches. OBJECTIVE: We aimed to assess the accuracy and safety of 3 different US-guided approaches for CMBB. STUDY DESIGN: A cadaveric study divided into ultrasound-guided needle placement and fluoroscopy evaluation stages. SETTING: Department of Pathology, Forensic, and Insurance Medicine, Semmelweis University. METHODS: Sonographically guided third occipital nerve (TON), C3, C4, C5 and C6 medial branch injections and radiology evaluations were performed. The 3 approaches compared were: 1. ES (published by Eichenberger-Siegenthaler): US probe in the coronal plane to visualize the cervical articular pillars, needle approach out of the plane, from anterior to posterior. 2. Fi (published by Finlayson): US probe in the transverse plane to visualize a cervical articular pillar and its lamina, needle approach in the plane, from posterior to anterior. 3. FiM (Modified Finlayson approach): Needles are placed as in Fi, but then adjusted with a coronal view of the cervical articular pillars. Fluoroscopy images were taken and later evaluated, for “crude”, “high precision” and “dangerous” placement. RESULTS: One hundred and fifty-five needle placements were assessed (10 were excluded, as no anterior-posterior fluoroscopy images were saved). Interobserver agreement on position of needle placement between the 5 observers was very high; the Fleiss’ Kappa was 0.921. For crude placement, no significant differences were identified between various approaches; (77.6%, 79.5%, and 75.6% for the ES, Fi, and FiM respectively). However, for placement in predefined high-precision zones, ES resulted in significantly more success (ES: 42.9%, Fi: 22.7%, and FiM: 24.4%, P = 0.032). Fi and FiM resulted in no dangerous placements, while ES led to the potential compromise of the exiting nerve root and vertebral artery on three occasions. In 10% of the placements, the levels were identified wrongly, with no difference between the various approaches. LIMITATIONS: Feedback from a live patient, may prevent some existing nerve root injections, unlike in a cadaver. Though a higher number of needles were placed in this study than in most available publications, the number is still low at each individual medial branch level. CONCLUSION: Fi proved safer than ES. Fi was equally successful in targeting the articular pillar, however, ES proved the most successful in placing the needle in the center of the articular pillar. Adding another, (coronal) US view to check needle position in FiM did not improve safety or precision. Identifying CMB levels with the US is challenging with all approaches, therefore we still recommend using fluoroscopy for level identification. While there were pros and cons with either procedure, the efficacy findings of previous papers were not replicated on elderly cadavers with arthritic necks. KEY WORDS: Cervical facet, medial branch block, safety, accuracy, ultrasound, fluoroscopy

Application of robot navigation system for insertion of femoral neck system in the treatment of femoral neck fracture

PurposeTo evaluate the short-term clinical efficacy and advantages of surgery robot positioning system for insertion of Femoral Neck System (FNS) in the treatment of femoral neck fractures.MethodsThe clinical data of 52 patients with Femoral neck fracture (FNF) who had been treated with FNS between June 2020 and September 2021 were retrospectively analyzed. Among them, 26 patients were treated with traditional FNS (control group), while 26 additional patients were treated with FNS assisted by an orthopaedic robot positioning system (study group). The operation duration, frequency of key-guide needle placement, intraoperative blood loss, incision length, fracture healing rate, fracture healing time, and the Harris scores at the last follow-up were calculated and compared between the 2 groups.ResultsThe study group had shorter operation duration, fewer numbers of placing the key-guide needle, less intraoperative blood loss, and smaller surgical incisions than the control group (all, P < 0.05). There was no significant difference in the rate of fracture healing rate between the 2 groups (P = 0.47), while the fracture healing duration of the study group was shorter than that of the control group (P = 0.03). At the last follow-up, compared with the control group, the Harris score and the number of excellent and good ratings were significantly higher in the study group (all, P < 0.05).ConclusionsUsing orthopaedic surgery robot positioning system-assisted FNS in the treatment of FNFs can effectively improve the efficiency of surgery, shorten operation time, and reduce the number of placing the key-guide needle, intraoperative blood loss, and operative trauma. Simultaneously, it shortens the duration of fracture healing and improves the recovery of hip function.

Acupuncture and dry needling for physical therapy of scar: a systematic review

BackgroundThere is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment.ObjectiveThe aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms ‘acupuncture,’ ‘needling,’ or ‘dry needling’ to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture.Search strategyThe search strategy included different combinations of the following keywords: ‘scar’, ‘keloid’, ‘dry needling’, ‘needling’, ‘acupuncture’, ‘treatment’, ‘physical therapy’. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023.Inclusion criteriaThe studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included.Data extraction and analysisThe main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results.ResultsAs a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2–4 out of 8 points on the JBI checklist, five studies scored 5–7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous.ConclusionsThe studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation.Systematic review registrationINPLASY no. 202310058.

The State of 21st Century Acupuncture in the United States.

The term "acupuncture" commonly refers to a non-pharmacologic therapy that is increasingly employed by diverse segments of the population for a wide variety of complaints including pain, insomnia, anxiety, depression, frozen shoulder, and other issues. The term is also used as a short-hand for the wider medical system from which the placement of needles into the skin for therapeutic benefit and related techniques evolved. Thus "acupuncture" refers both to the therapeutic technique and the therapeutic system of Acupuncture and Herbal Medicine (AHM). The other modalities included within AHM include a wide variety of physical and mechanical manipulations, herbal medicines, dietary recommendations, and lifestyle modifications. Clinically, acupuncture is increasingly offered in a variety of conventional medical settings such as hospitals, medical school clinics, veterans' healthcare centers, oncology facilities, and rehabilitation centers, and its safety profile is excellent overall. Barriers to further incorporation of acupuncture into biomedical sites include insurance coverage of acupuncture, education of conventional medical practitioners and other stakeholders about the utility, efficacy, and evidence base of acupuncture. Acupuncturists in the United States are skilled practitioners who are highly educated in the complex therapeutic system from which acupuncture arose and in the technical aspects of its utility as a treatment modality. The training, certification, licensure, and regulation of acupuncturists is similar to that of conventional providers such has physician's assistants, advanced practice nurses, and medical and osteopathic doctors. While clinical use and acceptance of acupuncture continues to grow, there is to date no definitive composite document explaining the utility of acupuncture in various healthcare settings, the current understanding of how acupuncture works, and the training, professional regulation, and certification of acupuncture practitioners. This article will address these topics and strive to create a reference for practitioners, administrators, legislators, insurance providers, patients and their families, and other stakeholders.

Ultrasound-assisted Upper Thoracic Epidural Anaesthesia in Awake Breast Surgeries: A Case Series

Carcinoma of the breast is a leading cause of hospitalisation in elderly women and the most common surgery performed in Surgical Oncology and General Surgery Departments. Traditionally, General Anaesthesia (GA) was used for patients undergoing modified radical mastectomy. However, GA is not an ideal choice for patients with restrictive pulmonary diseases, obesity, or Chronic Obstructive Pulmonary Disease (COPD), as it is associated with increased intraoperative and postoperative complications. Regional anaesthesia is a suitable alternative, as it has the advantages of reduced sympathetic stimulation, no airway manipulation, and avoids polypharmacy, thereby reducing the hospital stay. A series of 10 female patients were presented, who were scheduled for modified radical mastectomy surgery under ultrasound-assisted thoracic epidural anaesthesia, and the patients were awake and conscious throughout the surgery. The ultrasound-assisted upper thoracic epidural was performed with a 100% success rate, and the mean procedure time taken was 238.5 seconds (ultrasound examination plus needle placement). Out of the 10 patients, one patient had two needle punctures. The needle redirections were absent in three patients, two times in three patients, and one time in four patients. Except for one patient, the epidural was successfully placed on the first attempt. Patient comfort was assessed based on the Modified Comfort Scale, with Grade-1 in five patients, Grade-2 in four patients and Grade-3 in one patient. No complications such as dural puncture or bloody tap were reported. In patients scheduled for modified radical mastectomy, performing an upper thoracic epidural using a landmark-guided technique is challenging, as the thoracic spines are very acutely angulated (T3-T6). Therefore, the ultrasound-assisted thoracic epidural technique is a safe and effective bedside tool that can be used to identify the epidural space without any side effects for the patients.

Tunneled Percutaneous Transesophageal Gastrostomy for Treatment of Malignant Bowel Obstruction

ABSTRACT Introduction Malignant bowel obstruction is a common complication in patients with end-stage cancer. Gastric decompression can reduce symptoms; however, percutaneous gastrostomy tube placement may not always be feasible. A percutaneous transesophageal gastrostomy (PTEG) is an alternative for nasogastric decompression. This study describes a technical modification of PTEG tube placement for patient comfort. Methods: A single-center retrospective review was performed to compare outcomes from tunneled versus nontunneled PTEGs. Similar to previous descriptions, an esophageal balloon was percutaneously punctured with a needle for placement of a tube entering the neck and tracked through the esophagus into the stomach. Rather than suturing to the neck, the tube was navigated through a subcutaneous tunnel to create a tunneled transesophageal gastrostomy. Results: Between Dec 2017 and Oct 2023, 27 patients underwent attempted PTEG tube placement, 10 of which were tunneled. Median time to death was 24 days after the procedure. Adverse events occurred in 10 of 27 patients (37.0%) and included cellulitis, tube retraction requiring tube repositioning and replacement, tube clogging, failed placement, postprocedure extended intubation, postprocedure hypotension, and aspiration. More infections were noted in the tunneled PTEGs than in the nontunneled PTEGs. Twenty-four patients reported partial or complete symptom relief. Seventeen patients were able to tolerate a liquid, low-fiber, or soft regular diet with a PTEG. Conclusion: Using established techniques of tunneling central venous catheters and the process of placing PTEG tubes, a simple modification to the procedure can have the gastrostomy exit along the chest wall rather than the neck. However, this may cause increased infectious complications.

Functional Outcomes of Patients Who Underwent Anorectal Malformation Repair Using MRI Guidance

BackgroundDespite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes. MethodsA retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used. ResultsTwenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1–9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75). ConclusionsUsing MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population. Level of EvidenceLevel III.

Development and clinical implementation of simple needle attachment post placement interstitial template (SNAPP-IT) enabling a shorter, more direct needle path while preserving tumor visualization

Purpose: Historical gynecologic interstitial brachytherapy templates block direct tumor visualization during needle placement, presenting an opportunity for clinical innovation to develop a novel interstitial template allowing direct tumor visualization during needle insertion. Methods: We designed and implemented a novel interstitial template, Simple Needle Attachment Post Placement Interstitial Template (SNAPP-IT), that allowed direct visualization of the target vaginal tumor during interstitial needle placement while maintaining the ability to individually secure needles to the template, allow a vaginal cylinder, suture holes for securing to the perineum, MRI compatibility and sterilizable for repeat use. Procedure outcomes including procedure time, needle path lengths, and plan dosimetry were prospectively captured in a patient database. Results: Forty gynecologic interstitial brachytherapy cases were recorded (20 SNAPP-IT, 20 traditional templates). Needle insertion depth was reduced using the SNAPP-IT in comparison with traditional interstitial templates (11.8cm vs 3.6cm, p<0.0001). The average CTV volume was 25.6 cc for SNAPP-IT and 20.7 cc for traditional; both methods averaged a similar number of needles (15.8, 15.6). Dosimetric constraints were similarly met in both treatment groups. Procedures performed using the SNAPP-IT were shorter compared with those performed with traditional interstitial devices (83.4 minutes vs 100.7 minutes) and there were no post-operative infections in the SNAPP-IT group. Conclusion: Implementation of a novel gynecologic interstitial brachytherapy template (SNAPP-IT) reduced procedure times, allowed direct tumor visualization, and decreased needle insertion depth. SNAPP-IT provides a useful alternative approach for vaginal interstitial brachytherapy, may increase brachytherapist efficiency with complex procedures and potentially expands access to interstitial brachytherapy.

Brief Commentary and Based on the Article Entitled “Ultrasound-Guided Electroacupuncture Treatment for Rotator Cuff Tendinopathy: Proposing an Effective Alternative to Non-Operative Medical Treatments”

Specifically, it utilizes ultrasound to see areas of injury/pathology within the rotator cuff tendon(s) and ultrasound to visualize acupuncture needle placement into these areas

Real-time definition of single seed placement sensitivity in low-dose-rate prostate brachytherapy

PURPOSE: In low-dose-rate brachytherapy, iodine-125 seeds are implanted based on a treatment plan, generated with respect to different dose constraints. The quality of the dose distribution depends on a precise seed placement, however, during treatment planning the impact on the dose parameters when certain seeds fail to be placed precisely is not clear. METHODS AND MATERIALS: We developed a method using automatic differentiation to calculate gradients of dose parameters with regard to the seeds’ positions. Thus, we understand their sensitivity with respect to the seed placement. A statistical analysis is performed on a data set with 35 prostate brachytherapy patients. RESULTS: The most sensitive seeds regarding the dosimetric parameters of both rectum and urethra are close to the corresponding organ. Their gradient directions are mainly orthogonal to their surfaces. However, not all seeds close to the surface are equally sensitive with regard to the dose parameter. The most sensitive seeds regarding the prostate’s dose parameters are distributed throughout the prostate and the direction of the gradients are mainly parallel to its surface. A linear regression with respect to different patient parameters shows that dose constraints which are barely fulfilled have large gradients and thus are additionally sensitive to misplacement. CONCLUSION: Automatic differentiation can be used to analyze dose parameter sensitivity with respect to seed placement. Integrating this into treatment planning systems is valuable as it speeds up the planning procedure, making it more robust and less dependent on user experience while showing the operating physician which needle placements require greater accuracy than others.

Automatic GAN-based MRI volume synthesis from US volumes: a proof of concept investigation

Usually, a baseline image, either through magnetic resonance imaging (MRI) or computed tomography (CT), is captured as a reference before medical procedures such as respiratory interventions like Thoracentesis. In these procedures, ultrasound (US) imaging is often employed for guiding needle placement during Thoracentesis or providing image guidance in MISS procedures within the thoracic region. Following the procedure, a post-procedure image is acquired to monitor and evaluate the patient’s progress. Currently, there are no real-time guidance and tracking capabilities that allow a surgeon to perform their procedure using the familiarity of the reference imaging modality. In this work, we propose a real-time volumetric indirect registration using a deep learning approach where the fusion of multi-imaging modalities will allow for guidance and tracking of surgical procedures using US while displaying the resultant changes in a clinically friendly reference imaging modality (MRI). The deep learning method employs a series of generative adversarial networks (GANs), specifically CycleGAN, to conduct an unsupervised image-to-image translation. This process produces spatially aligned US and MRI volumes corresponding to their respective input volumes (MRI and US) of the thoracic spine anatomical region. In this preliminary proof-of-concept study, the focus was on the T9 vertebrae. A clinical expert performs anatomical validation of randomly selected real and generated volumes of the T9 thoracic vertebrae and gives a score of 0 (conclusive anatomical structures present) or 1 (inconclusive anatomical structures present) to each volume to check if the volumes are anatomically accurate. The Dice and Overlap metrics show how accurate the shape of T9 is when compared to real volumes and how consistent the shape of T9 is when compared to other generated volumes. The average Dice, Overlap and Accuracy to clearly label all the anatomical structures of the T9 vertebrae are approximately 80% across the board.

Risk Factors in Administering Spinal Anesthesia: A Comprehensive Review.

Numerous advantages, including a quick start and consistent anesthesia, are provided by spinal anesthesia, a method often utilized in contemporary medicine for various surgical operations. However, it has some hazards, just like any medical procedure.With an emphasis on identifying and assessing the risk factors associated with administering spinal anesthesia, the review analyzes published literature and clinical investigations carried out in the field of anesthesia. Various key factors, including technique-related procedural and patient-related aspects, can influence the effectiveness of spinal anesthesia. Among these factors are age, sex, body mass index, concurrent conditions (such as cardiovascular disease, diabetes, and respiratory problems), pre-existing neurological issues, allergies, and a history of adverse responses to anesthesia drugs. Additionally, the chance of problems might be increased by physical abnormalities or malformations in the spinal canal and vertebral column. The safety and effectiveness of spinal anesthesia depend significantly on procedural factors, such as the type and dosage of anesthesia agents administered and the patient's position and alignment maintained during the entire surgical procedure and the injection rate. Increased risks can also be caused by inadequate monitoring and a slow response to unfavorable circumstances. Risk factors related to the technique include the expertise and competency of the anesthesiologist or medical professional carrying out the procedure. Inadequate post-procedure monitoring, inadvertent dural puncture, and improper needle placement might lead to complications during or after the spinal anesthesia administration. This review emphasizes the need for a complete preoperative assessment, suitable patient selection, and rigorous procedural planning to reduce the likelihood of problems during the administration of spinal anesthesia. It also emphasizes the significance of ongoing monitoring and timely management of adverse events to guarantee patient safety and the best results. Healthcare professionals may put preventative measures in place and follow best practices to limit possible consequences efficiently by recognizing the risk factors associated with spinal anesthesia. This review helps encourage safer anesthesia practices and improvepatient care as medical knowledge and technology advance. However, further study and evidence-based recommendations are required to enhance patient outcomes and risk assessment.

Robotic-assisted versus manual Uro Dyna-CT-guided puncture in an ex-vivo kidney phantom

Introduction and objectives Challenging percutaneous renal punctures to gain access to the kidney requiring guidance by cross-sectional imaging. To test the feasibility of robotic-assisted CT-guided punctures (RP) and compare them with manual laser-guided punctures (MP) with Uro Dyna-CT (Siemens Healthcare Solutions, Erlangen, Germany). Material and methods The silicon kidney phantom contained target lesions of three sizes. RP were performed using a robotic assistance system (guidoo, BEC GmbH, Pfullingen, Germany) with a robotic arm (LBR med R800, KUKA AG, Augsburg, Germany) and a navigation software with a cone-beam-CT Artis zeego (Siemens Healthcare GmbH, Erlangen, Germany). MP were performed using the syngo iGuide Uro-Dyna Artis Zee Ceiling CT (Siemens Healthcare Solutions). Three urologists with varying experience performed 20 punctures each. Success rate, puncture accuracy, puncture planning time (PPT), and needle placement time (NPT) were measured and compared with ANOVA and Chi-Square Test. Results One hundred eighteen punctures with a success rate of 100% for RP and 78% for MP were included. Puncture accuracy was significantly higher for RP. PPT (RP: 238 ± 90s, MP: 104 ± 21s) and NPT (RP: 128 ± 40s, MP: 81 ± 18s) were significantly longer for RP. The outcome variables did not differ significantly with regard to levels of investigators’ experience. Conclusion The accuracy of RP was superior to that of MP. This study paves the way for first in-human application of this robotic puncture system.

Using random forest for brain tissue identification by Raman spectroscopy

The traditional definitive diagnosis of brain tumors is performed by needle biopsy under the guidance of imaging-based exams. This paradigm is based on the experience of radiogolists, and accuracy could be affected by uncertainty in imaging interpretation and needle placement. Raman spectroscopy has the potential to improve needle biopsy by providing fingerprints of different materials and performing in situ tissue identification. In this paper, we present the development of a supervised machine learning algorithm using random forest (RF) to distinguish the Raman spectrum of different types of tissue. An integral process from raw data collection and preprocessing to model training and evaluation is presented. To illustrate the feasibility of this approach, viable animal tissues were used, including ectocinerea (grey matter), alba (white matter) and blood vessels. Raman spectra were acquired using a custom-built Raman spectrometer. The hyperparameters of the RF model were determined by combining a cross-validation-based algorithm and manually adjusting. The experimental results show the ability of our approach to discriminate different types of tissues with high accuracy.

Optical Fiber-Based Needle Shape Sensing in Real Tissue: Single Core vs. Multicore Approaches.

Flexible needle insertion procedures are common in minimally-invasive surgeries for diagnosing and treating prostate cancer. Bevel-tip needles provide physicians the capability to steer the needle during long insertions to avoid vital anatomical structures in the patient and reduce post-operative patient discomfort. To provide needle placement feedback to the physician, sensors are embedded into needles for determining the real-time 3D shape of the needle during operation without needing to visualize the needle intra-operatively. Through expansive research in fiber optics, a plethora of bio-compatible, MRI-compatible, optical shape-sensors have been developed to provide real-time shape feedback, such as single-core and multicore fiber Bragg gratings. In this paper, we directly compare single-core fiber-based and multicore fiber-based needle shape-sensing through similarly constructed, four-active area sensorized bevel-tip needles inserted into phantom and ex-vivo tissue on the same experimental platform. In this work, we found that for shape-sensing in phantom tissue, the two needles performed identically with a p-value of 0.164 > 0.05, but in ex-vivo real tissue, the single-core fiber sensorized needle significantly outperformed the multicore fiber configuration with a p-value of 0.0005 < 0.05. This paper also presents the experimental platform and method for directly comparing these optical shape sensors for the needle shape-sensing task, as well as provides direction, insight and required considerations for future work in constructively optimizing sensorized needles.