Operative Exposure Research Articles

Phase-based evaluation of whole-body vibration exposure for hydraulic excavator operators

Phase-based evaluation of whole-body vibration exposure for hydraulic excavator operators

Evaluation of Percutaneous Unilateral Kyphoplasty Results in Osteoporotic Vertebral Compression Fractures Using Individual 3D Printed Guide Template Support.

To compare the clinical and radiological outcomes of unilateral percutaneous kyphoplasty (PKP) surgeries performed using 3D printing technology in patients with osteoporotic compression fractures to conventional unilateral PKP surgeries. Patients with acute painful single-level osteoporotic vertebral compression fracture (OVCF) who need surgical treatment were divided into two groups: group A (patients who had 3D template-guided PKP) and group B (patients who conventional PKP). To compare the two surgical procedures, Total Absorbed Radiation Dose (TARD), pre- and postoperative visual analog scale (VAS) scores, and Total Surgery Time (TST) were calculated and compared between groups in both surgical groups. A total of 44 patients with single-level OVCF who were experiencing acute pain were successfully operated on, with 22 patients in each group. TARD (2.6 ± 0.4 mGy vs. 6.1 ± 1.9 mGy, p < 0.05) and TST (12.4 ± 2.6 min vs. 20.2 ± 3.2 min, p < 0.05) differed significantly different between groups A and B. There was no statistically significant difference between the patient groups in preoperative and postoperative VAS values (p > 0.05). Cement leakage was lower in group A (3/22, 13.6%) than in group B (6/22, 27.3%) (p > 0.05). There were no neurological complications or infections in either group. When compared to the conventional procedure, the unilateral percutaneous kyphoplasty method was supported by a 3D printing guide template. By reducing operative time and radiation exposure, tt has resulted in a more effective surgical procedure for patients and a safer surgical procedure for surgeons and anaesthesiologists.

Preliminary assessment of nursery workers’ exposure to applied pesticides

Nursery workers can be exposed to pesticides via skin contact and respiratory inhalation when they mixing/loading pesticide product(s) and applying pesticide solution on a single spraying day. This study investigates how pesticide usage and agricultural practices among nursery workers affect their exposure to and potential health risk of pesticides applied over a 2-month period. Ten workers from different nurseries were involved in both personal interview and questionnaire survey to collect data for exposure modelling purposes. On a single spraying day, individuals’ total daily exposure to single active substances ranged from 0.002 to 0.024 mg kg-bw-1 day-1, mainly constituted of pesticide exposure during application activities (57.3 – 99.9% of total daily exposure). The total daily exposures were assessed against the respective acceptable operator exposure levels (AOELs) for single active substances. Overall, four nursery workers had at least one active substance application that exceeded the AOEL, indicating health risk is possible. While respondents generally worn long sleeves and long pants as the basic protective measures, the exceedances were likely caused by the usage of hazardous active substance (i.e., cypermethrin) and wettable powder formulation, and improper use of gloves. Future studies can consider the influence of different nursery plants on workers’ exposure to pesticides handled.

Training on Congenital 3D Cardiac Models - Will Models Improve Surgical Performance?

Technical skill development in congenital heart surgery (CHS) is challenging due to numerous factors which potentially limit the hands-on operative exposure in surgical training. These challenges have stimulated the growth of simulation-based training through the development of 3D-printed models, providing hands-on surgical training (HOST). From its inception in 2015, the models used in the HOST program have constantly improved, and now include valvar/subvalvar apparatus and better materials that mimic real tissue. Evidence shows that deliberate, regular simulation practice can improve a surgeon's technical skills across the spectrum of CHS. Furthermore, surgical trainees who undergo simulation training are able to translate this improved performance into the operative environment with improved patient outcomes. Despite evidence to support the incorporation of simulation methods into congenital training, its widespread adoption into training curricula remains low. This is due to numerous factors including funding, lack of dedicated time or proctorship and access to models-all of which can be overcome with the newer generation of models and committed trainers. Training programs should consider incorporating simulation-methods as a routine component of congenital training programs.

Use of surgical augmented intelligence maps can reduce radiation and improve safety in the endovascular treatment of complex aortic aneurysms

ObjectiveThe introduction of endovascular procedures has revolutionized the management of complex aortic aneurysms. Although repair has traditionally required longer operative times and increased radiation exposure compared with simple endovascular aneurysm repair, the recent introduction of three-dimensional technology has become an invaluable operative adjunct. Surgical augmented intelligence (AI) is a rapidly evolving tool initiated at our institution in June 2019. In our study, we sought to determine whether this technology improved patient and operator safety. MethodsA retrospective review of patients who had undergone endovascular repair of complex aortic aneurysms (pararenal, juxtarenal, or thoracoabdominal), type B dissection, or infrarenal (endoleak, coil placement, or renal angiography with or without intervention) at a tertiary care center from August 2015 to November 2021 was performed. Patients were stratified according to the findings from intelligent maps, which are patient-specific AI tools used in the operating room in conjunction with real-time fluoroscopic images. The primary outcomes included operative time, radiation exposure, fluoroscopy time, and contrast use. The secondary outcomes included 30-day postoperative complications and long-term follow-up. Linear regression models were used to evaluate the association between AI use and the main outcomes. ResultsDuring the 6-year period, 116 patients were included in the present study, with no significant differences in the baseline characteristics. Of the 116 patients, 76 (65.5%) had undergone procedures using AI and 40 (34.5%) had undergone procedures without AI software. The intraoperative outcomes revealed a significant decrease in radiation exposure (AI group, 1955 mGy; vs non-AI group, 3755 mGy; P = .004), a significant decrease in the fluoroscopy time (AI group, 55.6 minutes; vs non-AI group, 86.9 minutes; P = .007), a decrease in the operative time (AI group, 255 minutes; vs non-AI group, 284 minutes; P = .294), and a significant decrease in contrast use (AI group, 123 mL; vs non-AI group, 199 mL; P < .0001). No differences were found in the 30-day and long-term outcomes. ConclusionsThe results from the present study have demonstrated that the use of AI technology combined with intraoperative imaging can significantly facilitate complex endovascular aneurysm repair by decreasing the operative time, radiation exposure, fluoroscopy time, and contrast use. Overall, evolving technology such as AI has improved radiation safety for both the patient and the entire operating room team.

Reduction of radiation dose using real‐time visual feedback dosimetry during angiographic interventions

This prospective study sought to evaluate potential savings of radiation dose to medical staff using real-time dosimetry coupled with visual radiation dose feedback during angiographic interventions. For this purpose, we analyzed a total of 214 angiographic examinations that consisted of chemoembolizations and several other types of therapeutic interventions. The Unfors RaySafe i2 dosimeter was worn by the interventionalist at chest height over the lead protection. A total of 110 interventions were performed with real-time radiation dosimetry allowing the interventionalist to react upon higher x-ray exposure and 104 examinations served as the comparative group without real-time radiation monitoring. By using the real-time display during interventions, the overall mean operator radiation dose decreased from 3.67 (IQR, 0.95-23.01) to 2.36μSv (IQR, 0.52-12.66) (-36%; p=0.032) at simultaneously reduced operator exposure time by 4.5min (p=0.071). Dividing interventions into chemoembolizations and other types of therapeutic interventions, radiation dose decreased from 1.31 (IQR, 0.46-3.62) to 0.95μSv (IQR, 0.53-3.11) and from 24.39 (IQR, 12.14-63.0) to 10.37μSv (IQR, 0.85-36.84), respectively, using live-screen dosimetry (p≤0.005). Radiation dose reductions were also observed for the participating assistants, indicating that they could also benefit from real-time visual feedback dosimetry during interventions (-30%; p=0.039). Integration of real-time dosimetry into clinical processes might be useful in reducing occupational radiation exposure time during angiographic interventions. The real-time visual feedback raised the awareness of interventionalists and their assistants to the potential danger of prolonged radiation exposure leading to the adoption of radiation-sparing practices. Therefore, it might create a safer environment for the medical staff by keeping the applied radiation exposure as low as possible.

Comparative evaluation of an innovative deflectable percutaneous kyphoplasty versus conventional bilateral percutaneous kyphoplasty for osteoporotic vertebral compression fractures: a prospective, randomized and controlled trial

BACKGROUND CONTEXTOsteoporotic vertebral compression fractures (OVCFs) can be treated with percutaneous kyphoplasty (PKP). In contrast to conventional PKP, the novel deflectable percutaneous kyphoplasty (DPKP), is a unilateral transpedicular approach procedure allowing a similar bilateral puncture effect, which owes to the deflectable curved bone expander creating a transcentral line cavity to achieve uniform distribution of cement and biomechanical balance while reducing operative time and radiation exposure. PURPOSEThe purpose of this study was to prospectively compare and evaluate an innovative surgical procedure, DPKP, versus conventional bilateral percutaneous kyphoplasty (BPKP). STUDY DESIGNThis is a prospective randomized controlled trial (RCT). SAMPLEThe totality of the participants (n=90) suffering from OVCFs between May 2019 and October 2020, were randomized by SAS 9.3 to generate a block randomization sequence, which was utilized to randomize the groups in a 1:1 ratio, assigned to the DPKP group (n=45) and the BPKP group (n=45) to undergo accordingly procedures. OUTCOME MEASURESThe primary outcome was the total operative time. The secondary outcomes included: comparative assessment of visual analog scale (VAS) scores, Oswestry disability index (ODI), kyphosis angle (KA), anterior border height (AH) of the injured vertebra, frequency of intraoperative X-ray fluoroscopy, the injection volume, distribution pattern and leakage rate of bone cement. METHODSAll subjects underwent assessment by at least one senior orthopedist and radiologist for the VAS scores, ODI, KA, AH of the injured vertebra, total operative time, the injection volume, distribution pattern, leakage rate of bone cement at preoperative and 24 hours, 6 months, and 1 year postoperatively. Inclusion criteria for subjects in this prospective study were as follows: (1) 60 < age < 80 years old; (2) preoperative spinal X-ray, CT, and MRI confirmed as single-segment, fresh thoracolumbar OVCFs (T5–L5, 15% < collapse < 80%); MRI shows low signal on T1–WI and high signal on T2–WI, especially with STIR high signal characterized by vertebral edema; (3) painful OVCFs refractory to medical treatment, 2 weeks < Symptom duration < 3 months;(4) With significant physical signs of local tenderness; (5) T score of bone mineral density (BMD) < -2.5. RESULTSThe total operative time was significantly reduced in the DPKP group (43.3±19.58 minutes, 95% CI: 37.23–49.37) compared to the BPKP group (55.16±11.56 minutes, 95% CI: 51.78–58.54) (p<.001). Compared to the BPKP group (frequency of intraoperative X-ray fluoroscopy: 43.42±8.64, 95% CI: 40.90–45.95; the volume of bone cement injected: 5.56±0.85 mL, 95% CI: 5.31–5.81), the frequency of intraoperative X-ray fluoroscopy (30.05±17.41, 95% CI: 24.66–35.45) and volume of bone cement injected (5.08±0.97 mL, 95% CI: 4.78–5.38) significantly reduced in the DPKP group compared to the (p<.001). In addition, compared to the preoperative period, both groups showed significant improvements in the postoperative VAS scores, ODI, KA, and AH (p<.001), but there was no statistical difference between the DPKP and BPKP groups (p>.05) at any time-point. Interestingly, although without statistical differences, a tendency towards a lower rate of bone cement leakage was observed in the DPKP group. CONCLUSIONOur study results indicate that the innovative DPKP is as safe and effective as BPKP in relieving pain, improving the patient's quality of life, and reconstructing vertebral body height. Particularly, DPKP did reduce operative time and radiation exposure compared to BPKP, which correlated with unilateral and bilateral exposure procedures. Moreover, the final cement distribution was less predictable in DPKP, and further studies are warranted to clarify the advantages of DPKP versus conventional unilateral percutaneous kyphoplasty (UPKP) and BPKP.

Dermal measurement of exposure to plant protection products: Actual hand exposure from hand washing vs. wearing cotton gloves.

For the authorization of plant protection products, a quantitative non-dietary exposure risk assessment relies on established dermal exposure models, measured mainly using passive dosimetry. Exposure to the hands is determined via hand washing or using cotton gloves as a surrogate for skin. This study compared both methods using operator exposure data available from the Agricultural Operator Exposure Model (AOEM) project report. These data indicate that hand exposure determined using cotton gloves resulted in markedly higher exposure values for all exposure scenarios compared to those determined by hand washes. One explanation for this is that dermal uptake of the residues reduces the amount of residue that can be recovered by hand washing. Uncertainty due to dermal uptake can be addressed by either default assumptions or by specific dermal absorption data. However, this cannot solely account for the large difference observed between the values and is mainly likely to be due to the higher capacity of the cotton gloves vs. human skin to retain residues. The results further indicate that the variability between hand wash samples and cotton glove samples differs between the exposure scenarios. Hence, the level of conservatism related to the use of cotton gloves as surrogate skin remains unknown. In conclusion, this evaluation of the AOEM data indicates that the cotton glove method results in much higher levels of measured hand exposure than the hand wash method. It cannot be excluded that dermal uptake has contributed to that result. However, the findings suggest the higher retention capacity of cotton gloves vs. human skin to be the main impact parameter. The cotton glove method does not provide the results with regards to the protection level that can be expected from the use of protective gloves. Therefore, we believe that the application of the hand wash method is a more accurate measure of exposure levels, if either specific dermal absorption data or, in its absence, default assumptions are applied as adjustment factor.

A comparative analysis of distal locked and unlocked long proximal femoral nail antirotation (PFNA-II) in the fixation of stable intertrochanteric fractures

PurposeLong proximal femoral nail anti-rotation (PFNA-II) is a preferred implant in recent years for fixation of pertrochanteric fractures, especially in osteoporotic patients. The purpose of this study is to prospectively investigate the effect of distal locking in long PFNA-II fixation of stable intertrochanteric fractures. MethodsA total of 58 patients with isolated stable intertrochanteric fractures and treated in our hospital during the study period of 2017–2019 by distal locked or unlocked long PFNA-II fixation were included in this study. Patients who had multiple injuries or open fractures were excluded. There were 40 female and 18 male patients, with 33 affecting the left side and 25 the right side. Of them, 31 belonged to the distal locked group (group A) and 27 to the unlocked group (group B). Surgical procedures and implants used in both groups were similar except for the distal locking of the nails. General data (age, gender, fracture side, etc.) showed no significant difference between two groups (all p > 0.05). The intraoperative parameters like operative time, radiation exposure and follow-up parameters like functional and radiological outcomes were recorded and compared. Statistical tests like the independent samples t-test Fischer's exact and Chi-square test were used to analyze association. ResultsThe distribution of the fractures according to AO/OTA classification and 31A1.2 type of intertrochanteric fractures were most common in our study. All the included fractures united and the average functional outcome in both groups were good and comparable at the end of one year. The operative time (mL, 107.1 ± 12.6 vs. 77.0 ± 12.0, p < 0.001) and radiation exposure (s, 78.6 ± 11.0 vs. 40.3 ± 9.3, p < 0.001) were significantly less among the patients in group B. Fracture consolidation, three months after the operative procedures, was seen in a significantly greater proportion of patients in group B (92.6% vs. 67.7%, p = 0.025). Hardware irritation because of distal locking bolt was exclusively seen in group A, however this was not statistically significant (p = 0.241). ConclusionWe conclude that, in fixation of stable intertrochanteric fractures by long PFNA-II nail, distal locking not only increases the operative time and radiation exposure but also delays the fracture consolidation and increases the chances of hardware irritation, and hence is not required.

The effect of noise exposure on mental workload, noise sensitivity and general and mental health of overhead crane operators in one of the Steel Industries in south of Iran

Introduction: Overhead cranes play a vital role in guiding steel industries and maintaining their normal condition. These machines are operated by humans and pose a great risk of accidents that may occur due to mistakes made by operators. According to the mentioned contents, the non-negligible effects of noise on the physical and mental health of people in the work environment, the complexity and sensitivity of overhead crane operators, as well as the serious injuries caused by the error of this task, this study aimed at the effect of exposure to noise on mental workload, noise sensitivity and general and mental health of overhead crane operators in one of the steel industries in southern Iran.&#x0D; Materials and Methods: This study was conducted in two phases. In the first phase, the worker's exposure to the sound level was carefully evaluated. In this way, the sound pressure leveling was done during the operator's duty and in the crane cabin according to the recommendation of ISO 9612. In the second phase of the research, after determining the level of exposure of overhead crane operators to noise, noise sensitivity questionnaires, mental assessment of exposure to noise conditions, and general health questionnaires were distributed and subjected to statistical analysis. Statistical analysis of data was done using SPSS version 22 software. Using a one-way analysis of variance, independent t-test, and Pearson's correlation coefficient, the relationship between different factors was investigated. In this study, a significance level of 5% was considered.&#x0D; Results: The average equivalent level of exposure of overhead crane operators for 8 hours is 76.4 dB and the maximum and minimum equivalent levels of 8-hour exposure, respectively; 84 and 68.2 dB were obtained. The results of this study showed that there is a significant relationship between the variables of gender, marital status, and working hours with noise sensitivity and the variables of gender, education, a mental crisis in the last month and second job with mental load, and the variable of mental crisis in the last month with general health (P&lt;0.05). Pearson's correlation coefficient was used to investigate the relationship between noise sensitivity, mental load, and general health with sound. The results showed, there is no significant relationship between noise sensitivity, mental load, and general health with sound (P&gt; 0.05). There is a negative or inverse relationship between noise sensitivity and general sound health. This means that with the increase in volume, sensitivity to sound and general health will decrease and vice versa.&#x0D; Conclusion: The results of this research can provide the necessary platform to improve the working conditions of overhead crane operators to prevent the occurrence of inconveniences and problems of inaudible noise in values ​​less than 85 dB.

Integrity of personal radiation protective equipment (PRPE): a 4-year longitudinal follow-up study

BackgroundPersonal radiation protective equipment (PRPE) such as lead aprons minimises radiation exposure of operators using X-ray systems. However, PRPE might be prone to cracks in the attenuating layer resulting in inadequate radiation protection. This study aims to investigate the prevalence, qualification and quantification of PRPE integrity during a longitudinal follow-up study.MethodsAll PRPE of a large, general hospital was evaluated yearly in the period 2018–2021. The equipment was inspected on a tele-operated X-ray table, and tears were qualified and quantified using an X-ray opaque ruler. Rejection criteria of Lambert & McKeon, with an extra rejection criterion of 15 mm2 for individual tears, were applied to accept or reject further use of the PRPE.ResultsOver the 4-year follow-up period, a total of 1011 pieces of PRPE were evaluated. In total, 47.3% of the PRPE showed tears of which 31% exceeded the mentioned rejection criteria. Remarkably, of the 287 newly registered pieces of PRPE, 6.0% showed tears in the first year of use of which 88.2% needed to be rejected. Also, 48% of the repaired PRPE was rejected again in the consecutive year.ConclusionsPRPE is prone to cracks. Up to 50% of PRPE showed tears and cracks resulting in 31% rejections. Newly purchased PRPE is not guaranteed to remain free of cracks and tears in the first year of use. Repair does not guarantee a long-term solution for prolonging the lifespan. Regular X-ray-based integrity analysis of PRPE is needed to ensure adequate radioprotection for operators using X-ray systems.

Technology Focus: Production and Facilities (December 2022)

The COVID-19 pandemic has caused unprecedented circumstances affecting production and facilities. Restrictions in mobility between sites and reduction in manpower challenged the business continuity of several operations. This accelerated the development and implementation of various technological solutions. We can see many examples in the works submitted this year: drone surveillance, inspection robots, digital twins, and automated systems. The digitalization tendency brought by the fourth industrial revolution continues to be the dominant topic of the works submitted. Approximately 28% were on simulation and modeling, of which one-third used machine learning. A total of 9% addressed intelligent management systems, 5% robotics and drones, 3% 3D printing, and 1.5% digital twins and augmented reality. The main topics addressed were inspection and maintenance (20%), flow assurance (7%), corrosion (6%), drilling (6%), nonmetallic materials (3%), and debottlenecking (2%). A few papers were on clean energy subjects, such as hydrogen energy and wind turbines (2%). I would like to highlight the following works as promising technological developments for production and facilities: innovative measurement techniques, such as the development of a new adjustable cone meter that adapts automatically to flow conditions of wet and dry gas (paper SPE 207505); improvements to drilling safety, such as the design of a new casing connector that significantly reduces rig time and health, safety, and environmental exposure risks (paper OTC 31075); new developments in piping inspection, such as the combination of direct-response spectroscopy with microwave for inspection of hard-to-inspect piping with coatings and overwraps (paper IPTC 21799); and a very interesting study of triangular vs. circular cross-sectional pipes, which shows that triangular pipes and elbows have significant less erosion, better heat transfer properties, and reduced slug frequencies for multiphase flow (paper SPE 208101). In the matter of optimizing production, debottlenecking continues to be a challenge. Whether it is for increase of production needs or for handling greater water cuts from aging wells, new technological solutions are arising to make production facilities increasingly efficient. Paper IPTC 22365 discusses dual-frequency AC/DC desalting technology. It shows a reduction in costs and energy requirements while achieving superior basic sediment and water removal. One of the topics becoming more relevant is the reduction of CO2 emissions. At least 5% of the abstracts I reviewed addressed lowering CO2 emissions as their main topic. Energy harvesting is an economically interesting way to reduce emissions because the energy consumption of the facility is reduced. The study shown in paper OTC 31724 describes energy harvesting from hydraulic pressure drops as an example of the circular economy applied to oil-production facilities. In this study, the energy and costs savings were evaluated at different pressure-drop points of a gas/oil separation plant. Paper SPE 207096 uses pinch analysis to perform a detailed heat-exchange-network retrofitting study of a crude distillation unit, predicting 8% of energy savings. I sincerely hope that we can see more developments in this area in coming years. Recommended additional reading at OnePetro: www.onepetro.org. IPTC 21799 Effectiveness of Dynamic-Response Spectroscopy and Microwave-Inspection Technology for Substrate Pipe and Composite Wraps by Rehan Ahmed, Petronas, et al. OTC 31075 Premium Antirotation Casing Connector With Metal-to-Metal Seal Optimized for High-Fatigue Performance To Meet Market Needs by Reducing Operational Expenditure and Risk Exposure by Scott Patrick Ellisor, Dril-Quip, et al. SPE 207096 A Practical Approach to Energy Optimization Using Pinch Analysis: A Case Study of an Oil Refinery by Paschal Uzoma Ndunagu, Honeywell, et al. OTC 31724 Circular Economy Initiatives at Upstream Surface Facilities by Ahmed Khalid Bu Ali, Aramco, et al.

The 7th International Akademie Fresenius Conference on Worker, Operator, Bystander and Resident Exposure and Risk Assessment Was Held on 13–14th December 2022

The conference began with a presentation by Frederique Istace, Scientific Officer at EFSA (European Food Safety Authority) concerning the first update of the EFSA Open Guidance in 2014, initiated by an EC Mandate in 2017 and adopted on 30 November 2021. Changes included Inclusion of GH scenarios Update of mixing/loading data Rounding of coefficients in formulas Optional calculation of air concentration Inclusion of soil-borne residue approach Pro-rata calculation of dermal absorption Inclusion of safe re-entry period calculation Combined exposure for different active substances in one product.

Evaluation of aerial drift during drone spraying of an artificial vineyard

Drones have many advantages over the helicopters that were used in steeply sloping vineyards before the ban on aerial spraying. They are cheaper, safer, quieter, more precise and smaller, allowing them to fly lower and thus limit aerial drift. The drone also appears to be a promising alternative to ground spraying (the only option currently authorized) in terms of operator safety and exposure.

Particle emissions and respiratory exposure to hazardous chemical substances associated with binder jetting additive manufacturing utilizing poly methyl methacrylate

BackgroundDuring industrial scale binder jetting utilising poly methyl methacrylate (PMMA) hazardous chemical substances (HCSs) such as PMMA powder particles, methyl methacrylate (MMA) and acetone may be emitted and potentially inhaled by Additive Manufacturing (AM) operators. MethodsPhysical and chemical characterisation of virgin and used PMMA powder samples were characterised in terms of their size, shape and chemical composition. Direct reading particle counting instruments were used to determine particle emissions and emission rates (ER). Internationally recognised methods were used to monitor HCSs in the ambient workplace environment and personal respiratory exposure of the AM operators. ResultsThere were no differences between the median powder size distributions of virgin and used PMMA powders. Scanning Electron Microscopy images indicated the presence of <10 µm and <4 µm sized particles in virgin and used powders. Particle ERs as high as 3.33 × 106 particles/min for 0.01 - ∼1.00 µm sized particles were measured during the post-processing phase. Inhalable and respirable particles, acetone, pentane and toluene were detected in ambient air and AM operators were exposed to quantifiable concentrations of these HCSs. ConclusionsParticles sized 0.01 - ∼1.00 µm were the most prevalent particles emitted, with a maximum ER of 3.33×106 particles/min. Eight-hour Time Weighted Average personal exposures were below their respective Occupational Exposure Limit (OELs), with the exception of inhalable particles (mean >50% of the South African OEL). Recommendations were made to reduce exposure to inhalable particles, which could be applied to other AM facilities.

Radiographic factors associated with inferior alveolar nerve exposure during mandibular third molar surgery and their influence on neurosensory deficit: A prospective study.

The inferior alveolar nerve (IAN) can occasionally be observed in the extraction socket of the mandibular third molar (M3M) intraoperatively. Exposure of inferior alveolar neurovascular bundle during surgery primarily depends upon the absence of bony cortex between the canal and root of impacted third molar or either by existence of a very thin cortical lining between two which gets broken during luxation of tooth. Accurate anatomical relationship of inferior alveolar canal with root apex of impacted (M3M) and the location of canal can be determined by Cone beam computed tomography (CBCT). Initially 200 patients evaluated by Orthopantomogram (OPG) for anatomical relationship of IAN with impacted (M3M) and various radiographic risk factors for nerve injury. Among these 200, 75 showed the presence of two or more than two risk factors for IAN injury which then were further evaluated by using CBCT for presence or absence of cortex of canal and location of canal on buccal, lingual, inferior, and interradicular position. Cortex of canal is an important barrier between the root apex and inferior alveolar neurovascular bundle. Interruption of cortex on CBCT, the interradicularly and lingually positioned neurovascular bundle become a strong affirmation for intra operative nerve exposure during (M3M) surgery. Although its exposure is affected by various factors such as bone density, sex and age of patient, surgeon's expertise, operative tissue damage, post operative edema, surgical procedure, but neurosensory deficit do not occur simply after the exposure of neurovascular bundle.

ITER Test Blanket Module—Engineering Investigations for Port Cell Pipe Forest Replacement

The ITER Test Blanket Modules (TBMs) are installed and operated inside the vacuum vessel (VV) at the equatorial ports located within port plugs (PP), and each of them includes two TBMs. After each plasma operation campaign, the TBM research plan testing program requires the replacement of the TBMs by new ones during the ITER long-term shutdown (LTM). The replacement of a TBM requires the removal/reinstallation of all test blanket system (TBS) equipment present in the port cell (PC), including those in the port interspace called pipe forest (PF). The TBS equipment in PC shall be designed so that occupational radiation exposure can be as low as reasonably achievable (ALARA) over the life of the plant to follow the ITER Policy. To implement ALARA process requirements, a design shall consider careful integration assessment since early phase to address all engineering aspects of the replacement sequence. The design of the TBS equipment in PC shall optimize the reconfiguration operation by including human factor considerations and providing adequate space. Provisions for dose reduction measures (DRMs) considering protection means and minimization of occupancy times in radiation fields are also investigated by assessing remote technics to reduce operator exposure. This article describes engineering investigations for optimized PF replacement operations in various engineering fields. Results on the design of the TBS equipment in the TBM-PC are discussed. The PF design shall implement nuclear engineering aspects. Design options shall demonstrate constructability and maintainability meaning compliance with ALARA process and adequate construction codes (RCC-MRx, EN 13480). TBM-PP replacement sequence drives several elements of the TBM-PC component design and associated integration. Concepts are discussed with regard to nuclear engineering and operation aspects. Use of prototyping demo, including virtual reality (VR), will support the preliminary validation during the system engineering process in order to prepare the full-scale mock-up validation phase.

Laparoscopic Resection of Large Abdominal Wall Endometriosis

<h3>Study Objective</h3> To demonstrate surgical techniques for resection of large fascial and rectus muscle endometriosis implants. <h3>Design</h3> N/A. <h3>Setting</h3> The patient underwent surgery at a tertiary care center. She was placed in dorsal lithotomy position in steep Trendelenburg. Insufflation was carried out to 15 mmHg. A primary 10mm subxiphoid port was used for the camera and three additional 5mm assist ports were placed. <h3>Patients or Participants</h3> The patient is a 44-yo G1P1 with a history of a cesarean delivery, laparoscopic excision of endometriosis, and subsequent hysterectomy who presented with cyclic abdominal wall pain consistent with abdominal wall endometriosis diagnosed on MRI. <h3>Interventions</h3> Laparoscopic excision of abdominal endometriosis lesion with placement of polypropylene mesh. <h3>Measurements and Main Results</h3> Large sub-fascial abdominal wall endometriosis lesion was completely excised and resultant fascial defect successful closed with synthetic mesh. Patient was discharged same day, recovered without issue, and notes complete resolution of pre-operative symptoms. <h3>Conclusion</h3> Abdominal wall endometriosis involving the fascia or underlying structures can be safely and effectively resected using the laparoscopic techniques outlined in this video. This minimally invasive approach allows excellent operative exposure and a quicker recovery. In cases with large fascial defects, synthetic mesh should be utilized, and several techniques can be employed to reduce the incidence of post-op adhesions.

Evaluation of Performance of Robotic-Assisted Coronary Angioplasty System Over Conventional/Manual PCI

Most percutaneous coronary intervention (PCI) might present hazards for patients, procedure operators, and the laboratory staff [1-3]. Due to complex nature of lesions and procedures, both patients and laboratory team may be subjected to exposure of longer procedural duration and radiation [3]. The long hours of standing for operators while wearing a lead apron commonly leads to exhaustion and injuries that frequently results in reduced performance and sub optimal clinical results [1]. A remote-control, robotic-assisted angioplasty system was developed to address some of the procedural challenges and occupational hazards associated with traditional PCI in addition to enhancing the degree of precision and control for the interventional procedure. A remote- control, robotic-assisted angioplasty system is used to address some of the procedural challenges and occupational hazards associated with traditional PCI. The objective of this study was to assess the safety and feasibility of the operating robotic system in patients undergoing elective PCI. This review summarises the safety and feasibility of a robotic angioplasty system in delivery and manipulation of coronary guidewires, balloons, and stents in patients undergoing PCI. Patients with coronary artery disease and clinical indication for elective PCI were enrolled. The coronary angioplasty procedure was performed with the CorPath 200 robotic system (Corindus, Inc.) The operating system consists of a remote interventional cockpit and a multicomponent bedside unit that contains advance, retract, and rotate guidewires within rapid exchange catheters. The primary endpoint was device clinical success (30% residual stenosis) with- out in-hospital major adverse cardiac events. The procedural success was defined as the ability of the system to complete all the planned angioplasty steps based on procedural segments.30 days follow up after angioplasty procedure was done. A total of 47 patients were enrolled in the study. Primary endpoint had been achieved in all patients. The success of the robotic system was 98.1% in completing 48 of 49 planned steps. No device or procedure-related complications were reported and no in-hospital or 30-day major adverse cardiac events were observed. We rated the robotic system performances as equal to as or better than manual procedures in 97.7% of the cases. Cardiologist’s radiation exposure was 97% lower than found at the standard table position. Our procedure results demonstrated better safety, feasibility and procedural effectiveness than manual operation. Besides, total operator exposure to radiation was quite low. However, a larger study is warranted to confirm the safety and effectiveness of robotic-assisted percutaneous coronary intervention.

Portable X-ray devices: technique, image quality and regulations

Portable intraoral X-ray devices are marketed as an alternative for conventional wall mounted devices. On the basis of a recent clinical trial the diagnostic quality of portables appears to measure up to the conventional devices. When CE-certified portable devices are used with rectangular collimation and a backshatter radiation shield with adapted technique resulting in a beam parallel to the ground, operator exposure stays well within dose limits. However, the dose to the operator is higher than when using conventional devices. Therefore, in the Netherlands, guidelines restrict the use of portable devices to ambulant use outside the dental clinic while deploying additional radiation protection measures. If presumed advantages of increased control over the exposure due to proximity to the patient would be substantiated by research, this restricted use could be reconsidered. Dentists should be aware of online availability of non-CE-certified portable intra-oral X-ray devices that are potentially unsafe.