Analysis of Intraoperative Cone-Beam Computed Tomography Combined With Image Guidance for Lateral Lumbar Interbody Fusion

2017 ◽  
Vol 14 (6) ◽  
pp. 620-626
Author(s):  
Xilin Liu ◽  
Jacob R Joseph ◽  
Brandon W Smith ◽  
Yamaan Saadeh ◽  
Paul Park
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Cone Beam Computed Tomography ◽  
Interbody Fusion ◽  
Cone Beam ◽  
Lumbar Interbody Fusion ◽  
Lateral Lumbar Interbody Fusion ◽  
Spinal Navigation ◽  
Male Patients ◽  
Biplanar Fluoroscopy

Abstract BACKGROUND Minimally invasive lateral lumbar interbody fusion (LLIF) is traditionally performed with biplanar fluoroscopy. Recent literature demonstrates that intraoperative cone-beam computed tomography combined with spinal navigation can be safely utilized for localization and cage placement in LLIF. OBJECTIVE To evaluate the accuracy and safety of cage placement using spinal navigation in LLIF, as well as to evaluate the radiation exposure to surgeon and staff during the procedure. METHODS The authors performed a retrospective analysis of a prospectively acquired database of patients undergoing LLIF with image-based navigation performed from April 2014 to July 2016 at a single institution. The medical records were reviewed, and data on clinical outcomes, cage accuracy, complications, and radiation exposure were recorded. All patients underwent a minimum 30-d clinical follow-up to assess intraoperative and short-term complications associated with their LLIF. RESULTS Sixty-three patients comprising 117 spinal levels were included in the study. There were 36 (57.1%) female and 27 (42.9%) male patients. Mean age was 62.7 yr (range 24-79 yr). A mean 1.9 (range 1-4) levels per patient were treated. Cages were placed in the anterior or middle of 115 (98.3%) disc spaces. Image-guided cage trajectory was accurate in 116/117 levels (99.1%). In a subgroup analysis of 18 patients, mean fluoroscopy time was 11.7 ± 9.7 s per level. Sixteen (25.4%) patients experienced a complication related to approach. CONCLUSION Use of intraoperative cone-beam computed tomography combined with spinal navigation for LLIF results in accurate and safe cage placement as well as significantly decreased surgeon and staff radiation exposure.

Three-Dimensional Computed Tomography-Based Spinal Navigation in Minimally Invasive Lateral Lumbar Interbody Fusion: Feasibility, Technique, and Initial Results

2015 ◽  
Vol 11 (2) ◽  
pp. 259-267 ◽  
Author(s):  
Paul Park
Keyword(s):  
Computed Tomography ◽  
Minimally Invasive ◽  
Navigation System ◽  
Interbody Fusion ◽  
Cone Beam Ct ◽  
Cone Beam ◽  
Lumbar Interbody Fusion ◽  
Disk Space ◽  
Image Guided ◽  
Spinal Navigation

Abstract BACKGROUND As with most minimally invasive spine procedures, lateral lumbar interbody fusion (LLIF) requires the use of biplanar fluoroscopy for localization and safe interbody cage placement. Computed tomography (CT)-based intraoperative spinal navigation has been shown to be more effective than fluoroscopic guidance for posterior-based approaches such as pedicle screw instrumentation. However, the use of spinal navigation in LLIF has not been well studied. OBJECTIVE To present the technique for using an intraoperative cone-beam CT and image-guided navigation system in LLIF and to provide a preliminary analysis of outcomes. METHODS We retrospectively analyzed a prospectively acquired database and the electronic records of patients undergoing LLIF with spinal navigation. Eight patients were identified. Postoperative neurological deficits were recorded. All patients underwent postprocedural CT and x-ray imaging for analysis of accuracy of cage placement. Accuracy of cage placement was determined by location within the disk space. RESULTS The mean age was 66 years, and 6 patients were women. A mean 2.8 levels were treated with a total of 22 lateral cages implanted via navigation. All cages were placed within quarters 1 to 2 or 2 to 3, signifying the anterior half or middle portions of the disk space. There were no sensory or motor deficits postoperatively. CONCLUSION Use of an intraoperative cone-beam CT with an image-guided navigation system is feasible and safe and appears to be accurate, although a larger study is required to confirm these results.

scholarly journals Application of 3D tooth model for monitoring of implant space and inter-root distance without radiographs: a proof of concept study

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Kyungmin Lee ◽  
Gyu-Hyoung Lee
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Cone Beam Computed Tomography ◽  
Alveolar Bone ◽  
Tooth Movement ◽  
Treatment Evaluation ◽  
Cone Beam ◽  
Proof Of Concept ◽  
Cbct Image ◽  
Root Position

Abstract Background Radiographs are integral in evaluating implant space and inter-root distance. The purpose of this report is to introduce a method for evaluating the 3D root position with minimal radiation using a 3D tooth model composed of an intraoral-scanned crown and a cone-beam computed tomography (CBCT)-scanned root. Materials and methods Intraoral scan and CBCT scan of the patient were obtained before treatment. In the CBCT image, tooth segmentation was performed by isolating individual teeth from the maxillary and mandibular alveolar bone using software program. The 3D tooth model was fabricated by combining segmented individual teeth with the intraoral scan. Results A post-treatment intraoral scan was integrated into the tooth model, and the resulting position of the root could be predicted without additional radiographs. It is possible to monitor the root position after a pretreatment CBCT scan using a 3D tooth model without additional radiographs. Conclusion The application of the 3D tooth model benefits the patient by reducing repeated radiation exposure while providing the clinician with a precise treatment evaluation to monitor tooth movement.

scholarly journals The nasopalatine canal and its relationship with the maxillary central incisors: a cone-beam computed tomography study

2021 ◽  
Vol 10 (15) ◽  
pp. e351101522978
Author(s):  
Ana Carolina Neves Melgaço de Lima ◽  
Dominique A. Peniche ◽  
Thais M. C. Coutinho ◽  
Fábio R. Guedes ◽  
Maria Augusta Visconti ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cone Beam Computed Tomography ◽  
Average Diameter ◽  
Cone Beam ◽  
Nasopalatine Canal ◽  
Gender And Age ◽  
Post Test ◽  
Male Patients ◽  
And Gender ◽  
Student’S T

Objective: To evaluate the dimensions of the nasopalatine canal (NPC) and its relationship with the maxillary central incisors (MCI) using cone-beam computed tomography (CBCT) and to determine variations in the NPC in relation to age and gender. Methods: CBCT scans from 333 patients (67% female; 35.9 ± 14.6 years) were included. The CBCT scan was analyzed to determine the length and diameter of the NPC, the distance between the NPC and the MCI, and to evaluate the morphology of the NPC. The data were analyzed using the independent Student's t-test, the Mann–Whitney and Kruskal–Wallis tests, and Dunn's post-test (p < 0.05). Results: The average diameter and length of the NPC were 2.92 ± 0.91 mm and 12.67 ± 3.32 mm, respectively. The minimum and maximum distance between the MCI and the NPC were 0.78 ± 0.42 mm and 2.56 ± 1.38 mm, respectively. The NPC of male patients was greater in length compared with the female patients (p < 0.05). The majority presented a funnel-like morphology (34.1%), followed by a cylindrical morphology (27.5%). Conclusions: There was variability in the dimensions of the NPC and its relationship with the MCI, which was influenced by gender and age.

Cone beam computed tomography: Rejuvenating dentistry

2016 ◽  
Vol 7 (2) ◽  
pp. 74-77 ◽  
Author(s):  
Zaid Baqain ◽  
Abeer Al Hadidi
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Radiation Protection ◽  
Cone Beam Computed Tomography ◽  
Developing World ◽  
Image Interpretation ◽  
Three Dimensional ◽  
Cone Beam ◽  
Three Dimensional Imaging ◽  
Developed World

Dental cone beam computed tomography (CBCT) is the three-dimensional imaging of choice in modern dentistry. In the developed world, guidelines have been published on the use of CBCT in dentistry, largely in response to the risks associated with ionising radiation exposure. However, the availability of different models on the market at affordable prices has made this machine an integral part of the contemporary dentists’ apparatus, even in the developing world. Here, we underline the importance of awareness on radiation protection, image acquisition, familiarity with the software and image interpretation.

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

2013 ◽  
Vol 19 (2) ◽  
pp. 226-231 ◽  
Author(s):  
Eric W. Nottmeier ◽  
Stephen M. Pirris ◽  
Steven Edwards ◽  
Sherri Kimes ◽  
Cammi Bowman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Operating Room ◽  
Cone Beam Computed Tomography ◽  
Spinal Surgery ◽  
Image Guidance ◽  
Cone Beam ◽  
3D Image ◽  
Image Guided ◽  
Radiation Scatter

Object Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Methods Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Results Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Conclusions Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

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