Acquisition of Spine Injection Skills Using a Beef Injection Simulator

2007 ◽  
Vol 4;10 (7;4) ◽  
pp. 591-598
Author(s):  
Michael Behrend
Keyword(s):  
Fluoroscopy Time ◽  
Teaching Staff ◽  
X Ray ◽  
Injection Needle ◽  
Spine Pain ◽  
Needle Technique ◽  
Injection Model ◽  
Speed Accuracy ◽  
Spine Injection ◽  
Needle Injection

Background: Students of interventional spine procedures typically learn needle injection technique using cadaver specimens or live patients in an operating room. This can be expensive, inefficient, uncomfortable to patients, and requires a significant time commitment from teaching staff. Purpose: To present a simple and inexpensive simulator using a cut of beef as an injection model that can be used to teach certain components of interventional spine injection needle technique in a more efficient and cost effective fashion. Basic Procedures: A needle injection practice model using beef muscle attached to a plastic base was constructed. Students of interventional spine pain were instructed in C-arm x-ray operation and basic needle handling technique, then performed a series of mock injection procedures using this simulator. Procedure time, fluoroscopy time, and accuracy were measured. Main findings: Speed, accuracy of needle placement, and fluoroscopy time of the subjects improved with the number of practice sessions completed. The subjects felt better prepared to perform live patient procedures as a result of this training. Conclusions: Use of an inexpensive beef injection model is a valid, reliable, and feasible adjunct to teaching C-arm x-ray operation and spine injection needle technique to beginning students of intervention spine pain management. Keywords: models, educational ; models, anatomic; models, structural

O-Arm–Guided Balloon Kyphoplasty: Prospective Single-Center Case Series of 54 Consecutive Patients

2011 ◽  
Vol 68 (suppl_2) ◽  
pp. ons250-ons256 ◽  
Author(s):  
Frédéric Schils
Keyword(s):  
Case Series ◽  
Balloon Kyphoplasty ◽  
Guidance System ◽  
Fluoroscopy Time ◽  
Vertebral Compression Fractures ◽  
Additional Time ◽  
Minimally Invasive Spinal Surgery ◽  
X Ray ◽  
Clinical Series ◽  
The Mean

Abstract Background: Balloon kyphoplasty is widely used to treat vertebral compression fractures. Procedure outcome and safety are directly linked to precise radiological imaging requiring 1 or 2 C arms to allow correct visualization throughout the procedure. This minimally invasive spinal surgery is associated with radiation exposure for both patient and surgeon. In our center, we switched from using a C-arm to an O-arm image guidance system to perform balloon kyphoplasty. Our preliminary experience is reported in Acta Neurochirurgica, and the encouraging results led us to study this subject more extensively. This article presents our complete results. To the best of our knowledge, there is no comparable clinical series describing O-arm use in kyphoplasty procedures published in the literature. Objective: To report our complete results of using the O-arm guidance system to perform balloon kyphoplasty. Methods: We prospectively evaluated O-arm–guided kyphoplasty procedure in 54 consecutive patients and measured x-ray exposure and fluoroscopy time. Results: The mean surgical time for the procedure was 38 minutes with a mean fluoroscopy procedure time of 3.1 minutes. The mean fluoroscopy time by level was 2.5 minutes. Mean irradiation dose by procedure was 220 mGy and by level was 166 mGy. There was a significant reduction in fluoroscopy time and x-ray exposure from 5.1 minutes with classic C-arm use to 3.1 minutes when with O-arm use without additional time required for positioning the system. Conclusion: With this new intraoperative system, the overall surgical and fluoroscopy times can be further reduced in the near future.

Comparison of Dual-Channel Wavelength and Secondary-Target Energy-Dispersive X-Ray Spectrometers

1986 ◽  
Vol 30 ◽  
pp. 225-236
Author(s):  
John F. Croke ◽  
Joseph A. Nicolosi
Keyword(s):  
List Type ◽  
Qualitative And Quantitative Analysis ◽  
X Ray ◽  
Qualitative And Quantitative ◽  
The Past ◽  
Dual Channel ◽  
Target Energy ◽  
Overall Performance ◽  
Channel Wavelength ◽  
Speed Accuracy

Over the past 30 years, X-ray fluorescence spectrometry has become one of the more valuable methods for the qualitative and quantitative analysis of materials. Today, there are many methods of instrumental analysis available, and among the factors that will be taken into account in the method of selection are: -Accuracy-Range of application-Speed-Sensitivity-ReliabilityNo one technique can provide all of the features that a given analyst requires. XRF does offer good overall performance over the widest range of elements. Speed, accuracy, and versatility are among the features that have made XRF the method of choice for over 15,000 laboratories worldwide.

scholarly journals Observations and Considerations on Patient X-ray Exposure in the Electrophysiology Lab

2013 ◽  
Vol 2 (2) ◽  
pp. 141 ◽  
Author(s):  
Xianxian Jiang ◽  
Lukas RC Dekker ◽  
◽  
Keyword(s):  
Catheter Ablation ◽  
Dose Rate ◽  
Pulmonary Vein ◽  
Fluoroscopy Time ◽  
Radiation Dose Rate ◽  
X Ray ◽  
Dose Area Product ◽  
Air Kerma ◽  
Area Product ◽  
Patient Radiation Exposure

To assess patient radiation during catheter ablation procedures and operator differences. From 84 patients (51 males, age 63 ± 10 years) undergoing complex catheter ablation by three experienced operators we collected: body mass index (BMI), procedure type and time, fluoroscopy time, dose area product (DAP), air kerma and X-ray system setting (cine, collimation and angiographic imaging angle). A new factor, fluoroscopy DAP–fluoroscopy time ratio, was introduced to compare operator differences. The results show the average procedure time was 179 (± 57) minutes (min), fluoroscopy time was 31 (± 21) min, DAP was 26.4 (± 19.6) Gy.cm2and air kerma was 0.26 (± 0.19) Gy. Procedure types were: pulmonary vein isolation (PVI) (52 %), redo PVI (11 %), pulmonary vein ablation catheter (PVAC) (14 %), ventricular tachycardia (VT) (8 %) and others (15 %). Inter-operator difference was observed in fluoroscopy and cine usage. Fluoroscopy DAP-time ratios showed a similar level of patient radiation dose rate by operator A and B (correlation: 0.89), and a significantly higher dose rate by operator C (correlation: 0.20, p<0.001; 0.26, p<0.01, to operator A and B). In conclusion, operators should be aware of patient radiation exposure levels and the influencing factors. Inter- and intra-operator differences can be measured and bench marked for improvement in X-ray efficiency and patient radiation reduction.

Three-Dimensional Holographic Guidance, Navigation, and Control (3D-GNC) for Endograft Positioning in Porcine Aorta: Feasibility Comparison With 2-Dimensional X-Ray Fluoroscopy

2021 ◽  
pp. 152660282110250
Author(s):  
Karl West ◽  
Sara Al-Nimer ◽  
Vikash R. Goel ◽  
Jeffrey H. Yanof ◽  
Aydan T. Hanlon ◽  
...  
Keyword(s):  
Stent Graft ◽  
Delivery System ◽  
Fluoroscopy Time ◽  
Fluoroscopic Guidance ◽  
Procedure Time ◽  
X Ray ◽  
Landing Zone ◽  
Increased Risk ◽  
Navigation And Control ◽  
And Control

Objectives Intraprocedural deployment of endovascular devices during complex aortic repair with 2-dimensional (2D) x-ray fluoroscopic guidance poses challenges in terms of accurate delivery system positioning and increased risk of x-ray radiation exposure with prolonged fluoroscopy times, particularly in unfavorable anatomy. The objective of this study was to assess feasibility of using an augmented reality (AR) system to position and orient a modified aortic endograft delivery system in comparison with standard fluoroscopy. Materials and Methods The 3-dimensional guidance, navigation, and control (3D-GNC) prototype system was developed for eventual integration with the Intra-Operative Positioning System (IOPS, Centerline Biomedical, Cleveland, OH) to project spatially registered 3D holographic representations of the subject-specific aorta for intraoperative guidance and coupled with an electromagnetically (EM) tracked delivery system for intravascular navigation. Numerical feedback for controlling the endograft landing zone distance and ostial alignment was holographically projected on the operative field. Visualization of the holograms was provided via a commercially available AR headset. A Zenith Spiral-Z AAA limb stent-graft was modified with a scallop, 6 degree-of-freedom EM sensor for tracking, and radiopaque markers for fluoroscopic visualization. In vivo, 10 interventionalists independently positioned and oriented the delivery system to the ostia of renal or visceral branch vessels in anesthetized swine via open femoral artery access using 3D-GNC and standard fluoroscopic guidance. Procedure time, fluoroscopy time, cumulative air kerma, and contrast material volume were recorded for each technique. Positioning and orientation accuracy was determined by measuring the target landing-zone distance error (δLZE) and the scallop-ostium angular alignment error (θSOE) using contrast-enhanced cone beam computed tomography imaging after each positioning for each technique. Mean, standard deviation, and standard error are reported for the performance variables, and Student’s t tests were used to evaluate statistically significant differences in performance mean values of 3D-GNC and fluoroscopy. Results Technical success for the use of 3D-GNC to orient and position the endovascular device at each renal-visceral branch ostium was 100%. 3D-GNC resulted in 56% decrease in procedure time in comparison with standard fluoroscopic guidance (p<0.001). The 3D-GNC system was used without fluoroscopy or contrast-dye administration. Positioning accuracy was comparable for both techniques (p=0.86), while overall orientation accuracy was improved with the 3D-GNC system by 41.5% (p=0.008). Conclusions The holographic 3D-GNC system demonstrated improved accuracy of aortic stent-graft positioning with significant reductions in fluoroscopy time, contrast-dye administration, and procedure time.

scholarly journals Extensive Use of 3D Nonfluoroscopic Mapping Systems for Reducing Radiation Exposure during Catheter Ablation Procedures: An Analysis of 10 Years of Activity

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Massimiliano Marini ◽  
Marta Martin ◽  
Daniele Ravanelli ◽  
Maurizio Del Greco ◽  
Silvia Quintarelli ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Radiation Exposure ◽  
Imaging Modality ◽  
Disease Free Survival ◽  
Fluoroscopy Time ◽  
Free Survival ◽  
X Ray ◽  
Significant Difference ◽  
Disease Free ◽  
Mapping Systems

Purpose. 3D nonfluoroscopic mapping systems (NMSs) are generally used in the catheter ablation (CA) of complex ventricular and atrial arrhythmias. The aim of this study was to evaluate the efficacy, safety, and long-term effect of the extended, routine use of NMSs for CA. Methods. Our study involved 1028 patients who underwent CA procedures from 2007 to 2016. Initially, CA procedures were performed mainly with the aid of fluoroscopy. From October 2008, NMSs were used for all procedures. Results. The median fluoroscopy time of the overall CA procedures fell by 71%: from 29.2 min in 2007 to 8.4 min in 2016. Over the same period, total X-ray exposure decreased by 65%: from 58.18 Gy⁎cm2 to 20.19 Gy⁎cm2. This reduction was achieved without prolonging the total procedure time. In AF CA procedures, the median fluoroscopy time fell by 85%, with an 86% reduction in total X-ray exposure. In SVT CA procedures, the median fluoroscopy time fell by 93%, with a 92% reduction in total X-ray exposure. At the end of the follow-up period, the estimated probability of disease-free survival was 67.7% at 12 months for AF CA procedures and 97.2% at 3 months for SVT CA, without any statistically significant difference between years. Conclusions. Our study shows the feasibility of using NMSs as the main imaging modality to guide CA. The extended, routine use of NMSs dramatically reduces radiation exposure, with only slight fluctuations due to the process of acquiring experience on the part of untrained operators, without affecting disease-free survival.

Space and Time Distribution of Hard X-Ray Emission in a Loop at the Beginning of a Flare

1994 ◽  
Vol 144 ◽  
pp. 275-277
Author(s):  
M. Karlický ◽  
J. C. Hénoux
Keyword(s):  
Time Distribution ◽  
Electron Bombardment ◽  
Spatial Evolution ◽  
Superthermal Electrons ◽  
Flare Loop ◽  
X Ray ◽  
Superthermal Electron ◽  
Flare Loops ◽  
Chromospheric Evaporation ◽  
Temporal And Spatial

AbstractUsing a new ID hybrid model of the electron bombardment in flare loops, we study not only the evolution of densities, plasma velocities and temperatures in the loop, but also the temporal and spatial evolution of hard X-ray emission. In the present paper a continuous bombardment by electrons isotropically accelerated at the top of flare loop with a power-law injection distribution function is considered. The computations include the effects of the return-current that reduces significantly the depth of the chromospheric layer which is evaporated. The present modelling is made with superthermal electron parameters corresponding to the classical resistivity regime for an input energy flux of superthermal electrons of 109erg cm−2s−1. It was found that due to the electron bombardment the two chromospheric evaporation waves are generated at both feet of the loop and they propagate up to the top, where they collide and cause temporary density and hard X-ray enhancements.

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