Comparing the Efficacy of Radiation Free Machine-Vision Image-Guided Surgery With Traditional 2-Dimensional Fluoroscopy: : A Randomized, Single-Center Study

Background: Three-dimensional (3D) computer-assisted navigation (CAN) has emerged as a potential alternative to 2-dimensional (2D) fluoroscopy in the surgical placement of spinal instrumentation. Recently, 3D-CAN systems have improved significantly in their ability to provide real-time anatomical referencing while shortening the registration and set-up time. A novel system in navigation, Machine-Vision Image-Guided Surgery (MvIGS; 7D Surgical, Toronto, Canada) was cleared by the US Food and Drug Administration, but its potential benefits in reducing intra-operative radiation exposure to patients and enhancing surgical accuracy of pedicle screw placement are not fully known. Purpose: We sought to conduct a prospective, randomized, clinical study comparing the 3D-MvIGS spinal navigation system and 2D-fluoroscopy for pedicle screw insertion up to 3 levels (T10-S1) and for various measures of surgical efficacy. Methods: Sixty-two eligible patients were randomized to receive spine surgery using either the 3D-MvIGS group or the conventional 2D-fluoroscopy for pedicle screw fixation for the treatment of spinal stenosis and degenerative spondylolisthesis. Intra-operative parameters and procedure-related unintended protocol violations were recorded. Results: Operative time and estimated blood loss were not significantly different between groups. Radiation time and exposure to patients were significantly reduced in the 3D-MvIGS group. There was no difference between groups in pedicle screw placement accuracy (2D-fluoroscopy group, 96.6%; 3D-MvIGS group, 94.2%). There were no major complications or cases that required revision surgery. Conclusion: The 3D-MvIGS navigation system performed comparably with 2D-fluoroscopy in terms of pedicle screw placement accuracy and operative time. The 3D-MvIGS showed a significant reduction in radiation exposure to patients. In more complex cases or larger cohorts, the true value of greater anatomical visualization can be elucidated.

The Role of the Radiation Safety Officer in Patient Safety

The role of the Radiation Safety Officer (RSO) is to prevent unnecessary exposure to ionizing radiation and maintain necessary exposures as low as reasonably achievable (ALARA). The RSO is delegated broad authority throughout the organization by senior management. This authority includes permission to stop unsafe practices and identifying radiation protection problems, initiating, recommending, or providing corrective actions and verifying implementation of these actions. For the most part, these efforts are focused on maintaining radiation doses to employees and the public ALARA. Regulations do not address a role for the RSO in reducing radiation exposure to patients, except when unnecessary exposure is suspected due to equipment malfunction or human error. There is increasing concern about the risks of cancer and other effects from the use of medical imaging procedures. This chapter will discuss the tools and resources available to the RSO to educate members of the medical community and senior management on the need to manage radiation doses to patients so that the physician is able to obtain information necessary to properly diagnose and treat patients while avoiding unnecessary exposure.

Intraoperative radiation exposure in hip arthroscopy: a systematic review

Fluoroscopy is used in hip arthroscopy (HA) for portal placement, instrument localisation, and guidance in bony resection. The recent increase in arthroscopic hip procedures may place patients and surgeons at risk for increased radiation exposure and radiation-induced complications. The purpose of the current systematic review was to assess intraoperative radiation exposure in HA. The systematic review was conducted according to PRISMA guidelines; inclusion criteria were studies assessing radiation exposure in HA. 9 studies including 994 patients were included. Mean age was 38.6 years and 48% (436 of 906) were female. Mean time of fluoroscopy exposure was 0.58 minutes. Dose area product was 129.5 cGycm2. Mean intraoperative absorbed radiation dose studies was 12.6 mGy. Mean intraoperative effective dose was 0.48 mSv. The mean occupational exposure to the surgeon per case was 0.0031 mSv. Higher patient body mass index (BMI) correlated to greater patient effective and cumulative dose ( p < 0.05, r = 0.404), and greater occupational exposure ( p < 0.001, r = 0.460). Increasing surgeon experience decreased fluoroscopy time ( p = 0.039) and radiation dose ( p = 0.002). Radiation dose and effective dose were well under the thresholds for deterministic effects (2 Gy) and annual radiation exposure for occupational workers (20 mSv). Intraoperative radiation exposure to patients and surgeons is within acceptable annual radiation limits. Ensuring careful selection of perioperative imaging modalities, proper protective shielding, specifically the use of leaded eyeglasses, and optimal C-arm positioning are key strategies to reduce radiation exposure to patients and surgeons alike.

Techniques ‒ Ultrasound-guided percutaneous nephrolithotomy: How we do it

Ultrasonography has emerged as an alternative to fluoroscopy for image-guided percutaneous nephrolithotomy (PCNL) in many countries. Compared to fluoroscopy-guided PCNL (F-PCNL), ultrasound-guided PCNL (US-PCNL) is easier to learn and reduces radiation exposure to patients and providers. Despite these advantages, uptake of ultrasound-guided PCNL (US-PCNL) in Canada has been almost nonexistent, largely because it is not incorporated into urologists’ training. In this article, we seek to familiarize Canadian urologists with this approach by describing our step-by-step technique for US-PCNL. Additionally, we provide keys to successful implementation of this technique.