Interventional fluoroscopy

Specific Approach When Protective Aprons Are Worn During Diagnostic and Interventional Medical Procedures Using Fluoroscopy... 

Clinical staff taking part in diagnostic and interventional procedures using fluoroscopy wear protective aprons to shield internal tissues and organs in the torso from scattered x rays. Use of the measurements from monitoring devices worn outside and above protective aprons as the record of or E for these individuals results in significant overestimates of their actual risk. 

Other uses of fluoroscopy would have the potential for higher cumulative collar exposures. For example, abdominal interventional and angiography procedures typically use image intensifiers and x-ray field sizes which are larger than those used in a cardiac catheterization laboratory. Depending on the orientation of the primary beam, the scattered radiation from the patient may have greater intensity in these other clinical situations than in a cardiac catheterization laboratory. 

ROSENSTEIN, M. and WEBSTER, E.W. (1994). Effective dose to personnel wearing protective aprons during fluoroscopy and interventional radiology, Health Phys. 67, 88-89. 

For the interventional staff, radiation exposure is a product of the procedure, and the occupational dose received during all such procedures should be minimized to the extent possible without compromising appropriate patient care, a precaution referred to as ALARA (as low as reasonably achievable). Relevant aspect to minimize radiation exposure is reducing the amount of fluoroscopy and cine time to the clinically required minimum. It is important to avoid the Tead-foot syndrome the operator must learn to press the fluoroscopy pedal briefly, when it is necessary to confirm the sheath position, and to reflexively take his or her foot off the pedal whenever looking away from the television monitor [8]. 

The detectability of embolization particles has long been a matter of debate among interventional radiologists. Since calibrated microspheres have a high content in water, they are not detectable by fluoroscopy, CT, or MR scan, and operators cannot localize them during and after embolization. 

Loser, M.H., Navab, N. A new robotic system for visually controlled percutaneous interventions under ct fluoroscopy. In Medical Image Computing and Computer-Assisted Intervention (MICCAI), Pittsburgh, USA, pp. 887-896, October 11-14 2000... 

Nawfel RD, Judy PF, Silverman SG, Hooton S, Tuncali K, Adams DF (2000) Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. Radiology 216 180-184... 

Satava RM (2003) Robotic surgery from past to future - a personal journey. Surg Clin North Am 83 1491-1500, xii Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PE (1999) CT fluoroscopy-guided abdominal interventions techniques, results, and radiation exposure. Radiology 212 673-681... 

The major complication during acrylic cement injection is epidural overflow with spinal nerve compression. Monitoring the vertebral filling by lateral fluoroscopy during the injection of the pasty cement minimizes this risk. The next most serious complication is infection to avoid this complication, strict sterility during the intervention is mandatory. 

Carlson 8K etal. (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219 515-520... 

Daly B, Templeton PA (1999) Real-time CT fluoroscopy evolution of an interventional tool. Radiology 211 309-3015 Elvin A et al. (1990) Biopsy of the pancreas with a biopsy gun. Radiology 176 677 79... 

Silverman SG etal. (1999) CT fluoroscopy-guided abdominal interventions techniques, results, and radiation exposure. Radiology 212 673-681... 

Percutaneous vertebroplasty (PV) is a safe and efficient therapeutic option for patients suffering from otherwise untreatable pain and disability caused by osteoporotic fracture or tumoral involvement of a vertebra. Vertebroplasty provides nearly immediate pain relief and stabilization, leading to a high rate of successful treatments with low morbidity, no or only short hospitalization, and rare adverse events. In addition, PV contributes to spinal stabilization and can be successfully combined with chemotherapy, radiation therapy, tumor ablation, and posterior laminectomy. Therefore, the number of procedures performed has continuously increased over the last few yccus. However, indications and contraindications, technical aspects, and possible complications of PV always have to be taken into account by the interventional radiologist. The success rate strongly depends - besides on the experience of the physician performing the procedure - on the visualization equipment used, such as CT fluoroscopy. 

The advantage in combining CT and fluoroscopy is the precise needle placement, which is particularly important in the upper thoracic spine, tumor cases, and other difficult cases. This dual-guidance technique reduces complications and increases the comfort and the confidence of the interventional radiologist. It allows for visualization in three dimensions with exact differentiation of anatomic structures at risk. Fluoroscopy is provided by placing a mobile C-arm in front of the CT gantry. When the position of the needle tip is considered satisfactory, the imaging mode is switched to C-arm fluoroscopy for real-time visualization of cement application in an AP and lateral view. 

The availabihty of FD technology in fluoroscopy and as rotational C-arm-based CT imaging (FD-CT) has stimulated a surprising number of novel developments for clinical imaging. Especially diagnostic and interventional neuroangiography profits from these innovative developments (Reran et al. 2006). 

Spinal examinations, such as myelography, or interventions, such as kyphoplasty or vertebroplasty, benefit from FD-CT, because on the one hand they have to be performed under fluoroscopy and on the other hand cross-sectional and three-dimensional imaging is helpful or sometimes even necessary. 

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