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James A Crowhurst, Gregory M Scalia, Mark Whitby, Dale Murdoch, Brendan J Robinson, Arianwen Turner, Liesie Johnston, Swaroop Margale, Sarvesh Natani, Andrew Clarke, Darryl J Burstow, Owen C Raffel, Darren L Walters
BACKGROUND: Transesophageal echocardiography operators (TEEOP) provide critical imaging support for percutaneous structural cardiac intervention procedures. They stand close to the patient and the associated scattered radiation. OBJECTIVES: This study sought to investigate TEEOP radiation dose during percutaneous structural cardiac intervention. METHODS: Key personnel (TEEOP, anesthetist, primary operator [OP1], and secondary operator) wore instantly downloadable personal dosimeters during procedures requiring TEE support...
March 20, 2018: Journal of the American College of Cardiology
Georg Böning, Willie M Lüdemann, Julius Chapiro, Martin Jonczyk, Bernd Hamm, Rolf W Günther, Bernhard Gebauer, Florian Streitparth
PURPOSE: The aim of this study was to evaluate the feasibility of cone-beam computed tomography (CBCT)-based real-time 3-D guidance of TIPSS placement and its positioning compared to standard guiding methods. MATERIALS AND METHODS: In a prospective, randomized, consecutive study design from 2015 to 2017, we included 21 patients in the CBCT guided group and 15 patients in the ultrasound (US) guided group. The prospective groups were compared in terms of success rate of intervention, portal vein puncture/procedure time, number of puncture attempts and applied dose...
March 14, 2018: Cardiovascular and Interventional Radiology
Giulio Illuminati, Giulia Pizzardi, Rocco Pasqua, Francesca Frezzotti, Piergaspare Palumbo, Francesco Macrina, Francesco Calio
BACKGROUND: Tandem stenoses of the internal carotid artery (ICA) and proximal, ipsilateral common carotid artery (CCA) or innominate artery can be treated with a hybrid approach, combining conventional carotid endarterectomy (CEA) and retrograde stenting of the proximal stenosis, through surgical exposure of the carotid bifurcation. The purpose of this study was to evaluate the results of combining eversion CEA with retrograde CCA/innominate artery stenting. MATERIAL AND METHODS: From January 2015 to July 2017, 7 patients, 6 men of a mean age of 72 years (range 59-83 years) underwent simultaneous, retrograde stenting of the proximal CCA/innominate artery and an eversion CEA of the ipsilateral ICA, through surgical exposure of the carotid bifurcation, for severe tandem stenoses...
March 10, 2018: International Journal of Surgery
Nuria Kotecki, Axel Le Cesne, Emmanuelle Tresch-Bruneel, Isabelle Ray-Coquard, Christine Chevreau, François Bertucci, Emilie Bogart, Olivier Mir, Patricia Pautier, Emilie Decoupigny, Stéphanie Clisant, Jean-Yves Blay, Nicolas Penel
OBJECTIVE: To assess the impact of trabectedin rechallenge. PATIENTS AND METHODS: In the T-DIS trial (NCT0130309), after the 6 initial cycles of trabectedin, patients who were free from progressive disease (PD) were randomly assigned either to continuous treatment with trabectedin (C arm) or therapy interruption (I arm). Patients randomized in the interruption arm were allowed to restart trabectedin in case of PD. Herein we report an update of the impact of trabectedin discontinuation after subsequent rechallenge...
March 5, 2018: American Journal of Clinical Oncology
L Fidalgo Domingos, E M San Norberto García, D Gutiérrez Castillo, C Flota Ruiz, I Estévez Fernández, C Vaquero Puerta
BACKGROUND: Endovascular procedures come with a potential risk of radiation hazards both to patients and to the vascular staff. Classically, most endovascular interventions took place in regular operating rooms using a fluoroscopy C-arm unit controlled by a third party. Hybrid operating rooms (HOR) provide an optimal surgical suit with all the qualities of a fixed C-arm device, while allowing the device to be controlled by the surgical team. The latest studies suggest that an operator-controlled system may reduce the radiation dose...
February 28, 2018: Annals of Vascular Surgery
N Befrui, M Fischer, B Fuerst, S-C Lee, J Fotouhi, S Weidert, A Johnson, E Euler, G Osgood, N Navab, W Böcker
BACKGROUND: Despite great advances in the development of hardware and software components, surgical navigation systems have only seen limited use in current clinical settings due to their reported complexity, difficulty of integration into clinical workflows and questionable advantages over traditional imaging modalities. OBJECTIVES: Development of augmented reality (AR) visualization for surgical navigation without the need for infrared (IR) tracking markers and comparison of the navigation system to conventional imaging...
March 2, 2018: Der Unfallchirurg
Christopher R James, Blake E Peterson, Julia R Crim, James L Cook, Brett D Crist
BACKGROUND: Direct anterior approach total hip arthroplasty (THA) with fluoroscopic assistance is growing in popularity. Variables such as pelvic tilt, c-arm technique, and patient positioning can affect the perceived fluoroscopic view. This study evaluates the effect of these variables on the position of the acetabular component. METHODS: Forty-one hips in 40 patients undergoing direct anterior arthroplasty THA with fluoroscopic assistance underwent routine postoperative radiographs and postoperative pelvic computed tomography scan...
February 1, 2018: Journal of Arthroplasty
David E Gerber, Mark A Socinski, Joel W Neal, Heather A Wakelee, Keisuke Shirai, Lecia V Sequist, Rachel P Rosovsky, Rogerio C Lilenbaum, Bruno R Bastos, Chao Huang, Melissa L Johnson, Paul J Hesketh, Deepa S Subramaniam, Martin F Dietrich, Feng Chai, Yunxia Wang, Julia Kazakin, Brian Schwartz, Joan H Schiller, Julie R Brahmer, Ronan J Kelly
BACKGROUND: KRAS mutations are identified in approximately 25% of non-small cell lung cancer (NSCLC) cases and are associated with resistance to currently available targeted therapies. The MET oncogene may be implicated in malignant progression of KRAS-mutant tumors. In a pre-specified subset analysis of KRAS mutant cancers in an earlier phase 2 study of erlotinib plus the oral MET inhibitor tivantinib, combination therapy was associated with substantial clinical benefit compared to erlotinib alone (progression-free survival [PFS] HR 0...
March 2018: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Yinsheng Li, John William Garrett, Ke Li, Yijing Wu, Kevin Johnson, Sebastian Schafer, Charles Strother, Guang-Hong Chen
Time-resolved C-arm cone-beam CT (CBCT) angiography (TR-CBCTA) images can be generated from a series of CBCT acquisitions that satisfy data sufficiency condition in analytical image reconstruction theory. In this work, a new technique was developed to generate TR-CBCTA images from a single short-scan CBCT data acquisition with contrast media injection. The reconstruction technique enabling this application is a previously developed image reconstruction technique, Synchronized Multi-Artifact Reduction with Tomographic Reconstruction (SMART-RECON)...
March 1, 2018: Physics in Medicine and Biology
Tharindu De Silva, Joshua Punnoose, Ali Uneri, Mahadevappa Mahesh, Joseph Goerres, Matthew Jacobson, Michael D Ketcha, Amir Manbachi, Sebastian Vogt, Gerhard Kleinszig, Akhil Jay Khanna, Jean-Paul Wolinksy, Jeffrey H Siewerdsen, Greg Osgood
Positioning of an intraoperative C-arm to achieve clear visualization of a particular anatomical feature often involves repeated fluoroscopic views, which cost time and radiation exposure to both the patient and surgical staff. A system for virtual fluoroscopy (called FluoroSim) that could dramatically reduce time- and dose-spent "fluoro-hunting" by leveraging preoperative computed tomography (CT), encoded readout of C-arm gantry position, and automatic 3D-2D image registration has been developed...
January 2018: Journal of Medical Imaging
Yukiko Enomoto, Keita Yamauchi, Takahiko Asano, Katharina Otani, Toru Iwama
Background and purpose C-arm cone-beam computed tomography (CBCT) has the drawback that image quality is degraded by artifacts caused by implanted metal objects. We evaluated whether metal artifact reduction (MAR) prototype software can improve the subjective image quality of CBCT images of patients with intracranial aneurysms treated with coils or clips. Materials and methods Forty-four patients with intracranial aneurysms implanted with coils (40 patients) or clips (four patients) underwent one CBCT scan from which uncorrected and MAR-corrected CBCT image datasets were reconstructed...
January 1, 2018: Interventional Neuroradiology
Yasser A Noureldin, David M Hoenig, Philip Zhao, Sammy E Elsamra, Joshua Stern, Geoffrey Gaunay, Piruz Motamedinia, Zeph Okeke, Ardeshir R Rastinehad, Robert M Sweet
OBJECTIVES: To assess for usefulness and validity evidence for incorporating the C-Arm Trainer (CAT) simulator into the annual AUA hands on course for training percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: The course started with a didactic session followed by four stations for training the "bull's eye" technique using the CAT simulator. Each station included a pre-test, 30-min practice on the simulator, and post-test. All participants were assessed using a 4-item checklist...
February 17, 2018: World Journal of Urology
A Sonig, S V Setlur Nagesh, V S Fennell, S Gandhi, L Rangel-Castilla, C N Ionita, K V Snyder, L N Hopkins, D R Bednarek, S Rudin, A H Siddiqui, E I Levy
BACKGROUND AND PURPOSE: The ROI-dose-reduced intervention technique represents an extension of ROI fluoroscopy combining x-ray entrance skin dose reduction with spatially different recursive temporal filtering to reduce excessive image noise in the dose-reduced periphery in real-time. The aim of our study was to compare the image quality of simulated neurointerventions with regular and reduced radiation doses using a standard flat panel detector system. MATERIALS AND METHODS: Ten 3D-printed intracranial aneurysm models were generated on the basis of a single patient vasculature derived from intracranial DSA and CTA...
February 15, 2018: AJNR. American Journal of Neuroradiology
Michele Amadori, Domenico Barone, Emanuela Scarpi, Devil Oboldi, Elena Amadori, Gianfranco Bandi, Alice Rossi, Fabio Ferroni, Angela Ragazzini, Andrea Casadei Gardini, Giovanni Luca Frassineti, Giampaolo Gavelli, Alessandro Passardi
OBJECTIVES: To investigate early changes in tumour perfusion parameters by dynamic contrast-enhanced ultrasonography (D-CEUS) and to identify any correlation with survival and tumour response in patients with metastatic colorectal cancer (CRC) treated with bevacizumab (B). METHODS: Thirty-seven patients randomized to either chemotherapy (C) plus B or C alone were considered for this study. D-CEUS was performed at baseline and after the first treatment cycle (day 15)...
February 7, 2018: European Radiology
M Fiebich, D Weber
CLINICAL/METHODICAL ISSUE: Digital volume tomography (DVT) and cone-beam computed tomography (CT) with C‑arm systems have become established three-dimensional imaging systems as an alternative to CT in some application areas. STANDARD RADIOLOGICAL METHODS: The technology of the systems is well developed so that they have become a competing method to CT imaging in terms of image quality and radiation exposure. PERFORMANCE: An advantage is the better spatial resolution, preferably with dedicated scanner systems, especially in the z direction...
February 7, 2018: Der Radiologe
Yi-Shuan Hwang, Hui-Yu Tsai, Yu-Ying Lin, Kar-Wai Lui
BACKGROUND: To investigate the organ dose, effective dose (ED), conversion factor, and the C-arm rotation angle effects on dose variations of abdominal C-arm cone-beam computed tomography (CBCT) during transarterial chemoembolization (TACE). METHODS: The organ doses and EDs for abdominal C-arm CBCT were retrospectively calculated according to a Monte Carlo technique for 80 patients. Dose variations from projections, ED to dose-area product (DAP) ratios, and effects of body mass index (BMI) on the ED and ED to DAP ratios were also analyzed...
February 5, 2018: BMC Medical Imaging
Florian Horn, Martino Leghissa, Sebastian Kaeppler, Georg Pelzer, Jens Rieger, Maria Seifert, Johannes Wandner, Thomas Weber, Thilo Michel, Christian Riess, Gisela Anton
X-ray grating-based phase-contrast imaging has raised interest regarding a variety of potential clinical applications, whereas the method is feasible using a medical x-ray tube. Yet, the transition towards a clinical setup remains challenging due to the requirement of mechanical robustness of the interferometer and high demands applying to medical equipment in clinical use. We demonstrate the successful implementation of a Talbot-Lau interferometer in an interventional c-arm setup. The consequence of vibrations induced by the rotating anode of the tube is discussed and the prototype is shown to provide a visibility of 21...
February 2, 2018: Scientific Reports
Mikiko Yamashita, Ryo Takahashi, Masaki Kokubo, Kenji Takayama, Hiroaki Tanabe, Masaki Sueoka, Masao Ishii, Hidenobu Tachibana
Dose verification for a gimbal-mounted image-guided radiotherapy system, Vero4DRT (Mitsubishi Heavy Industries Ltd., Tokyo, Japan) is usually carried out by pretreatment measurement. Independent verification calculations using Monte Carlo methods for Vero4DRT have been published. As the Clarkson method is faster and easier to use than measurement and Monte Carlo methods, we evaluated the accuracy of an independent calculation verification program and its feasibility as a secondary check for Vero4DRT. Computed tomography (CT)-based dose calculation was performed using a modified Clarkson-based algorithm...
January 25, 2018: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
Adeline Schwein, Ponraj Chinnadurai, Greg Behler, Alan B Lumsden, Jean Bismuth, Carlos F Bechara
BACKGROUND: Fenestrated endovascular aneurysm repair (FEVAR) is an evolving technique to treat juxtarenal abdominal aortic aneurysms (AAAs). Catheterization of visceral and renal vessels after the deployment of the fenestrated main body device is often challenging, usually requiring additional fluoroscopy and multiple digital subtraction angiograms. The aim of this study was to assess the clinical utility and accuracy of a computed tomography angiography (CTA)-fluoroscopy image fusion technique in guiding visceral vessel cannulation during FEVAR...
January 30, 2018: Journal of Vascular Surgery
Sebastian Andress, Alex Johnson, Mathias Unberath, Alexander Felix Winkler, Kevin Yu, Javad Fotouhi, Simon Weidert, Greg Osgood, Nassir Navab
Fluoroscopic x-ray guidance is a cornerstone for percutaneous orthopedic surgical procedures. However, two-dimensional (2-D) observations of the three-dimensional (3-D) anatomy suffer from the effects of projective simplification. Consequently, many x-ray images from various orientations need to be acquired for the surgeon to accurately assess the spatial relations between the patient's anatomy and the surgical tools. We present an on-the-fly surgical support system that provides guidance using augmented reality and can be used in quasiunprepared operating rooms...
April 2018: Journal of Medical Imaging
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