Search Results (362)

Background and Objectives: Balloon kyphoplasty is one of the most commonly performed minimally invasive surgical procedures for the treatment of osteoporotic vertebral fractures, with the bipedicular technique being the conventional approach. However, the use of both pedicles may present certain disadvantages, including higher costs, longer operative times, increased radiation exposure, and a greater risk of bone cement leakage. This study aims to report the 3-year follow-up outcomes of double-pedicle and single-pedicle kyphoplasty performed at our institution. Materials and Methods: Between June 2016 and May 2019, a total of 136 patients who presented to our clinic with osteoporotic vertebral fractures and underwent balloon kyphoplasty were included in this retrospective study. Pain relief and quality of life indices were assessed preoperatively and postoperatively. During follow-up examinations, radiographs, VAS (Visual Analog Scale) scores, and ODI (Oswestry Disability Index) scores were evaluated. Radiation exposure was assessed using fluoroscopy time and dose area product (DAP) values. Additionally, total injected cement volume, operative time, and procedural complications were retrieved from patient records. Results: The procedure was successful in all patients. The mean bone cement volume used was 3.4 ± 1.4 mL in the unipedicular group and 5.3 ± 2.1 mL in the bipedicular group. Fluoroscopy time and DAP values were significantly higher in the bipedicular technique compared to the unipedicular technique. At the final follow-up, the average kyphosis correction and mean vertebral height correction ratio were greater in the bipedicular group. The mean reduction in VAS and ODI scores was superior in the bipedicular group at the 1-, 2-, and 6-month follow-ups. However, at the 1-, 2-, and 3-year follow-ups, there was no significant difference in VAS and ODI scores between the two groups. Conclusions: The unipedicular balloon kyphoplasty technique offers several advantages, including shorter operative time, lower cement leakage risk, reduced radiation exposure, and comparable pain score reductions at 1- to 3-year follow-ups. However, the bipedicular technique provides superior short-term pain relief and demonstrates better sagittal alignment correction in long-term follow-ups compared to the unipedicular approach. Full article

Background: Severe pulmonary regurgitation (PR) often occurs after treatment of tetralogy of Fallot with a valve ring patch, leading to enlargement and diverse morphological characteristics of the native right ventricular outflow tract (nRVOT), which increases the difficulty of transcatheter pulmonary valve replacement (TPVR). The purpose of this study was to use the TPVR simulator to help doctors improve their surgical skills by simulating the surgical process in vitro. Methods: The TPVR simulator was developed using three-dimensional (3D) printing technology under computer-aided design. In this study, the TPVR simulator was used for preoperative simulation training and teaching. First, 10 specialists were equally divided into a 3D-printed group and a non-3D-printed group, each performing one TPVR; then, another six specialists and six young surgeons were selected to complete three TPVR simulations. Results: For the 3D-printed simulation group, the over-flap time (5.22 min (range: 4.85–5.87 min) vs. 6.72 min (range: 6.12–7.70 min), p = 0.016), fluoroscopy time (15.00 min (range: 13.50–16.50 min) vs. 19.00 min (range: 17.50–21.50 min), p = 0.012), and total operative time for the five surgeons (57.00 min (range: 54.00–62.50 min) vs. 67.00 min (range: 62.00–69.50 min), p = 0.036) were shorter. In addition, the results showed significant reductions in the median over-flap time and total time required in both the expert panel and young surgeon groups (all p < 0.05). Conclusions: The reliability and validity of the TPVR simulator was initially demonstrated and has the potential to be a teaching and training tool for surgeons. Full article

In this study, we developed an application for radiation protection that calculates in real time the distribution of scattered radiation during fluoroscopy using ray tracing technology, assuming that most of the scattered radiation in the room originates from the patient and that the scattered radiation originating from the patient travels linearly. The directional vectors and energy information for the scattered radiation spreading from the patient’s body surface to the outside of the body were obtained via simulation in a virtual X-ray fluoroscopy room. Based on this information, the scattered dose distribution in the X-ray room was calculated. The ratio of the scattered doses calculated by the method to those obtained from the Monte Carlo simulation was mostly within the range of 0.7 to 1.8 times, except for behind the X-ray machine. The scattered radiation distribution changed smoothly as the radiation protective plates were moved. When using protection plates with a high degree of freedom in their placement, it is not practical to measure the scattered radiation distribution each time. This application cannot be used for dose estimation for medical staff in clinical settings because it does not take into account the scattered radiation of non-patients and its dose calculation accuracy is low. However, the simple confirmation of the scattered radiation distribution and changes in staff dose led to an intuitive understanding of the appropriate placement of the protection plates. Full article

Background: Septal accessory pathways (APs) are challenging ablation targets. This study aims to contribute to the pediatric literature by presenting our long-term experience of septal AP ablations with limited fluoroscopy. Methods: This is a retrospective study of all patients who underwent septal AP ablations from July 2012 to July 2023 at a single center. Results: We identified 298 septal AP connections in 291 (11.8 ± 4.9 years) patients. Seventy-nine (27%) cases were diagnosed with supraventricular tachycardia, and 212 (73%) cases were diagnosed with Wolff–Parkinson–White (WPW). The AP locations were posteroseptal (n = 159; 54%), anteroseptal (n = 86; 30%), and midseptal (n = 46; 16%). Of those diagnosed with WPW, 61 (28%) had high-risk AP, and 90 (40%) were adenosine-responsive. Cryoablation was used in 190 (66%), radiofrequency ablation (RFA) was used in 36 (12.5%), and both were used in 62 (21.5%) patients. The overall acute success rate of initial procedures was 89.6% (the acute success rate of cryoablation = 86.6%, and of RFA = 94.1%). No statistically significant difference was observed between cryoablation and RFA (p = 0.617). During a mean follow-up of 88.5 ± 33.0 months, the overall recurrence rate was 11.3% (cryoablation vs. RFA; p = 0.834), with the highest at the right-posteroseptal location. An irrigated-tip RFA was preferred during redo procedures in 20 (45%) cases. The long-term success rate was 99% when the repeat procedures were considered. No complications were observed. Conclusions: Due to the higher recurrence rates in septal AP ablations compared to other locations, repeated procedures might be needed to achieve definitive long-term success. This study indicates that similar acute and long-term success rates can be achieved with cryoablation compared to RFA, with the significant benefit of increased safety. Full article

Background: Atrial fibrillation is the most common sustained arrhythmia worldwide. Pulmonary vein isolation (PVI) is the most effective catheter ablation technique for treating paroxysmal atrial fibrillation (pAF). Common ablation methods include point-by-point radiofrequency (RF) ablation and single-shot techniques such as cryoballoon ablation (CB). This single-center, prospective study aimed to compare the efficacy of ablation index-guided RF ablation (AI-RF) and CB in patients with symptomatic, antiarrhythmic-resistant pAF. Methods: A total of 154 patients undergoing initial PVI were divided into two groups (CB: 51, AI-RF: 103), based on the operators’ decision. Procedural data (total procedure time, fluoroscopy time, radiation dose, complication rate) and recurrence rates were analyzed over a 12-month follow-up period. Results: The CB group had a significantly shorter total procedure time compared to the AI-RF group (64 [57; 74.8] minutes vs. 92 [76; 119] minutes; p < 0.001). However, the CB group experienced higher fluoroscopy times (559 [395; 868] seconds vs. 167 [126; 224] seconds; p < 0.001) and a greater fluoroscopy dose (21.8 [11.7; 40.1] mGy vs. 7.65 [5.21; 14.5] mGy; p < 0.001). Recurrence rates were similar during both the blanking period (11.7% vs. 10.7%; p = 0.84) and the 12-month follow-up period (22.7% vs. 13.4%; p = 0.22). No major complications were reported during this study. Conclusions: In this single-center study, there were no significant differences in long-term recurrence or complication rates between the CB and AI-RF groups for patients with antiarrhythmic-refractory, symptomatic pAF. While the CB group benefited from a significantly shorter procedure time, it required a higher fluoroscopy dose and a longer fluoroscopy time. Full article

Background/Objectives: Fluoroscopy has been widely adopted in interventional pulmonology, as it facilitates real-time visualization of the bronchoscope, endobronchial ultrasound, and biopsy tools during procedures. The purpose of this study was to evaluate the effectiveness of radiation shields in minimizing scattered X-ray dose to the bronchoscopist in a phantom study and to determine the dose of scattered X-ray dose to medical staff with radiation shields in clinical application. Methods: An anthropomorphic torso phantom was positioned on the fluoroscopic table between the C-arm X-ray tube and the image detector to mimic bronchoscopic operations. Upper and lower body lead shields were used to examine the effectiveness of radiation shielding. Scatter radiation rates were assessed at a first operator location using real-time dosimeters with and without protective devices. In clinical application, the scattered X-ray dose of the first operator and main assistant was measured using wearable radiation dosimeters during 20 procedures. Results: In the phantom study, scattered radiation without shielding was 266.34 ± 8.86 μSv/h (glabella), 483.90 ± 8.01 μSv/h (upper thorax), 143.97 ± 8.20 μSv/h (hypogastrium), and 7.22 ± 0.28 μSv/h (ankle). The combination of upper and lower body lead shields reduced the scattered X-ray dose by 98.7%, 98.3%, 66.2%, and 79.9% at these levels, respectively. In clinical application, mean scattered X-ray dose rates were 0.14 ± 0.05 μSv/procedure (eye), 0.46 ± 0.51 μSv/procedure (chest), 0.67 ± 0.50 μSv/procedure (hypogastrium), and 1.57 ± 2.84 μSv/procedure (assistant’s wrist). Conclusions: The combination of radiation shields significantly reduced the scattered X-ray dose at the operator site in the phantom study. The scattered X-ray dose to medical staff during bronchoscopy can be kept at a low level with the aid of a shielding system. Full article

Background/Objectives: Assessing the learning curve is essential for surgical techniques that require precision and technical adaptation. Although modified Reverdin–Isham and Akin percutaneous osteotomies (RIAOs) are well-established procedures for the treatment of hallux valgus (HV), their percutaneous nature and specific technical demands justify the evaluation of the learning curve. Therefore, this study aimed to assess the learning curve of RIAOs for the HV correction, using for the first time a Bayesian approach. Methods: Modified RIAOs were applied to treat mild-to-moderate HV in patients who were prospectively enrolled. The hallux valgus angle (HVA), inter-metatarsal angle (IMA), distal metatarsal articular angle (DMAA) and tibial sesamoid position were assessed. Clinical outcomes were evaluated with the American Orthopaedic Foot & Ankle Society (AOFAS) Scale, Visual Analog Scale (VAS) and Numerical Rating Scale (NRS). Surgery and fluoroscopy times were recorded. To evaluate the learning curve, a Bayesian analysis using a change point model was performed. Results: Analysis of 142 patients revealed three distinct phases in the learning curve, with a plateau reached after 112 procedures. Over time, the mean operation duration decreased from 55 to 27 min, and fluoroscopy time decreased from 60 to 28 s. Conclusions: A flexible change point model was used to model a learning curve, guaranteeing a robust interpretation of the data. The correction of the HV angles showed similar results in the three phases of the curve, demonstrating that the surgeon achieved positive results from the beginning of the surgery. Full article

Background/Objectives: Fluoroscopy has traditionally supported three-dimensional (3D) electroanatomical mapping (EAM)-guided left atrial (LA) electrophysiological procedures (EPs), but the associated ionizing radiation poses long-term health risks for patients and healthcare professionals. Advances in 3D EAM systems now enable nearly or entirely radiation-free ablations. Imaging techniques such as transesophageal echocardiography (TEE) are increasingly used for precise and safe LA access. This study evaluates the safety and efficacy of TEE-guided, zero-fluoroscopy/near-zero-fluoroscopy LA EPs in routine clinical practice. Methods: 142 consecutive patients undergoing LA EAM-guided radiofrequency ablation at the Ulm University Heart Center between October 2023 and November 2024 were analyzed. In total, 73 patients underwent zero-fluoroscopy/near-zero-fluoroscopy ablation guided solely by TEE, while another 69 patients received fluoroscopy-guided ablation using TEE and fluoroscopy guidance. Results: Of the 142 patients, 58.0 (40.8%) were female, and the median age was 73.0 (64.0; 79.0) years. A total of 53 (37.3%) underwent zero-fluoroscopy EP, 20 (14.1%) underwent near-zero-fluoroscopy EP, and 69 (48.6%) underwent fluoroscopy-guided EP. Procedure duration was without significantly relevant difference between both groups (132.0 vs. 133.0 min; p = 0.52). Median radiation exposure in the zero-fluoroscopy/near-zero-fluoroscopy group was 0 (0.0; 0.0) minutes, compared to significantly higher values in the fluoroscopy group (9.7 (5.9; 15.3) minutes; p < 0.001). No significant differences in complications were observed (p = 0.09). Conclusions: TEE-guided, radiation-free LA EP offers a safe and effective approach, significantly reducing radiation exposure and its associated risks while maintaining high procedural efficacy without increasing the risk of complications. Full article

The widespread use of medical imaging techniques such as X-rays and computed tomography (CT) has raised significant concerns regarding ionizing radiation exposure, particularly among vulnerable populations requiring frequent imaging. Achieving a balance between high-quality diagnostic imaging and minimizing radiation exposure remains a fundamental challenge in radiology. Artificial intelligence (AI) has emerged as a transformative solution, enabling low-dose imaging protocols that enhance image quality while significantly reducing radiation doses. This review explores the role of AI-assisted low-dose imaging, particularly in CT, X-ray, and magnetic resonance imaging (MRI), highlighting advancements in deep learning models, convolutional neural networks (CNNs), and other AI-based approaches. These technologies have demonstrated substantial improvements in noise reduction, artifact removal, and real-time optimization of imaging parameters, thereby enhancing diagnostic accuracy while mitigating radiation risks. Additionally, AI has contributed to improved radiology workflow efficiency and cost reduction by minimizing the need for repeat scans. The review also discusses emerging directions in AI-driven medical imaging, including hybrid AI systems that integrate post-processing with real-time data acquisition, personalized imaging protocols tailored to patient characteristics, and the expansion of AI applications to fluoroscopy and positron emission tomography (PET). However, challenges such as model generalizability, regulatory constraints, ethical considerations, and computational requirements must be addressed to facilitate broader clinical adoption. AI-driven low-dose imaging has the potential to revolutionize radiology by enhancing patient safety, optimizing imaging quality, and improving healthcare efficiency, paving the way for a more advanced and sustainable future in medical imaging. Full article

Over 250,000 gastrostomy tubes (G-tubes) are placed annually in the United States. Percutaneous endoscopic gastrostomy (PEG) is the most widely used clinical method for placing G-tubes within the stomach. However, endoscope detectability is limited due to the scattering of light by tissues. Poor organ visibility and low sensitivity of the palpation techniques cause blind needle insertions, which cause colon/liver perforations, abdominal bleeding, and gastric resections. Additionally, imaging artifacts and the poor distinguishability between water-filled tissues make ultrasound (US) imaging-based techniques incompatible with G-tube placement. The risk of ionizing radiation exposure and the confinement of fluoroscopy to radiology suites limits its bedside utility in patients. Considering these limitations, we propose to design a safe, point-of-care integrated US and photoacoustic (PA) imaging system for accurate G-tube placement procedures, for a broad spectrum of patients, and to characterize the system’s effectiveness. Our proposed technology utilizes a clinically safe contrast agent and a dual-wavelength approach for precise procedures. Our ex vivo tissue studies indicated that PA imaging accurately differentiates the different organs at specific wavelengths. Our characterization studies revealed that PA imaging could detect lower concentrations of Indocyanine Green (ICG) dye coating the colon wall, minimizing the risk of ICG dye-related toxicity and providing safer G-tube placements. Full article

Background and aims: His bundle pacing (HBP) is considered the most physiological form of cardiac pacing. Although feasibility studies have included older patients, specific data for HBP in this population are scarce. This study aimed to evaluate gender differences in HBP long-term performance in elderly patients with atrioventricular (AV) block. Methods: This retrospective study included 73 patients aged over 65 years with successful HBP and at least 2 years of follow-up. The patients’ baseline and follow-up clinical and procedural characteristics were recorded. Results: The mean age of the cohort was 72.8 ± 6.3 years, with 43 males and 30 females. The paced QRS complex was significantly narrower than the baseline value for both genders. Females had a narrower-paced QRS complex without differences in detection, type of His bundle capture, impedance, or fluoroscopy time. The pacing threshold increased progressively, reaching statistical significance compared to the baseline values at the two-year follow-up. The pacing threshold increased by more than 1 V over the follow-up period in twenty-four patients (32.9%) and by more than 2 V in six patients (8.2%), with no significant difference between genders. The pacing threshold increase occurred within the first year for most patients, without gender differences. Multivariate Cox regression analysis demonstrated that the paced QRS duration, left ventricular ejection fraction, and ischemic cardiomyopathy were significantly associated with the pacing threshold increase over time. Conclusion: In elderly patients with AV block, HBP remains a feasible pacing method, without significant gender differences, over a long-term follow-up period. Pacing threshold increases are expected in up to one-third of the patients, requiring regular follow-ups to adjust the programmed parameters and optimize battery longevity. Full article

Background: The lumbopelvic region plays a pivotal role in enabling various functional activities. This study quantified and compared the kinematic changes between healthy individuals and patients with recurrent low back pain (LBP) in both rested and fatigued states to gain insight into the kinematic adaptation and mechanisms underlying kinematic variations that occur in the presence of these factors. Methods: Participants were divided into two groups: the LBP (n = 23) and healthy control groups (n = 19). Dynamic lumbopelvic measurements were taken using a biplane radiography image system while the participants performed weight-bearing forward-backward bending before and after fatigue. All lumbopelvic kinematics were described as the three-dimensional motion of the vertebra relative to the pelvis and were measured at normalized time intervals from maximum extension to approximately 45° of flexion. Results: Repetitive lifting- and lowering-induced fatigue significantly affected lumbopelvic kinematics in the anterior/posterior translation (mm) and rotation around the z-axis in both healthy individuals and patients with LBP (p < 0.05). In healthy individuals, significant differences occurred in approximately 13–83% of the forward-backward bending cycle (0–100%), whereas, in patients with LBP, significant differences mainly occurred in 61–93% of the cycle (p < 0.01). Conclusions: The lumbopelvic kinematic changes observed in both LBP patients and healthy individuals after fatigue may indicate protective compensation or vulnerability and could play a role in LBP dysfunction. Full article

Background: Diagnostic angiography of coronary arteries is one of the most common procedures in invasive cardiology and is mainly performed via the radial artery. Rapid improvements in the quality of the equipment and operator’s experience have changed the landscape of this procedure. Methods: In this study, 284 patients were analyzed to determine whether heparin administration should be a necessity for all patients to prevent radial artery occlusion (RAO). Moreover, the possible influence of 51 other factors on RAO was analyzed. Results: This study revealed that heparin administration does not have a significant impact on RAO incidence (p = 0.131). However, it was found that a longer fluoroscopy time (p < 0.001) and smaller (5F) vascular sheath (p = 0.001) might serve as protective factors against RAO. On the other hand, a greater number of catheters (p < 0.001), greater compression time (p = 0.001), wider (6F) vascular sheath (p = 0.002), spasm occurrence (p = 0.001), spasmolytic administration (p < 0.001) and atherosclerotic changes in the radial artery (p = 0.005) were risk factors for RAO. Conclusions: This study demonstrates the need for a more personalized approach to the patient when analyzing the individual risk of RAO. In our opinion, it is possible to omit heparin in cases of patients with an initial low risk of RAO or possible adverse drug reactions during diagnostic angiography. Full article

In recent years, pancreaticobiliary endoscopy (PBE) has evolved to include a wide range of endoscopic procedures used to treat various diseases. Several interventional endoscopic ultrasonography procedures have been developed for conditions that cannot be treated with conventional endoscopic methods. As PBE continues to advance, it is crucial to improve fluoroscopic systems to enhance image quality, ensure patient safety, reduce radiation exposure, and ensure the operation of video-recording systems. The difficult procedures require the precise imaging of thin pancreatic/biliary branch devices, including guidewires, catheters, and stents. It is crucial to reduce noise caused by patient breathing and movement, while retaining the necessary movement in the image on the screen. A stable table is effective for ensuring the safety of patients during the procedure. A reduction in radiation exposure is important, and the flame rate conversion technique is effective. Ensuring high-quality recording is useful for the video presentation of PBE procedures. In collaboration with Fujifilm (Tokyo, Japan), we researched and developed various functions in fluoroscopic systems for PBE. In this review, we outline the requirements for fluoroscopic procedures in PBE, the evolution of technology to date, and its prospects, while also presenting the commercial equipment currently available. Full article

Background and Objectives: Cardiac tamponade is managed through echo- or fluoroscopy-guided percutaneous pericardiocentesis. The European Society of Cardiology’s Working Group on Myocardial and Pericardial Diseases proposed a triage strategy for these patients. This study evaluated the triage score and compared the safety and efficacy of fluoroscopy- versus echo-guided procedures without additional visualization control. Materials and Methods: This prospective observational study included 71 patients with cardiac tamponade from February 2021 to June 2022. Pericardiocentesis was performed using fluoroscopy or echo guidance based on clinical assessment and catheterization laboratory availability, without the additional control of needle/guidewire position or ECG monitoring. Patients were followed for three months. Results: The study included 71 patients (52.1% female, mean age 59.7 ± 15.7 years). Malignancy was the most common comorbidity (59.2%). Echo criteria led to urgent procedures in 47.9%, with subcostal access used most often (60.6%), particularly in fluoroscopy-guided procedures (93.8%, p = 0.003). The success rate was 97.1%, with minor complications in 14% of patients. Diabetes and malignancy predicted complications regardless of access site or guiding method. The triage score did not affect complication rates or short-term mortality. Conclusions: Fluoroscopy- and echo-guided pericardiocentesis without additional visualization control showed no difference in safety or efficacy. Delaying the procedure for patients with a triage score ≥6, or performing it early for those with a low score, did not impact complication rates or mortality, which were more influenced by the progression of the underlying disease. Full article