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Sabaithip Juthakarn - One of the best experts on this subject based on the ideXlab platform.
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Endobronchial Ultrasound Plus Fluoroscopy Versus Fluoroscopy-Guided Bronchoscopy: A Comparison of Diagnostic Yields in Peripheral Pulmonary Lesions
Lung, 2012Co-Authors: Viboon Boonsarngsuk, Pensupa Raweelert, Sabaithip JuthakarnAbstract:Background Even though Fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus Fluoroscopy guidance with that of Fluoroscopy-guided bronchoscopy in the diagnosis of PPLs. Methods A retrospective study was conducted on 114 patients who were diagnosed with PPLs and underwent either EBUS plus Fluoroscopy or Fluoroscopy-guided bronchoscopy. The diagnostic yields of both modalities were calculated. Results The mean diameter of the PPLs measured by computed tomography of the chest was 23.7 mm. EBUS plus Fluoroscopy obtained higher diagnostic yield than Fluoroscopy-guided bronchoscopy (82.5 vs. 57.9%; P = 0.004). Subgroup analysis demonstrated that for PPLs larger than 20 mm, the accuracy of EBUS plus Fluoroscopy was not different from that of the Fluoroscopy-guided technique (85.7 vs. 72.2%, respectively; P = 0.19). In contrast, for lesions smaller than 20 mm, EBUS plus Fluoroscopy guidance provided significantly greater diagnostic performance than Fluoroscopy-guided bronchoscopy (79.3 vs. 33.3%; P = 0.001). Conclusions Bronchoscopy under EBUS and Fluoroscopy guidance improved the diagnostic yield of PPLs, especially of those smaller than 20 mm in diameter.
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Endobronchial Ultrasound Plus Fluoroscopy Versus Fluoroscopy-Guided Bronchoscopy: A Comparison of Diagnostic Yields in Peripheral Pulmonary Lesions
Chest, 2011Co-Authors: Viboon Boonsarngsuk, Pensupa Raweelert, Sabaithip JuthakarnAbstract:Background Even though Fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus Fluoroscopy guidance with that of Fluoroscopy-guided bronchoscopy in the diagnosis of PPLs.
Viboon Boonsarngsuk - One of the best experts on this subject based on the ideXlab platform.
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Endobronchial Ultrasound Plus Fluoroscopy Versus Fluoroscopy-Guided Bronchoscopy: A Comparison of Diagnostic Yields in Peripheral Pulmonary Lesions
Lung, 2012Co-Authors: Viboon Boonsarngsuk, Pensupa Raweelert, Sabaithip JuthakarnAbstract:Background Even though Fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus Fluoroscopy guidance with that of Fluoroscopy-guided bronchoscopy in the diagnosis of PPLs. Methods A retrospective study was conducted on 114 patients who were diagnosed with PPLs and underwent either EBUS plus Fluoroscopy or Fluoroscopy-guided bronchoscopy. The diagnostic yields of both modalities were calculated. Results The mean diameter of the PPLs measured by computed tomography of the chest was 23.7 mm. EBUS plus Fluoroscopy obtained higher diagnostic yield than Fluoroscopy-guided bronchoscopy (82.5 vs. 57.9%; P = 0.004). Subgroup analysis demonstrated that for PPLs larger than 20 mm, the accuracy of EBUS plus Fluoroscopy was not different from that of the Fluoroscopy-guided technique (85.7 vs. 72.2%, respectively; P = 0.19). In contrast, for lesions smaller than 20 mm, EBUS plus Fluoroscopy guidance provided significantly greater diagnostic performance than Fluoroscopy-guided bronchoscopy (79.3 vs. 33.3%; P = 0.001). Conclusions Bronchoscopy under EBUS and Fluoroscopy guidance improved the diagnostic yield of PPLs, especially of those smaller than 20 mm in diameter.
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Endobronchial Ultrasound Plus Fluoroscopy Versus Fluoroscopy-Guided Bronchoscopy: A Comparison of Diagnostic Yields in Peripheral Pulmonary Lesions
Chest, 2011Co-Authors: Viboon Boonsarngsuk, Pensupa Raweelert, Sabaithip JuthakarnAbstract:Background Even though Fluoroscopy-guided bronchoscopy has been well developed, the diagnostic yield of peripheral pulmonary lesions (PPLs) remains unsatisfying. Therefore, endobronchial ultrasound (EBUS) has been implemented recently to enhance the possibility of attaining true diagnosis. However, there are few studies that directly compare the success rate of fiber-optic bronchoscopy with fluoroscopic guidance to that of EBUS guidance in the diagnosis of PPLs in the same institute and in the same study period. The aim of this study was to compare the performance of EBUS plus Fluoroscopy guidance with that of Fluoroscopy-guided bronchoscopy in the diagnosis of PPLs.
Wookyung Kim - One of the best experts on this subject based on the ideXlab platform.
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use of navigation assisted Fluoroscopy to decrease radiation exposure during minimally invasive spine surgery
The Spine Journal, 2008Co-Authors: Choll W Kim, Yupo Lee, William R Taylor, Ahmet Oygar, Wookyung KimAbstract:Abstract Background Minimally invasive surgery decreases postoperative pain and disability. However, limited views of the surgical field require extensive use of intraoperative Fluoroscopy that may expose the surgical team to higher levels of ionizing radiation. Purpose To assess the feasibility and safety of navigation-assisted Fluoroscopy during minimally invasive spine surgery. Study Design A combined cadaveric and human study comparing minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using navigation-assisted Fluoroscopy with standard intraoperative Fluoroscopy to determine differences in surgical times and radiation exposures. Methods Eighteen fresh cadaveric spines underwent unilateral MIS TLIF by using either navigation-assisted Fluoroscopy or standard Fluoroscopy. Times for specific surgical steps were compared. In addition, a prospective short-term evaluation of the intraoperative and perioperative results of 10 patients undergoing navigation-assisted MIS TLIF (NAV group) compared with a retrospective review of 8 patients undergoing MIS TLIF performed by using standard Fluoroscopy (FLUORO group). Results In the cadaveric study, the times were similar between the NAV group and the FLUORO group for most key steps. No statistically significant differences were obtained for approach, exposure, screw insertion, facetectomy/decompression, or total surgical times. Statistically significant differences were obtained for the setup time and total Fluoroscopy time. The setup time for the NAV group averaged 9.67 (standard deviation [SD], 3.74) minutes compared with 4.78 (SD, 2.11) minutes for the FLUORO group (p=.034). The total Fluoroscopy time was higher for the FLUORO group compared with the NAV group (41.9 seconds vs. 28.7 seconds, p=.042). Radiation exposure was undetectable when navigation-assisted Fluoroscopy is used (NAV group). In contrast, an average 12.4 milli-REM (mREM) of radiation exposure is delivered to the surgeon during unilateral MIS TLIF procedure without navigation (FLUORO group). In the clinical series, the total fluoro time for the NAV group was 57.1 seconds (SD, 37.3; range, 18–120) compared with 147.2 seconds (SD, 73.3; range, 73–295) for FLUORO group (p=.02). No statistically significant differences are noted for operating time, estimated blood loss, or hospital stay. No inadvertent durotomies, postoperative weakness, or new radiculopathy were noted in the NAV group. One inadvertent durotomy was encountered in the FLUORO group that was repaired intraoperatively without clinical sequelae. Conclusion The use of navigation-assisted Fluoroscopy is feasible and safe for minimally invasive spine surgery. Radiation exposure is decreased to the patient as well as the surgical team.
Kevin T Foley - One of the best experts on this subject based on the ideXlab platform.
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virtual Fluoroscopy computer assisted fluoroscopic navigation
Spine, 2001Co-Authors: Kevin T Foley, David A Simon, Raja Y RampersaudAbstract:Study Design: In vitro accuracy assessment of a novel virtual Fluoroscopy system. Objectives: To investigate a new technology combining image-guided surgery with C-arm Fluoroscopy. of Background Data: Fluoroscopy is a useful and familiar technology to all musculoskeletal surgeons. Its limitations include radiation exposure to the patient and operating team and the need to reposition the fluoroscope repeatedly to obtain surgical guidance in multiple planes. Methods: Fluoroscopic images of the lumbar spine of an intact, unembaimed cadaver were obtained, calibrated, and saved to an image-guided surgery system (StealthStation; Medtronic Sofamor-Danek, Memphis, TN). A virtual Fluoroscopy system (FluoroNav; Medtronic Surgical Navigation Technologies, Broomfield, CO) was used for the sequential insertion of a light-emitting diode-fitted probe into the pedicles of L1-S1 bilaterally. The trajectory of a virtual tool corresponding to the tracked tool was overlaid onto the saved fluoroscopic views in real time. Live fluoroscopic images of the inserted pedicle probe were then obtained. Distances between the tips of the virtual and fluoroscopically displayed probes were quantified using the image-guided computer's measurement tool. Trajectory angle differences were measured using a standard goniometer and printed copies of the workstation computer display. The surgeon's radiation exposure was measured using thermolucent dosimeter rings. Results: Excellent correlation between the virtual fluoroscopic images and live Fluoroscopy was observed. Mean probe tip error was 0.97 ± 0.40 mm. Mean trajectory angle difference between the virtual and fluoroscopically displayed probes was 2.7° ± 0.6°. The thermolucent dosimeter rings measured no detectable radiation exposure for the surgeon. Conclusions: Virtual Fluoroscopy offers several advantages over conventional Fluoroscopy while providing acceptable targeting accuracy. It enables a single C-arm to provide real-time, multiplanar procedural guidance. It also dramatically reduces radiation exposure to the patient and surgical team by eliminating the need for repetitive fluoroscopic imaging for tool placement.
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radiation exposure to the spine surgeon during fluoroscopically assisted pedicle screw insertion
Spine, 2000Co-Authors: Y R Rampersaud, Kevin T Foley, A C Shen, S Williams, M SolomitoAbstract:Study Design. In vitro study to determine occupational radiation exposure during lumbar Fluoroscopy. Objectives. To assess radiation exposure to the spine surgeon during fluoroscopically assisted thoracolumbar pedicle screw placement. Summary of Background Data. Occupational radiation exposure during a variety of fiuoroscopically assisted musculoskeletal procedures has been previously evaluated. No prior study has assessed Fluoroscopy-related radiation exposure to the spine surgeon. Methods. Bilateral pedicle screw placement (T11-S1) was performed in six cadavers using lateral fluoroscopic imaging. Radiation dose rates to the surgeon's neck, torso, and dominant hand were measured with dosimeter badges and thermolucent dosimeter (TLD) rings. Radiation levels were also quantified at various distances from the dorsal lumbar surface using an ion chamber radiation survey meter. Results. The mean dose rate to the neck was 8.3 mrem/min. The dose rate to the torso was greatest when the surgeon was positioned ipsiiateral to the beam source (53.3 mrem/min, compared with 2.2 mrem/min on the contralateral side). The average hand dose rate was 58.2 mrem/min. A significant increase in hand dose rate was associated with placement of screws ipsilateral to the beam source (P = 0.0005) and larger specimens (P = 0.0007). Radiation levels significantly decreased as distance from the beam source and dorsal body surface increased. The greatest levels of radiation were noted on the side where the primary radiograph beam entered the cadaver. Conclusion. Fluoroscopically assisted thoracolumbar pedicle screw placement exposes the spine surgeon to significantly greater radiation levels than other, nonspinai musculoskeletal procedures that involve the use of a fluoroscope. In fact, dose rates are up to 10-12 times greater. Spine surgeons performing fluoroscopically assisted thoracolumbar procedures should monitor their annual radiation exposure. Measures to reduce radiation exposure and surgeon awareness of high-exposure body and hand positions are certainly called for.
Raja Y Rampersaud - One of the best experts on this subject based on the ideXlab platform.
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virtual Fluoroscopy computer assisted fluoroscopic navigation
Spine, 2001Co-Authors: Kevin T Foley, David A Simon, Raja Y RampersaudAbstract:Study Design: In vitro accuracy assessment of a novel virtual Fluoroscopy system. Objectives: To investigate a new technology combining image-guided surgery with C-arm Fluoroscopy. of Background Data: Fluoroscopy is a useful and familiar technology to all musculoskeletal surgeons. Its limitations include radiation exposure to the patient and operating team and the need to reposition the fluoroscope repeatedly to obtain surgical guidance in multiple planes. Methods: Fluoroscopic images of the lumbar spine of an intact, unembaimed cadaver were obtained, calibrated, and saved to an image-guided surgery system (StealthStation; Medtronic Sofamor-Danek, Memphis, TN). A virtual Fluoroscopy system (FluoroNav; Medtronic Surgical Navigation Technologies, Broomfield, CO) was used for the sequential insertion of a light-emitting diode-fitted probe into the pedicles of L1-S1 bilaterally. The trajectory of a virtual tool corresponding to the tracked tool was overlaid onto the saved fluoroscopic views in real time. Live fluoroscopic images of the inserted pedicle probe were then obtained. Distances between the tips of the virtual and fluoroscopically displayed probes were quantified using the image-guided computer's measurement tool. Trajectory angle differences were measured using a standard goniometer and printed copies of the workstation computer display. The surgeon's radiation exposure was measured using thermolucent dosimeter rings. Results: Excellent correlation between the virtual fluoroscopic images and live Fluoroscopy was observed. Mean probe tip error was 0.97 ± 0.40 mm. Mean trajectory angle difference between the virtual and fluoroscopically displayed probes was 2.7° ± 0.6°. The thermolucent dosimeter rings measured no detectable radiation exposure for the surgeon. Conclusions: Virtual Fluoroscopy offers several advantages over conventional Fluoroscopy while providing acceptable targeting accuracy. It enables a single C-arm to provide real-time, multiplanar procedural guidance. It also dramatically reduces radiation exposure to the patient and surgical team by eliminating the need for repetitive fluoroscopic imaging for tool placement.
