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Trauma and orthopedic surgery commonly rely on intraoperative radiography or fluoroscopy, which are essential for visualizing patient anatomy and safely completing surgical procedures. However, these imaging methods generate ionizing radiation, which in high doses carries a potential health risk to patients and operating personnel. There is an established need for formal training in obtaining precise intraoperative imaging while minimizing radiation exposure. Virtual reality (VR) simulation serves as a promising tool for orthopaedic trainees to develop skills in safe intraoperative imaging, without posing harm to patients, operating room staff, or themselves. This paper aims to provide a brief overview of literature surrounding VR training for intraoperative imaging in orthopaedic surgery. In addition, we discuss areas for improvement and future directions for development in the field. [ABSTRACT FROM AUTHOR]

Introduction: Traditionally, cancer pain has often been viewed as an independent third major category in pain medicine alongside acute pain and chronic non-cancer pain. However, the new chronic pain category MG30 in the eleventh version of International Classification of Diseases (ICD-11) includes cancer-related pain as one of its seven subgroups. In light of this, the aim of the paper is to investigate whether the traditional trichotomy should be replaced by a dichotomy between acute pain and chronic pain, cancer-related pain being part of both groups depending on the duration of pain. Methods: The rationale for viewing cancer pain as a separate category is reviewed. Results: Cancer being a deadly disease, cancer pain has a life-and-death and existential dimension that is different from non-cancer pain. It seems sensible to believe that this is an additional dimension to the suffering caused by cancer pain, and that clinicians should therefore take this existential dimension into consideration when assessing pain. Conclusion: Without challenging the place of chronic cancer-related pain under the MG30 heading, it is concluded that while using ICD-11 in the future, pain clinicians should continue being mindful of the fact that the reality of death shapes the experience of cancer pain. The traditional trichotomy is therefore still valid and mirrors the fact that human beings are vulnerable (acute pain), temporal (chronic pain) and mortal (cancer pain). [ABSTRACT FROM AUTHOR]

Simple Summary: Brachytherapy is a form of internal radiation therapy where radioactive sources are placed directly in or near tumors. This paper shows how brachytherapy can be personalized using new technologies like 3D-printed applicators, advanced imaging techniques, and artificial intelligence to make treatment more precise and effective. The authors also explore the role of genetic tests and biomarkers for choosing the best treatments for each patient, as well as future approaches such as combining brachytherapy with immunotherapy and developing new ways to shape radiation doses using shielding. By tailoring treatments to individual patients, personalized brachytherapy aims to effectively treat cancer while reducing treatment-related side effects. Brachytherapy offers a highly conformal and adaptive approach to radiation therapy for various oncologic conditions. This review explores the rationale, applications, technological advances, and future directions of personalized brachytherapy. Integration of advanced imaging techniques, 3D-printed applicators, and artificial intelligence are rapidly enhancing brachytherapy delivery and efficiency, while genomic tests and molecular biomarkers are refining patient and dose selection. Emerging research on combining brachytherapy with immunotherapy offers unique synergistic potential, and technologies such as intensity-modulated and shielded brachytherapy applicators present novel opportunities to further optimize dose distributions. Despite these promising advances, the field faces challenges including a need to train more practitioners and develop new approaches to treating a broader range of malignancies. As personalized medicine evolves, brachytherapy's ability to deliver highly targeted, individualized treatments positions it as a critical component in future cancer care. [ABSTRACT FROM AUTHOR]

This letter discusses a paper that examines the use of three-dimensional (3D) printing in the treatment of proximal humeral fractures (PHFs). The authors of the letter raise some concerns about the study, including the lack of postoperative imaging data and analysis of the impact of 3D printing on postoperative pain and quality of life. They also mention a study that found 3D-printed treatment of PHFs could increase the economic cost for patients, although the authors of the paper being discussed argue that it can save costs. The letter concludes by expressing gratitude to the authors of the paper and requesting their response to the raised questions. [Extracted from the article]

Introduction: This study investigates if inexpensive computer hardware, open-source computer vision and a phosphor screen from disused CR (computed radiography) Cassette can be used to quantitatively assess beam shape and area., Materials and Methods: The phosphor screen was affixed to a Carestream CS 8100 dental OPG system and the camera was mounted above the X-ray tube. Videos were acquired of the green light emissions during the tomographic irradiation. Images of a chessboard pattern, attached to the detector were used to correct for camera angulation and provide image pixel size calibration. K-Means colour clustering was used to define beam area. The effect of light conditions on beam dimension measurement was also investigated. The beam width measurement from optimised methodology was compared with that determined from dose calibrated GAFChromic TM XR-SP2film., Results: Videos in dark conditions provided the most reproducible results. FW20M gained from initial sampling matched that obtained using the GAFChromic TM film within the errors of the measurements,6.41 ± 0.09 mm FW20M from this methodology,compared with FW20M (full width at 20 % of maximum) 6.4 ± 0.1 mm from film. The height and area were 126 ± 0.22 mm and 807 ± 11 mm 2 respectively. The chess pattern imaging provided a robust means of perspective correction and pixel calibration. There is potential for this methodology to be employed using any digital camera, provided the camera acquisition settings remain constant, the sensor pixels are square, and the camera position is fixed., Conclusion: The potential of this low-cost open-source method of beam area measurement using computer vision is thus proven., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Associazione Italiana di Fisica Medica e Sanitaria. Published by Elsevier Ltd. All rights reserved.)

In clinical anesthesia and the rescue of critically ill patients, arterial puncture and catheterization are the most commonly chosen ways to establish central arterial access for patients. Invasive arterial puncture and catheterization facilitate the grasp of real-time vital sign information of patients during surgery, which strengthens patient monitoring during surgery and improves safety. However, the traditional method of arterial puncture and cannulation through palpation of the radial artery is often prone to complications related to mechanical injury, such as hemorrhage, hematoma, and accidental perforation of the artery. Studies have shown that ultrasound-guided radial artery puncture and cannulation can shorten the puncture cannulation time, reduce the incidence of complications related to puncture cannulation, and improve the success rate of puncture cannulation. In order to verify it, this paper uses the experimental group and the control group to conduct comparative experiments and uses the neural network method to evaluate the effects of the two methods. As a more mature method of artificial intelligence, BP neural network is widely used in a wide range of applications and has the characteristics of strong generalization ability and fast convergence, so we choose it as the base model. The specific work of this paper is as follows: (1) in-depth study of the relevant theory of BP neural network (BPNN), focusing on the structure of BPNN and the working principle of algorithm; the problems to be solved in the clinical anesthesia effect evaluation have laid a theoretical foundation for the establishment of an improved BPNN evaluation model in the following chapters. (2) introduce the basic principle of genetic neural network, analyze the benefits of combining genetic neural network and BPNN; introduce in detail the process of genetic algorithm to optimize the weights and thresholds of BPNN, and establish a GA-BP evaluation model. The test proves the feasibility and superiority of the model. [ABSTRACT FROM AUTHOR]

Background and Objectives: This paper evaluates the efficacy and safety of ureteral access sheath (UAS) utilization in retrograde intrarenal surgery (RIRS). Materials and Methods: We searched PubMed, Embase, and the Cochrane Library up to 30 August 2023. The inclusion criteria comprised English-language original studies on RIRS with or without UAS in humans. The primary outcome was SFR, while the secondary outcomes included intraoperative and postoperative complications, the lengths of the operation and the hospitalization period, and the duration of the fluoroscopy. Subgroup analyses and a sensitivity analysis were performed. Publication bias was assessed using funnel plots and Egger's regression tests. Dichotomous variables were analyzed using odds ratios (ORs) with 95% confidence intervals (CIs), while mean differences (MDs) were employed for continuous variables. Results: We included 22 studies in our analysis. These spanned 2001 to 2023, involving 12,993 patients and 13,293 procedures. No significant difference in SFR was observed between the UAS and non-UAS groups (OR = 0.90, 95% CI 0.63–1.30, p = 0.59). Intraoperative (OR = 1.13, 95% CI 0.75–1.69, p = 0.5) and postoperative complications (OR = 1.29, 95% CI 0.89–1.87, p = 0.18) did not significantly differ between the groups. UAS usage increased operation times (MD = 8.30, 95% CI 2.51–14.10, p = 0.005) and fluoroscopy times (MD = 5.73, 95% CI 4.55–6.90, p < 0.001). No publication bias was detected for any outcome. Conclusions: In RIRS, UAS usage did not significantly affect SFR, complications, or hospitalization time. However, it increased operation time and fluoroscopy time. Routine UAS usage is not supported, and decisions should be patient-specific. Further studies with larger sample sizes and standardized assessments are needed to refine UAS utilization in RIRS. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper is to propose a sequential deployment technique for the E-nside off-the-shelf endograft that could potentially enhance target visceral vessel (TVV) cannulation and overstenting in narrow aortic anatomies. Methods: All data regarding patients consecutively treated in two aortic centers with the E-nside graft employing the partial deployment technique were included in the study cohort and analyzed. To execute the procedure with partial endograft deployment, the device should be prepared before insertion by advancing, under fluoroscopy, all four dedicated 400 cm long 0.018″ non-hydrophilic guidewires until their proximal ends reach the cranial graft's edge. Anticipating this guidewire placement prevents the inability to do so once the endograft is partially released, avoiding potentially increased friction inside the constricted pre-loaded microchannels. The endograft is then advanced and deployed in the standard fashion, stopping just after the inner branch outlets are fully expanded. Tip capture is released, and the proximal end of the device is opened. Visceral vessel bridging is completed from an upper access in the desired sequence, and the graft is fully released after revascularizing one or more arteries. Preventing the distal edge of the graft from fully expanding improves visceral vessel cannulation and bridging component advancement, especially when dealing with restricted lumina. Results: A total of 26 patients were treated during the period December 2019–March 2024 with the described approach. Procedure was performed in urgent settings in 14/26 cases. The available lumen was narrower than 24 mm at the origin of at least one target vessel in 11 out of 26 cases performed (42.3%). Technical success was obtained in 24 out of 26 cases (92.3%), with failures being due to TVVs loss. No intraoperative death or surgical conversion was recorded, and no early reintervention was needed in the perioperative period. Clinical success at 30 days was therefore 80.7%. Conclusions: The described technique could be considered effective in saving space outside of the graft, allowing for safe navigation and target vessel cannulation in narrow visceral aortas, similar to what has already been reported for outer-branched endografts. [ABSTRACT FROM AUTHOR]

The increasing rate of minimally invasive procedures and the growing prevalence of cardiovascular disease have led to a demand for higher-quality guidance systems for catheter tracking. Traditional methods for catheter tracking, such as detection based on single points and applying masking techniques, have been limited in their ability to provide accurate pose information. In this paper, we propose a novel deep learning-based method for catheter tracking and pose detection. Our method uses a Yolov5 bounding box neural network with postprocessing to perform landmark detection in four regions of the catheter: the tip, radio-opaque marker, bend, and entry point. This allows us to track the catheter's position and orientation in real time, without the need for additional masking or segmentation techniques. We evaluated our method on a dataset of fluoroscopic images from two distinct datasets and achieved state-of-the-art results in terms of accuracy and robustness. Our model was able to detect all four landmark features (tip, marker, bend, and entry) used to generate a pose for a catheter with 0.285 ± 0.143 mm, 0.261 ± 0.138 mm, 0.424 ± 0.361 mm, and 0.235 ± 0.085 mm accuracy. We believe that our method has the potential to significantly improve the accuracy and efficiency of catheter tracking in medical procedures that utilize bi-plane fluoroscopy guidance. [ABSTRACT FROM AUTHOR]

Background: Pedicle screws provide excellent fixation for a wide range of indications. However, their adoption in the cervical spine has been slower than in the thoracic and lumbar spine, which is largely due to the smaller pedicle sizes and the proximity to the neurovascular structures in the neck. In recent years, technology has been developed to improve the accuracy and thereby the safety of cervical pedicle screw placement over traditional fluoroscopic techniques, including intraoperative 3D navigation, computer-assisted Systems and 3D template moulds. We have performed a systematic review into the accuracy rates of the various systems. Methods: The PubMed and Cochrane Library databases were searched for eligible papers; 9 valid papers involving 1427 screws were found. Results: fluoroscopic methods achieved an 80.6% accuracy and navigation methods produced 91.4% and 96.7% accuracy for templates. Conclusion: Navigation methods are significantly more accurate than fluoroscopy, they reduce radiation exposure to the surgical team, and improvements in technology are speeding up operating times. Significantly superior results for templates over fluoroscopy and navigation are complemented by reduced radiation exposure to patient and surgeon; however, the technology requires a more invasive approach, prolonged pre-operative planning and the development of an infrastructure to allow for their rapid production and delivery. We affirm the superiority of navigation over other methods for providing the most accurate and the safest cervical pedicle screw instrumentation, as it is more accurate than fluoroscopy and lacks the limitations of templates. [ABSTRACT FROM AUTHOR]

Diffusion models have achieved tremendous success in modeling continuous data modalities, such as images, audio, and video, yet their application in discrete data domains (e.g., natural language) has been limited. Existing methods primarily represent discrete text in a continuous diffusion space, incurring significant computational overhead during training and resulting in slow sampling speeds. This paper introduces LaDiffuSeq, a latent diffusion-based text generation model incorporating an encoder–decoder structure. Specifically, it first employs a pretrained encoder to map sequences composed of attributes and corresponding text into a low-dimensional latent vector space. Then, without the guidance of a classifier, it performs the diffusion process for the sequence's corresponding latent space. Finally, a pretrained decoder is used to decode the newly generated latent vectors, producing target texts that are relevant to themes and possess multiple emotional granularities. Compared to the benchmark model, DiffuSeq, this model achieves BERTScore improvements of 0.105 and 0.009 on two public real-world datasets (ChnSentiCorp and a debate dataset), respectively; perplexity falls by 3.333 and 4.562; and it effectively quadruples the text generation sampling speed. [ABSTRACT FROM AUTHOR]

This paper will introduce a simple locating system to track a stent when it is deployed into a human artery. The stent is proposed to achieve hemostasis for bleeding soldiers on the battlefield, where common surgical imaging equipment such as fluoroscopy systems are not available. In the application of interest, the stent must be guided to the right location to avoid serious complications. The most important features are its relative accuracy and the ease by which it may be quickly set up and used in a trauma situation. The locating approach in this paper utilizes a magnet outside the human body as the reference and a magnetometer that will be deployed inside the artery with the stent. The sensor can detect its location in a coordinate system centered with the reference magnet. In practice, the main challenge is that the locating accuracy will be deteriorated by external magnetic interference, rotation of the sensor, and random noise. These causes of error are addressed in the paper to improve the locating accuracy and repeatability under various conditions. Finally, the system's locating performance will be validated in benchtop experiments, where the effects of the disturbance-eliminating procedures will be addressed. [ABSTRACT FROM AUTHOR]

Background and Objective: Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) has been investigated and shown excellent short- and long-term outcomes. In this paper, we describe a new MIS-TLIF technique and pedicle screw insertion using a marker screw as a guidance method. Moreover, we report perioperative, postoperative, and patient-related outcomes. In addition, this paper outlines major differences in radiation exposure, cost effectiveness and accuracy of Marker Screw Minimally Invasive Transforaminal Interbody Fusion (MS-MIS TLIF) compared to other techniques. We report our technique to share our knowledge and experience with the aim of achieving a better MIS-TLIF that would help both surgeons and patients. Materials and Methods: A prospective case series was conducted between October 2018 and February 2021. Patients undergoing MS-MIS TLIF with marker screws were consecutively included. The surgery did not exceed two levels. The patients' medical records were reviewed, and the included patients were asked to complete two outcome-questionnaires before surgery and at the six-month visit. The surgical technique is described in this paper. Results: A total of 37 patients were recruited. The mean age was 57.35 ± 12.8 years, and more than half of the patients were females. The most common indications for surgery were degenerative disc disease and spondylolisthesis, with the typical level at L4–5. The operative time was 3.02 ± 0.83 h, while the estimated blood loss was 127.7 ± 71.1 mL. The average time for ambulation and hospitalization was 1 ± 1.1 and 2.84 ± 1.4 days, respectively. The patients described significant improvement in both questionnaires. No screw-related complications or screw revisions were needed up to two years of follow-up. Conclusions: The use of marker screws for pedicle screw placement through a minimally invasive fashion is shown to be a promising technique that can overcome many drawbacks, including cost, operative time, and radiation exposure. Performing MS-MIS TLIF can achieve a 360- degree fusion compared to percutaneous MIS-TLIF. [ABSTRACT FROM AUTHOR]

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Non-unions are quite rare in closed fractures in children. Most distal radius fractures require orthopedic reduction and conservative treatment with very good radiological and clinical/functional results. In case of unsatisfactory reduction, surgical treatment is necessary to correct significant displacement. Surgical treatment consists of closed reduction and percutaneous fixation using K-wires. If closed reduction is not possible, open reduction and fixation is mandatory. Generally, fixation is obtained using K-wires, in most cases, even if open reduction is necessary, rarely locking plates, especially in adolescents. The present paper presents a case of non-union that eventually required open reduction and plating. During surgery, however, it became evident that the cause for non-union was the traumatic transposition of the long extensor radialis tendon, through the fracture site to the volar side of the distal forearm. The movement of the carpus translated to constant mobility in the fracture site, leading to non-union and a continuous tendency towards anterior angulation of the distal fragment. The tendon was reduced to its anatomical position, the fracture was reduced, and fixed using a locking plate, and union was achieved with no complications. Traumatic transpositions of tendons should be considered in pediatric non-unions, and restoring anatomy is essential. [ABSTRACT FROM AUTHOR]

Effective neoadjuvant chemotherapy (NAC) can improve the survival of patients with locally progressive gastric cancer, but chemotherapeutics do not always exhibit good efficacy in all patients. Therefore, accurate preoperative evaluation of the effect of neoadjuvant therapy and the appropriate selection of surgery time to minimize toxicity and complications while prolonging patient survival are key issues that need to be addressed. This paper reviews the role of three imaging methods, morphological, functional, radiomics, and artificial intelligence (AI)-based imaging, in evaluating NAC pathological reactions for gastric cancer. In addition, the advantages and disadvantages of each method and the future application prospects are discussed. [ABSTRACT FROM AUTHOR]

The aim of this work was to propose a preliminary local diagnostic reference levels (DRL) for pediatric interventional cardiology (PIC) procedures in Argentina, for different ranges of age and weight. This work has been conducted in the framework of the "Optimization of Protection in Pediatric Interventional Radiology in Latin America and the Caribbean" (OPRIPALC) program coordinated by the World Health Organization and the Pan American Health Organization in cooperation with the International Atomic Energy Agency to ensuring that radiation exposures of pediatric patients are the minimum necessary during fluoroscopy-guided interventional procedures. The local DRL values presented in this paper by weight group and age group were 7.1 Gy·cm2 (<5 kg), 10.7 Gy·cm2 (5–15 kg), 18.0 Gy·cm2 (15–30 kg), 15.9 Gy·cm2 (30–50 kg), and 28.2 Gy·cm2 (50–80 kg) and 5.3 Gy·cm2 (<1), 11.2 Gy·cm2 (1 to 5<), 19.6 Gy·cm2 (5 to 10<), and 21.4 Gy·cm2 (10 to 16<), respectively. Our dose results are among the values found in other international studies; however, there is great potential for dose optimization. [ABSTRACT FROM AUTHOR]

Objective. Surgical guidewires are commonly used in placing fixation implants to stabilize fractures. Accurate positioning of these instruments is challenged by difficulties in 3D reckoning from 2D fluoroscopy. This work aims to enhance the accuracy and reduce exposure times by providing 3D navigation for guidewire placement from as little as two fluoroscopic images. Approach. Our approach combines machine learning-based segmentation with the geometric model of the imager to determine the 3D poses of guidewires. Instrument tips are encoded as individual keypoints, and the segmentation masks are processed to estimate the trajectory. Correspondence between detections in multiple views is established using the pre-calibrated system geometry, and the corresponding features are backprojected to obtain the 3D pose. Guidewire 3D directions were computed using both an analytical and an optimization-based method. The complete approach was evaluated in cadaveric specimens with respect to potential confounding effects from the imaging geometry and radiographic scene clutter due to other instruments. Main results. The detection network identified the guidewire tips within 2.2 mm and guidewire directions within 1.1°, in 2D detector coordinates. Feature correspondence rejected false detections, particularly in images with other instruments, to achieve 83% precision and 90% recall. Estimating the 3D direction via numerical optimization showed added robustness to guidewires aligned with the gantry rotation plane. Guidewire tips and directions were localized in 3D world coordinates with a median accuracy of 1.8 mm and 2.7°, respectively. Significance. The paper reports a new method for automatic 2D detection and 3D localization of guidewires from pairs of fluoroscopic images. Localized guidewires can be virtually overlaid on the patient's pre-operative 3D scan during the intervention. Accurate pose determination for multiple guidewires from two images offers to reduce radiation dose by minimizing the need for repeated imaging and provides quantitative feedback prior to implant placement. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic injections provide a treatment option for patients with joint and periarticular pain, those who are not surgical candidates, whom conservative treatment has failed, or those that are awaiting surgery. Injectable glucocorticoids are one of the most common therapeutic interventions in musculoskeletal healthcare and are widely used in pathologies of the first metatarsophalangeal joint. The aim of this paper is to highlight current concepts around first metatarsophalangeal joint injection injection accuracy. Anatomy: The first metatarsophalangeal joint is a condyloid synovial juncture and consists of the head of the first metatarsal, the base of the proximal phalanx, six muscles, eight ligaments and two sesamoid bones, with associated ligamentous attachments. The joint capsule is shaped like a box. Methods: To achieve the research aim, a scoping review was undertaken with a search strategy that identified evidence via the following sources: Electronic databases, Google scholar, and Reference lists. Results: The search yielded 193 articles, 48 of which appeared of potential relevance. After removing duplicate articles this total was reduced to 37 articles. After scanning the content, 27 were excluded to leave 10 articles. Twenty eight further articles were found through related author research, examination of reference lists and free text searches of Google Scholar. One reference was unobtainable. The final count of papers utilised for review was 37 which produced three themes, one of which was injection accuracy. Injection accuracy: In the long history of injection therapy, infiltrations have often been performed without image guidance, i.e., using palpation guidance, anatomical landmarks and clinical judgement to direct needle entry and advancement. Needle placement may also be confirmed by use of diagnostic imaging. Typical imaging modalities are fluoroscopy or ultrasound, used alone or in combination with contrast media. Discussion: The perceived wisdom is that if an injectate misses its target it is likely to be less effective and lead to false negative reporting of poor treatment outcomes, but the literature is not equivocal. This article discusses the recent literature in the field. Conclusions: The literature suggests that steroid injections are safe and effective for the short-term relief of joint pain. When injecting small synovial joints using palpated-guided methods, clinicians must be alert to the potential for failure of technique from the needle penetrating too far into the articulation and exiting the joint on the contralateral side from the entry point. Use of shorter needles and use of imaging, +/- the use of contrast media, might reduce the number of such failures. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor of the Clinical Orthopaedics & Related Research journal. The authors of the letter express their interest in a previous paper that discussed the association between anterior malreduction and lag screw cutout in intertrochanteric fractures. They provide some clarifications and comments on the terminology and evaluation methods used in the previous paper. The authors emphasize the importance of anteromedial cortical support reduction and suggest using a standardized technique for the oblique-lateral tangential view to improve patient outcomes and identify patients at risk for implant-related complications. [Extracted from the article]

Background: Speech and language therapists (SLTs) use videofluoroscopic swallow study (VFSS) results to manage dysphagia. Yet, in some services only doctors can directly request a VFSS, potentially creating workflow inefficiencies and delaying patient access to VFSS. An alternative model, where SLTs directly refer patients for VFSS, is used in many services in the UK and Australia. However, processes for implementing and sustaining this model have not been reported. Aims: To evaluate the implementation of an SLT‐led inpatient VFSS referring model using the Consolidated Framework for Implementation Research (CFIR) to ascertain implementation barriers, facilitators and critical sustainability factors. Methods & Procedures: This implementation evaluation examined stakeholder perceptions of implementing the SLT‐led VFSS referring model via interviews of (1) SLTs who treat and refer inpatients for VFSS; (2) doctors who manage and refer inpatients for VFSS; (3) radiologists; and (4) trained VFSS referring SLTs. The CFIR was used to prospectively guide implementation planning, evaluation and outcome reporting, regarding barriers, facilitators and sustainability factors. Outcomes & Results: Implementation facilitators were (1) the advantage of SLT‐led VFSS referring over the standard model (doctors referring), in promoting high‐quality VFSS referrals; (2) compatibility of the model with the SLT skill set; (3) supportive communication networks between staff groups; and (4) engaging stakeholders throughout implementation. Adequate availability of trained VFSS referring SLTs was both a barrier and a facilitator of implementation. It was also a critical sustainability factor, along with ongoing staff education and outcome monitoring. Conclusions & Implications: The CFIR supported systematic evaluation of implementation facilitators and barriers, and adjustment of factors critical for implementing and sustaining the new model. Findings may assist other organizations to establish the SLT‐led VFSS referring model. What this paper adds: What is already known on the subject: Models where SLTs directly refer patients for VFSS have been described in the literature, with evidence of appropriate referrals and adherence to radiation safety standards. However, the process for establishing and sustaining this referring model has not been published. What this paper adds to existing knowledge: This study describes the process and outcomes of implementing an SLT‐led VFSS referring model, using the CFIR. A key advantage of the new model that facilitated implementation was the improved quality of VFSS referrals compared with the standard referring model. Important facilitating factors in the environment were the compatibility of the model with SLTs' skillset and supportive communication network between doctors and SLTs. Initially, an implementation barrier was the inadequate availability of trained SLT referrers. Using proactive implementation strategies, more referrers were trained (which was a facilitating factor for implementing and sustaining the model). What are the potential or actual clinical implications of this work?: This study highlights that successful implementation requires more than just an effective model. Features of the environment require consideration to minimize barriers and optimize facilitating factors, supported by proactive implementation strategies. Planning and evaluating implementation processes and outcomes using a standardized implementation framework such as CFIR aided understanding of barriers and facilitators for introducing the SLT‐led VFSS referring model. This process may assist other services to implement the model. [ABSTRACT FROM AUTHOR]

Basically, augmented reality (AR) technology grants innovative ways so as to manipulate and visualize a three-dimensional (3D) model of an object through superimposing computer-generated images onto another object interactively. Being able to interact in real-time with digital and spatial information offers further chances in order to manipulate medical data efficiently and easily. In fact, surgeons encounter multiple challenges handling digital patient data during surgical interventions. Multiple techniques are invested in order to visualize the operative areas, as for example fluoroscopy and ultrasound methods. The latter display certain deficiencies. Therefore, the AR technique can stand for a good candidate in order to project a 3D model of a target organ into the surgeon's perspective and view field so as to enhance the efficiency and accuracy of the medical intervention intraoperatively. The basic target of this paper is to simulate a generated biomechanical model of the liver organ and visualize its deformations through the use of an AR headset during the open surgery. The proposed approach is validated by the use of acquired CT scans of a human liver organ. [ABSTRACT FROM AUTHOR]

Although much radiologic literature has focused on the short-term post-operative complications associated with ileal pouches, as the number of patients with long-term pouches has grown, there is increasing realization of the functional deficits that may occur long after pouch creation. Dynamic pouch imaging using fluoroscopy and MRI can provide assessment of the underlying causes of symptomatic pouch dysfunction and can provide critical insight to the management of this complex patient population. In this paper, we provide an overview of the unique problems encountered in patients with long-term ileal pouches, and provide an overview of the techniques, interpretation, and reporting for fluoroscopic and MR pouch defecography. [ABSTRACT FROM AUTHOR]

Background: Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees. Aims: This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self‐efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development. Methods & Procedures: Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected—the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing—Adults, self‐reported the number of dysphagia cases they managed on placement, and self‐rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis. Outcomes & Results: Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images. Conclusions & Implications: Novice analysts vary in the acquisition of beginner‐level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development. WHAT THIS PAPER ADDS: What is already known on the subject: The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds: This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work?: Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound as an adjunct to clinical swallowing evaluation provides quantitative physiological and morphological data. As a low‐risk procedure, ultrasound imaging can be performed outside of a medical setting. This is particularly important for patients living in rural areas with restricted access to a hospital. Technical advances have produced pocket‐sized ultrasound technology that is more affordable, and therefore within the fiscal reach of most allied health services. Aims: To explore the validity and reliability of pocket‐sized ultrasound technology in dysphagia assessment. Methods & Procedures: Data were acquired from 43 patients with dysphagia using the Clarius ultrasound device. Ultrasound and videofluoroscopic measures of hyoid and laryngeal displacement during liquid and puree swallowing were collected concurrently to quantify correlation and agreement between identical measures derived from the two instruments. Reliability of ultrasound was assessed for measures of hyoid and laryngeal displacement, tongue thickness, and size of the submental muscles in eight patients. Reliability was evaluated for the entire process of data acquisition including scanning and online measurement using an iPad in a clinical setting and for offline measurement on a computer screen to explore environmental influences on reliability. Outcomes & Results: Results revealed poor correlation between the measures of interest across instruments. Reliability of the entire process of data acquisition in a clinical setting was insufficient while reliability was more promising for offline measurements. Conclusions & Implications: The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing evaluation is not indicated at this time. Enhanced validity and reliability of the entire process of data acquisition are needed prior to clinical translation of such technology. WHAT THIS PAPER ADDS: What is already known on the subject: The use of ultrasound allows for radiation‐free, non‐invasive swallowing assessment. Some data suggest that ultrasound is valid and reliable in the evaluation of swallowing using standard‐sized equipment. Insufficient validity and reliability have been reported for pocket‐sized ultrasound technology in the assessment of healthy swallowing. What this paper adds to existing knowledge: This research is the first to provide validity and reliability data of the pocket‐sized Clarius technology in the evaluation of swallowing in patients with dysphagia. Insufficient validity and reliability of online data acquisition in a clinical environment were found. Reliability for offline measurement was more promising. What are the potential or actual clinical implications of this work?: The clinical use of pocket‐sized ultrasound devices, such as the Clarius system, for swallowing assessment is not indicated at this time. [ABSTRACT FROM AUTHOR]

Background: Videofluoroscopic swallow studies (VFSS) are integral to diagnosing and supporting dysphagia management. However, in many countries, only doctors are authorized to complete medical imaging request forms, in accordance with radiation safety regulations. This can impact workflow and timely access to VFSS. Enhanced scope of practice (ESP) models of care exist, where speech and language therapists (SLTs) are authorized to complete VFSS request forms. However, formal evaluations of these ESP models are currently lacking. Aims: The primary aim of this study was to examine service outcomes regarding the safety and efficiency of SLTs completing VFSS request forms compared with the medical referring model (standard care). The secondary aim was to ascertain the impacts on SLTs' daily workflow and the utility of training for SLTs to complete VFSS requests. Methods & Procedures: The study involved a mixed‐method design. First, referrals completed using standard care versus those completed under the new SLT‐led VFSS referring model were compared for efficiency (days to request completion, number of contacts between staff to complete requests and delay to VFSS appointments) and safety (compliance with radiation safety standards for requests, adverse events and change to dysphagia management to justify radiation exposure). Semi‐structured interviews were then conducted with SLT referrers (n = 7) exploring the impacts of the model on daily workflow and the utility of training. Outcomes & Results: VFSS inpatient requests were examined across a 3‐month period (n = 61 requests) using the standard model, and for 6 months (n = 109 requests) following the introduction of SLT‐led VFSS referring. Regarding efficiency, there was no significant difference between the two models, with most request forms taking less than or equal to 1 day to be completed. Adherence to radiation safety requirements was significantly greater in the SLT‐led VFSS referring model compared with the standard model (p < 0.001) in relation to the overall requisite clinical information being documented on the request forms. No adverse events occurred and 100% of VFSSs led to changed dysphagia management. Interviews of VFSS referring SLTs revealed that completing requests was not complex or onerous, and that the training equipped them well to undertake the role. Conclusions & Implications: The SLT‐led VFSS referring model was feasible for SLTs and resulted in satisfactory efficiency and greater adherence to radiation safety requirements for VFSS request forms than the standard model. Improved information on VFSS request forms provides clearer justification for the radiation procedure and helps optimize the diagnostic yield of VFSS. The evidence supports further widespread adoption of this model. What this paper adds: What is already known on the subject: Models of care permitting selected allied health professionals to refer patients for diagnostic radiology procedures have been established to achieve healthcare efficiencies. Evidence supports the safety and efficiency of physiotherapists referring to radiology. However, limited published outcome data exist regarding models of SLTs referring for radiology procedures, such as VFSS. What this paper adds to existing knowledge: This study describes the implementation of a SLT‐led VFSS inpatient referring model in a quaternary hospital and examines service outcomes. The findings reveal that VFSS request forms completed in the SLT‐led referring model had greater adherence to radiation safety standards compared with the standard referring model. Efficiency was similar across both models and there were no adverse events. Completing VFSS requests did not disrupt daily workflow for SLTs and training was effective preparation for the role. What are the potential or actual clinical implications of this work?: Results demonstrate that the SLT‐led VFSS referral model can be safely and appropriately implemented in the inpatient setting. Improved quality of information documented on request forms by SLTs increases adherence with radiation safety standards, providing clearer justification for radiation assessments and potentially eliciting more targeted diagnostic information to inform dysphagia treatment planning. These findings may support other hospital services to establish this type of referring model. [ABSTRACT FROM AUTHOR]

Introduction: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. Method: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: ("Transitional cell carcinoma of the bladder" OR "urothelial cancer" OR "urinary bladder cancer" OR "bladder cancer") AND (("sentinel lymph node") OR ("lymphatic mapping") OR ("lymphoscintigraphy") OR ("lymphangiography") OR ("lymph node metastases")). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. Results: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. Discussion: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging. [ABSTRACT FROM AUTHOR]

Purpose: We address the misconception that the typical physician dose is higher for CT fluoroscopy (CTF) procedures compared to C‐Arm procedures. Methods: We compare physician scatter doses using two methods: a literature review of reported doses and a model based on a modified form of the dose area product (DAP). We define this modified form of DAP, "cumulative absorbed DAP," as the product of the area of the x‐ray beam striking the patient, the dose rate per unit area, and the exposure time. Results: The patient entrance dose rate for C‐Arm fluoroscopy (0.2 mGy/s) was found to be 15 times lower than for CT fluoroscopy (3 mGy/s). A typical beam entrance area for C‐Arm fluoroscopy reported in the literature was found to be 10.6 × 10.6 cm (112 cm2), whereas for CTF was 0.75 × 32 cm (24 cm2). The absorbed DAP rate for C‐Arm fluoroscopy (22 mGy*cm2/s) was found to be 3.3 times lower than for CTF (72 mGy*cm2/s). The mean fluoroscopy time for C‐Arm procedures (710 s) was found to be 21 times higher than for CT fluoroscopy procedures (23 s). The cumulative absorbed DAP for C‐Arm procedures was found to be 9.4 times higher when compared to CT procedures (1.59 mGy*m2 vs. 0.17 mGy*m2). Conclusions: The higher fluoroscopy time in C‐Arm procedures leads to a much lower cumulative DAP (i.e., physician scatter dose) in CTF procedures. This result can inform interventional physicians deciding on whether to perform inter‐procedural imaging inside the room as opposed to retreating from the room. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis is a spinal deformity with unknown etiology and high incidence, especially in adolescent females. If scoliosis patients do not get effective treatment in the early stage, the degree of scoliosis will continue to worsen with the growth of age or the rapid development of scoliosis in a short time, and the appearance deformities such as high and low shoulders and razor back will gradually appear, which can affect the cardiopulmonary function and even shorten life expectancy. It has a great impact on the physical and mental health of the patients. Mild scoliosis is often well controlled by bracing, and moderate to severe scoliosis deformity often requires scoliosis corrective surgery. In adolescent idiopathic scoliosis correction, pedicle screws offer better stability and firmness, stronger orthopedic force, and lower incidence of related complications caused by instruments than traditional hook and conical internal fixation instruments. At the same time, scoliosis patients have uneven development of the left and right sides of the vertebral body, narrow diameter of concave pedicle and varying degrees of rotation of parietal vertebra, resulting in changes in the position of important anatomical structures such as spinal cord and thoracic aorta in the spinal canal. It makes it difficult to place pedicle screws, resulting in a high misplacement rate. How to improve the safety of screw placement, reduce the misplacement rate and the risk of spinal cord, nerve root, blood vessels, viscera and so on, has always been the focus of spinal surgeons. This paper summarizes the related literature on the effects of new techniques such as pedicle anatomy, complications of nail placement and computer navigation, and 3D guided template on the accuracy of screw placement in adolescent idiopathic scoliosis patients, and the safety of nail placement. In order to provide reference for clinical practice. [ABSTRACT FROM AUTHOR]

An increasing number of medical centers are adopting an intraoperative computed tomography (iCT) navigation system (iCT-Navi) to provide three-dimensional navigation for pediatric scoliosis surgery. While iCT-Navi has been reported to provide higher pedicle screw (PS) insertion accuracy, it may also result in higher radiation exposure to the patient. What innovations and studies have been introduced to reduce radiation exposure and further improve PS insertion? Evaluate the level of evidence and quality of papers while categorizing the tips and pitfalls regarding pediatric scoliosis surgery using iCT-Navi. Compare iCT-Navi with other methods, including preoperative CT navigation. Systematic review. Articles on pediatric scoliosis surgery with iCT-Navi published through to June 2022. PS perforation rate and patient intraoperative radiation dose. Following PRISMA guidelines, the Cochrane Library, Google Scholar, and PubMed databases were searched for articles satisfying the criteria of iCT-Navi use and pediatric scoliosis surgery. The level of evidence and quality of the articles meeting the criteria were evaluated according to the guidelines of the North American Spine Society and American Academy of Orthopedic Surgeons, respectively. The articles were also categorized by theme and summarized in terms of PS insertion accuracy and intraoperative radiation dose. The origins and characteristics of five major classification methods of PS perforation grade were summarized as well. The literature search identified 811 studies, of which 20 papers were included in this review. Overall, 513 pediatric scoliosis patients (381 idiopathic, 44 neuromuscular, 39 neurofibromatosis type 1, 28 congenital, 14 syndromic, seven other) were evaluated for PS perforations among 6,209 iCT-Navi insertions. We found that 232 (3.7%) screws were judged as major perforations (G2 or G3), 55 (0.9%) screws were judged as dangerous deviations (G3), and seven (0.1%) screws were removed. There were no reports of neurovascular injury caused by PSs. The risk factors for PS perforation included more than six vertebrae distance from the reference frame, more than nine consecutive insertions, upper thoracic level, thinner pedicle, upper instrumented vertebra proximity, short stature, and female. The accuracy of PS insertion did not remarkably decrease when the radiation dose was reduced to 1/5 or 1/10 by altering the iCT-Navi protocol. iCT-Navi has the potential to reduce PS perforation rates compared with other methods. The use of low-dose radiation protocols may not significantly affect PS perforation rates. Although several risk factors for PS perforation and measures to reduce radiation dose have been reported, the current evidence is limited by a lack of consistency in classifying PS perforation and evaluating patient radiation dose among studies. The standardization of several outcome definitions is recommended in this rapidly developing field. [ABSTRACT FROM AUTHOR]

Objective: C2 pedicle screw insertion is very important in posterior upper cervical surgery. The traditional screw placement technique requires us to consider both medial inclination and cephalad angle, it is difficult to operate intraoperatively. This paper is to explore a novel method of C2 pedicle screw placement compared with traditional C2 pedicle screw. Methods: A total of 44 patients diagnosed with atlantoaxial fracture or instability from May 2018 to November 2020 were involved in this retrospective study, and they were divided into C2‐PPS group (perpendicular to the coronal plane C2 screw, 24 patients) and C2‐TPS group (traditional C2 pedicle screw, 20 patients). The diameter of the maximum tangential circle, distance between geometric center and median sagittal plane and screw length of PPS and TPS were measured based on the 3D model of C2, respectively. Then the 3D printed navigation templated were designed and manufactured by 3D printing to assisted the PPS and TPS placement, respectively. The surgical time and radiation exposure times during operation were recorded; the post‐operative grading criteria, deviation of screw entry point and deviation of screw angle of two groups were evaluated, respectively. Results: A total of 48 screws were inserted in the C2‐PPS group, and 40 screws were inserted in the C2‐TPS group. There were 46 screws with grade 0 (95.8%) in the PPS group and 31 screws with grade 0 (77.5%) in the TPS group, (P = 0.03). The radiation exposure times in the C2‐PPS group and C2‐TPS group were 4.7 ± 1.5 and 7.8 ± 3.8, respectively, (P = 0.045). The deviations of screw entry point in the C2‐PPS group and C2‐TPS group were 1.2 ± 0.8 mm and 3.2 ± 1.3 mm, respectively; the deviations of screw angle in the C2‐PPS group and C2‐TPS group were 2.1 ± 1.6° and 4.8 ± 2.0°, respectively, (P = 0.000). The diameters of the maximum tangential circle in the C2‐PPS group and C2‐TPS group were 5.5 ± 1.0 mm and 5.3 ± 0.9 mm, respectively. The distances between the geometric center and median sagittal plane in the C2‐PPS group and C2‐TPS group were 15.4 ± 2.3 mm and 18.0 ± 3.3 mm, respectively; The screw lengths in the C2‐PPS group and C2‐TPS group were 25.9 ± 3.2 mm and 27.6 ± 3.7 mm, respectively, (P = 0.000). Conclusion: Eighty percent of C2‐PPS corridor can accommodate a 3.5 mm diameter screw, and with an average screw length of 26 mm. Navigation templates assisted the C2‐PPS placement is less surgical time, less radiation exposure times, more safe and more accurate than C2‐TPS. [ABSTRACT FROM AUTHOR]

The article presents the authors' response to a commentary on their paper about biomechanical analysis of tibial motion and anterior cruciate ligament graft forces after anterior cruciate ligament reconstruction with and without lateral extra-articular tenodesis. Identified by the commenters are several concerns including the decision to standardize each slope to 5 degrees before testing, accuracy of the methodology and the stiffness of the tibia after osteotomy.

Purpose: This study aims to evaluate the efficacy and satisfaction of using a multi-angle laser device (MLD) for C-arm fluoroscopy to assist novice learners during lumbar spine surgery. Methods: Forty novice learners were randomly assigned to Group A using an MLD-equipped C-arm or Group B using a traditional C-arm. Both groups performed X-ray fluoroscopy on a lumbar spine model in supine and rotated positions. Time, number of shots, and deviation from the target were compared. A questionnaire was used to assess the learning experience. Results: Group A required less time (13.66 vs. 25.63 min), and fewer shots (15.05 vs. 32.50), and had a smaller deviation (22.9% vs. 61.5%) than Group B (all p<0.05). The questionnaire revealed higher scores in Group A for comfort, efficiency, and knowledge mastery (all p<0.05). Conclusion: The MLD significantly improves novice learning of C-arm fluoroscopy during lumbar spine surgery. [ABSTRACT FROM AUTHOR]

Background: Nowadays, both lateral mass screw (LMS) and pedicle screw were effective instrumentation for posterior stabilization of cervical spine. This study aims to evaluate the feasibility of a new free-hand technique of C7 pedicle screw insertion without fluoroscopic guidance for cervical spondylotic myelopathy (CSM) patients with C3 to C6 instrumented by lateral mass screws. Methods: A total of 53 CSM patients underwent lateral mass screws instrumentation at C3 to C6 levels and pedicle screw instrumentation at C7 level were included. The preoperative 3-dimenional computed tomography (CT) reconstruction images of cervical spine were used to determine 2 different C7 pedicle screw trajectories. Trajectory A passed through the axis of the C7 pedicle while trajectory B selected the midpoint of the base of C7 superior facet as the entry point. All these 53 patients had the C7 pedicle screw inserted through trajectory B by free-hand without fluoroscopic guidance and the postoperative CT images were obtained to evaluate the accuracy of C7 pedicle screw insertion. Results: Trajectory B had smaller transverse angle, smaller screw length, and smaller screw width but both similar sagittal angle and similar pedicle height when compared with trajectory A. A total of 106 pedicle screws were inserted at C7 through trajectory B and only 8 screws were displaced with the accuracy of screw placement as high as 92.5%. Conclusion: In CSM patients with C3 to C6 instrumented by LMS, using trajectory B for C7 pedicle screw insertion is easy to both identify the entry point and facilitate the rod insertion. [ABSTRACT FROM AUTHOR]

The activity recognition gained immense popularity due to increasing number of surveillance cameras. The purpose of activity recognition is to detect the actions from the series of examination by varying the environmental condition. In this paper, Chaotic Whale Atom Search Optimisation (CWASO)-based Deep stacked autoencoder (CWASO-Deep SAE) is proposed for crowd behaviour recognition. The key frames are subjected to the descriptor of feature to extort the features, which bring out the classifier input vector. In this model, the statistical features, optical flow features and visual features are conducted to extract important features. Furthermore, the significant features are shown in the deep stacked auto-encoder (Deep SAE) for activity recognition, as the guidance of deep SAE is performed byCWASO, that is planned is designed by adjoining Atom search optimisation (ASO) algorithm and Chaotic Whale optimisation algorithm (CWOA). The proposed systems' performance is analysed using two datasets. By considering the training data, the projected method attains performance that is high for dataset-1 with maximum precision, sensitivity, and with specific value of 96.826%, 96.790%, and 99.395%, respectively. Similarly, by considering the K-Fold, this method attains the maximum precision of 96.897%, sensitivity of 96.885%, and with specific values of 97.245% for the dataset-1. [ABSTRACT FROM AUTHOR]

In orthopedic surgeries, such as osteotomy and osteosynthesis, an intraoperative 3D reconstruction of the bone would enable surgeons to quickly assess the fracture reduction procedure with preoperative planning. Scanners equipped with such functionality are often more expensive than a conventional C-arm fluoroscopy device. Moreover, a C-arm fluoroscopy device is commonly available in many orthopedic facilities. Based on the widespread use of such equipment, this paper proposes a method to reconstruct the 3D structure of bone with a conventional C-arm fluoroscopy device. We focus on wrist bones as the target of reconstruction in this research as this will facilitate a flexible imaging scheme. Planar markers are attached to the target object and are tracked in the fluoroscopic image for C-arm pose estimation. The initial calibration of the device is conducted using a checkerboard pattern. In general, reconstruction algorithms are sensitive to geometric calibration errors. To assess the practicality of the method for reconstruction, a simulation study demonstrating the effect of checkerboard thickness and spherical marker size on reconstruction quality was conducted. [ABSTRACT FROM AUTHOR]

Minimization of the surgical approaches to spinal extradural metastases resection and stabilization was advocated by the 2012 Oncological Guidelines for Spinal Metastases Management. Minimally invasive approaches to spine oncology surgery (MISS) are continually advancing. This paper will describe the evolution of minimally invasive surgical techniques for the resection of metastatic spinal lesions and stabilization in a single institute. A retrospective analysis of patients who underwent minimally invasive extradural spinal metastases resection during the years 2013–2019 by a single surgeon was performed. Medical records, imaging studies, operative reports, rates of screw misplacement, operative time and estimated blood loss were reviewed. Detailed description of the surgical technique is provided. Of 138 patients operated for extradural spinal tumors during the study years, 19 patients were treated in a minimally invasive approach and met the inclusion criteria for this study. The mortality rate was significantly improved over the years with accordance of improve selection criteria to better prognosis patients. The surgical technique has evolved over the study years from fluoroscopy to intraoperative 3D imaging and navigation guidance and from k-wire screw insertion technique to one-step screws. Minimally invasive spinal tumor surgery is an evolving technique. The adoption of assistive devices such as intraoperative 3D imaging and one-step screw insertion systems was safe and efficient. Oncologic patients may particularly benefit from the minimization of surgical decompression and fusion in light of the frailty of this population and the mitigated postoperative outcomes associated with MIS oncological procedures. [ABSTRACT FROM AUTHOR]

Neuroendovascular catheterization using fluoroscopy poses the problem to operators and staffs of cumulative radiation exposure. To solve this problem, we are developing a remote-controlled master-slave robot. Because a wire-like elongated treatment device is inserted into a blood vessel using a catheter, the robot requires a sensor to detect the insertion force of the wire. The proposed sensor is integrated into a robot installed in an X-ray fluoroscopy room that is remotely controlled from another room. The features of this sensor include measurement of the insertion force with sufficient accuracy, simple wire attachment, and an inexpensive disposable sensor head, rendering it very suitable for practical application. In this paper, we report on these features, as well as the results of a practical test of the sensor using a cerebrovascular model. [ABSTRACT FROM AUTHOR]

Objective: For pelvic ring fractures, screw fixation became a popular technique for its good biomechanical performance. The safe insertion of anterograde the transpubic screw is important for patients with anterior pelvic ring fractures. This paper is to research the anatomical parameters of the anterograde transpubic screw corridor and evaluate the safety of anterograde transpubic screw placement assisted by the assembled navigation template. Methods: Fifty subjects with normal pelvic, 25 men and 25 women, age from 20 to 60 were enrolled, and their ilium were 3D reconstructed. The ilium was divided into zone I, zone II and zone III. Zone I and zone III was defined as medial and lateral to the obturator foramen, respectively. Zone II is located between zones I and III. The corridor A is formed by zone I and zone II and corridor B is formed by zone I, zone II and zone III. The diameter and length of the inner circle, the distance from the center of the inner circle to the posterior superior and to the inferior iliac spine of corridor A and corridor B were measured, respectively. Nine patients with pelvic fractures underwent anterograde transpubic screw and transverse sacroiliac screw placement assisted by the assembled navigation template and were retrospectively analyzed. Operation time, blood loss, incision length and fluoroscopy times were recorded. Grading score and Matta score were evaluated after surgery. Results: In the 50 subjects, the diameter of corridor A was 11.16 ± 2.13 mm, and that of corridor B was 8.54 ± 1.52 mm. The length of corridor A was 86.39 ± 9.35 mm, and that of corridor B was 117.05 ± 5.91 mm. The surface distance from the screw entry point to the posterior superior iliac spine in corridor A was 109.31 ± 11.06 mm, and that in corridor B was 127.86 ± 8.23 mm. The surface distance from the screw entry point to the posterior inferior iliac spine in corridor A was 91.16 ± 10.34 mm, and that in corridor B was 106.92 ± 7.91 mm. A total of 18 sacroiliac transverse screws and 11 anterograde transpubic screws were inserted assisted by assembled navigation templates for nine patients. The average operation time was 108.75 ± 25.71 min, the blood loss was 141.11 ± 50.21 ml, the incision length was 14 ± 4.62 cm, and the intraoperative fluoroscopy was 17.89 ± 4.01 times. Conclusion: Transpubic screw corridor can be obtained by 3D reconstruction. For the majority of patients, the anterograde pubic ramus corridor accommodated a 6.5 mm diameter screw. It is safe to use anterograde transpubic screw placement assisted by an assembled navigation template. [ABSTRACT FROM AUTHOR]

Background: Lumbar facet joints (LFJs) are usually related to the pathogenesis of the spine. The purpose of this paper is to study the effects of lifting load on the motion of lower lumbar facet joints in vivo., Methods: Ten healthy volunteers aged 25 ≤ 39 years, 5 males and 5 females, were recruited. Using a dual fluoroscopy imaging system (DFIS) combined with CT, firstly, the L3-S1 segment image scanned by CT was converted into a three-dimensional model. Then, the lumbar motion images of L3-S1 vertebrae taken by the DFIS under different loads (0 kg, 5 kg, 10 kg) and different body postures (maximum flexion and extension, maximum left and right bending, and maximum left and right torsion) were captured. Finally, in the Rhino software, the instantaneous motion state of the lumbar spine is reproduced by translation and rotation according to the anatomical structure of the lumbar spine and the previous images. With the help of computer software, a Cartesian coordinate system was placed in the center of each articular surface to measure the kinematics of the articular process and to obtain 6DOF data under different loads (0 kg, 5 kg, 10 kg) in the lumbar facet joints.  RESULTS: In the flexion and extension of the trunk, weight bearing reduced the translational range in the mid-lateral direction. In the L3/4 segment, the lateral translational range of the left and right facet joints gradually decreased with increasing load, and the translational range at 0 kg was significantly greater than that at 10 kg (left side: 0 kg, 0.86° ± 0.57°, 10 kg, 0.24° ± 0.26°, p = 0.01; right side: 0 kg, 0.86° ± 0.59°, 10 kg, 0.26° ± 0.27°, p = 0.01). In the L5/S1 segment, the translation range of the LFJ at 0 kg was significantly greater than that at 10 kg (p = 0.02). Other bending and rotation movements were not found to cause differential changes in the 6DOF of the LFJ. In bending, the rotation range was the largest in the L3/4 segment (p < 0.05) and gradually decreased from top to bottom. At the same level, there were significant differences in the translation range of the left and right facets in the anterior posterior and craniocaudal directions (p < 0.05)., Conclusion: Increasing the load has a significant impact on the coupled translational movement of lumbar facet joints. The asymmetric translational movement of the left and right facet joints may be a factor that accelerates the degeneration of facet joints., (© 2022. The Author(s).)

Percutaneous nephrolithotomy is the gold standard for the treatment of renal stones larger than 20 mm in diameter. The treatment outcomes of PCNL are highly dependent on the accuracy of the puncture step, in order to achieve a suitable renal access and reach the stone with a precise and direct path. Thus, performing the puncturing to get the renal access is the most crucial and challenging step of the procedure with the steepest learning curve. Many simulation methods and systems have been developed to help trainees achieve the requested competency level to achieve a suitable renal access. Simulators include human cadavers, animal tissues and virtual reality simulators to simulate human patients. On the other hand, the availability of pre-operative information (e.g., computed tomography or magnetic resonance imaging) and of intra-operative images (e.g., ultrasound images) has allowed the development of solutions involving augmented reality and robotic systems to assist the surgeon during the operation and to help a novel surgeon in strongly reducing the learning curve. In this context, the real-time awareness of the 3D position and orientation of the considered anatomical structures with reference to a common frame is fundamental. Such information must be accurately estimated by means of specific tracking systems that allow the reconstruction of the motion of the probe and of the tool. This review paper presents a survey on the leading literature on augmented reality and robotic assistance for PCNL, with a focus on existing methods for tracking the motion of the ultrasound probe and of the surgical needle. [ABSTRACT FROM AUTHOR]

Anorectal and cloacal malformations are a broad mix of congenital abnormalities related to the distal rectum and anus. Confusion exists between all the forms in this large and heterogeneous group. The spectrum includes everything from anal stenosis, ventral anus, anal atresia (with and without fistula) and the full spectrum of cloacal malformations. Imaging in these conditions is done through the whole armamentarium of radiologic modalities, with very different imaging strategies seen across the centres where these conditions are managed. In 2017, the European Society of Paediatric Radiology (ESPR) abdominal imaging task force issued recommendations on the imaging algorithm and standards for imaging anorectal malformations. This was followed by further letters and clarifications together with an active multispecialty session on the different imaging modalities for anorectal malformations at the 2018 ESPR meeting in Berlin. Through this paper, the abdominal task force updates its guidelines and recommended imaging algorithm for anorectal malformations. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game-changer in transcatheter interventions. Aim: This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions. Material and methods: We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months. Results: A cohort of 83 patients (mean age: 72.1 ±8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 ±34.3 min, contrast medium usage averaged 33.7 ±22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 ±3.4 days. Adverse effects were rare, including minimal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates. Conclusions: This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the average fluoroscopy time, as well as the patient and surgical staff average radiation exposure in the context of intraoperative fluoroscopy use during anterior total hip arthroplasty (THA). Methods: PubMed, Cochrane, Embase, Web of Science and Scopus were systematically searched for studies pertaining to intraoperative anterior THA fluoroscopy (PROSPERO ID 258049). The comprehensive literary search was conducted using "THA," "fluoroscopy" and "radiation exposure" as the search criteria, which resulted in 187 total papers. Of these 187 papers, 11 studies were included in this systematic review as they involved anterior THA and specifically contained data regarding radiation exposure dose and/or time. Results: Eleven studies were included, enrolling 1839 patients. The average fluoroscopy time was 21.4 (95% confidence interval [CI] 16.6–26.1) seconds, whereas the average patient radiation dose was 1.8 × 10–3 (95% CI 7.4 × 10–4–2.9 × 10–3) Gy. Conclusions: Although several studies fail to report fluoroscopy time and radiation dose in THA patients, fluoroscopy-guided THA has emerged as a safe procedure. Additional studies may analyze if radiation exposure during the surgeon's THA learning curve is significantly higher, as well as what protocols may potentially reduce radiation exposure even further. [ABSTRACT FROM AUTHOR]

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Introduction: Closed static interlocking nailing with c-arm guidance is the standard procedure for the treatment of closed diaphyseal fractures. In low-income settings, it is still very difficult to carry out such procedures because of few or absent image intensifiers (c-arm) despite the necessity. Authors provide a review of the literature on interlocking intramedullary nailing without fluoroscopy in resource-limited settings, followed by strategies, outcomes, and outlook. Materials and method: A comprehensive search of the PubMed, Web of Science, Embase, and Cochrane Library databases was performed with the help of a biomedical information specialist. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Results: We identified 15 series of interlocking intramedullary nailing without fluoroscopy in resource-limited settings. All papers focused on the care for long bones (humerus, femur, tibia). All studies discussed the quality of the nailing operative procedure. The entry point was described in five series; the nail insertion in the proximal and distal medullary canal was good in all studies. The distal locking was missed between 0 and 27%. Discussion: Intraoperative strategies depend on the type of bone affected, the opening of the fracture site, the fracture line, and the availability of a functional orthopaedic table. Three techniques to insert the nail in the proximal and distal fracture fragment with reduction of the fracture site are described. Insertion of distal screws is possible by using ancillary devices. Outcomes are comparable to those of the series using c-arm guidance. In low-income countries, it can been proposed as an alternative to the gold standard in resources constraints settings. In high-income setting this technique can help to reduce exposure of X-ray. Conclusion: There is a need to improve equipment in low-income countries hospitals to make trauma surgery with c-arm a gold standard with a minimal exposure to radiation. [ABSTRACT FROM AUTHOR]