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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.)

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]

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]

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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]

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]

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]

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]

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]

Pregnancy can trigger maternal tachycardias, and the onset of recurrent or incessant focal atrial tachycardia (AT) can lead to tachycardia-induced cardiomyopathy. Medical interventions are commonly employed, but they carry potential fetal and maternal risks. Catheter ablation (CA), particularly with non-fluoroscopic navigation systems, may be considered as an alternative. This systematic review aims to explore the feasibility and outcomes of CA for focal AT during pregnancy. A thorough literature search was conducted until September 30th, 2023, on PubMed, Embase, and Cochrane databases. Included articles described maternal focal ATs diagnosed through electrophysiological studies and treated with CA. Data derived from these studies were organized into tables and subsequently analyzed. Out of 278 papers reviewed, 15 articles involving 24 patients were retrieved. CA, utilizing radiofrequency energy achieved acute success in 95.8% of cases. Sixteen patients (66.7%) underwent complete fluoroless procedures, with two adverse events directly related to the procedure reported. Long-term follow-up revealed minimal AT recurrences, with a 0.06% arrhythmia burden in one case. Focal ATs during pregnancy can be incessant and refractory to medical intervention, precipitating an acute decline in left ventricular ejection fraction. In this setting, CA emerges as an efficacious treatment modality, particularly in cases of tachycardia-induced cardiomyopathies. Whenever feasible, it is advisable to perform these procedures with minimal or no fluoroscopy guidance. Larger studies are needed to establish the safety and the efficacy of CA for focal ATs during pregnancy, as current research consists of case reports or small case series. • The onset of recurrent or incessant focal atrial tachycardia during pregnancy can lead to tachycardia-induced cardiomyopathy. • Medical therapy may be ineffective and poses risks for both the mother and the fetus. • We reported a high acute success rate (95.8%) of catheter ablation utilizing radiofrequency. • The majority of procedures (66.7%) were effectively performed without fluoroscopy. • In long-term follow-up, only one recurrence was identified, with a minimal arrhythmia burden (0.06%). [ABSTRACT FROM AUTHOR]

Catheter-based embolization has become a widely adopted minimally-invasive treatment for a broad range of applications. However, assessment of embolization endpoints requires x-ray fluoroscopic monitoring, exposing patients and physicians performing embolization procedures to harmful ionizing radiation. Moreover, x-ray fluoroscopy assessment of embolization endpoints is low sensitivity, subjective, and may not reflect the actual physiology of blood flow reduction, thus providing little oversight of the embolization procedure. Inspired by the observation that the dielectric properties of blood differ from those of fluids injected during the embolization procedure, a customized angiographic catheter was created with embedded electrodes for catheter-based electrochemical impedance spectroscopy as a way to monitor embolization. Real-time electrochemical impedance spectroscopy was performed in a phantom and compared to visual and videographic monitoring. Electrochemical impedance spectroscopy was able to sense endpoints of embolization, including stasis, reflux, and persistent flow. This new technique offers a label-free method of sensing embolization progress with potentially higher sensitivity and reproducibility compared to x-ray, as well as offer substantial reduction in x-ray exposure to patients and physicians. [ABSTRACT FROM AUTHOR]

Objective: To investigate in vivo 6-degree-of-freedom (DOF) vertebral motion in patients with isthmic spondylolisthesis (IS) during various functional weight-bearing activities. Methods: Fifteen asymptomatic volunteers (mean age 54.8 years) and fourteen patients with IS at L4-5 (mean age 53.4 years) were recruited. The positions of the vertebrae (L4-L5) in the supine, standing, flexion–extension, left–right twisting and left–right bending positions were determined using previously described CT-based models and dual fluoroscopic imaging techniques. Local coordinate systems were established at the center of the anterior vertebra of L4 isthmic spondylolisthesis (AIS), the posterior lamina of L4 isthmic spondylolisthesis (PIS) and the center of the L5 vertebra to obtain the 6DOF range of motion (ROM) at L4-L5 and the range of motion (ROM) between the AIS and the PIS. Results: The translation along the anteroposterior axis at L4-L5 during flexion–extension, left–right bending and left–right twisting was significantly greater than that of the healthy participants. However, the translation along the mediolateral axis at L4-L5 presented paradoxical motion under different positions: the ROM increased in the supine-standing and flexion–extension positions but decreased in the left–right bending and left–right twisting positions. The separation along the anteroposterior axis during flexion was significantly greater than that during standing, on average, reaching more than 1 mm. The separation along the mediolateral axis during standing, flexion and extension was significantly greater than that in the supine position. Conclusions: This study revealed the occurrence of displacement between the AIS and PIS, primarily in the form of separation during flexion. Symptomatic patients with isthmic spondylolisthesis exhibit intervertebral instability, which might be underestimated by flexion–extension radiographs. [ABSTRACT FROM AUTHOR]

Background: Distal tibial fractures represent common lower limb injuries, frequently accompanied by significant soft tissue damage. The optimal surgical approach for managing these fractures remains a topic of considerable debate. The aim of this study was to perform a comparative analysis of the outcomes associated with retrograde intramedullary tibial nails (RTN) and minimally invasive plate osteosynthesis (MIPO) in the context of treating extra-articular distal tibial fractures. Methods: A retrospective review was conducted on a cohort of 48 patients who sustained extra-articular distal tibial fractures between December 2019 and December 2021. Patients underwent either RTN or MIPO procedures. Various parameters, including operative duration, intraoperative fluoroscopy exposure, time to union, duration until full weight-bearing, American Orthopedic Foot and Ankle Society (AOFAS) scores, and complications, were recorded and compared between the two treatment groups. Results: No statistically significant differences were observed in operative duration, time to union, angulation of the distal tibial coronal plane, or AOFAS scores between the RTN and MIPO groups. However, the RTN group had a higher average number of intraoperative fluoroscopy images (8.2 ± 2.3) compared to the MIPO group (4.1 ± 2.0). The RTN group demonstrated shorter average hospital stays (7.1 ± 1.4 days) and a quicker return to full weight-bearing (9.9 ± 1.3 weeks), which were significantly superior to the MIPO group (9.0 ± 2.0 days and 11.5 ± 1.5 weeks, respectively). In terms of complications, the RTN group had one case of superficial infection, whereas the MIPO group exhibited two cases of delayed union and nonunion, two occurrences of deep infection, and an additional three cases of superficial infection. Conclusions: Both RTN and MIPO are effective treatment options for extra-articular distal tibial fractures. However, RTN may offer superior outcomes in terms of decreased inpatient needs, faster return to full weight-bearing capacity, and a lower rate of complications. [ABSTRACT FROM AUTHOR]

Breast-conserving surgery (BCS) followed by radiotherapy is preferred for early-stage breast cancer because its survival rate is equivalent to that of mastectomy. Achieving negative surgical margins in BCS is crucial to minimize the risk of recurrence. Intraoperative ultrasound (IOUS) enhances surgical accuracy, but its efficacy is operator dependent. This study aimed to compare the success of achieving negative margins using IOUS between an experienced breast surgeon and general surgical residents and to evaluate the learning curve for the residents. A prospective study involving 96 patients with BCS who underwent IOUS guidance was conducted. Both the breast surgeon and residents assessed the surgical margins using IOUS, with the breast surgeon making the final margin adequacy decision. Permanent histopathological analysis was used to confirm the status of the margins and was considered the gold standard for comparison. The breast surgeon accurately assessed the margin status in all 96 cases (100% accuracy), with 93 negative and three positive margins. All of these were ductal carcinomas in situ. Initially, the residents demonstrated low accuracy rates in predicting margin positivity using intraoperative ultrasonography. However, the learning curves of the three residents demonstrated that, with an average 12th case onwards, a significant improvement in the cumulative accuracy rates was observed, which reached the level of the breast surgeon. IOUS is an effective tool for accurately predicting the margin status in BCS, with an acceptable learning curve for novice surgeons. Training and experience are pivotal for optimizing surgical outcomes. These findings support the integration of IOUS training into surgical education programs to enhance proficiency and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Hyoid bone is attached to the mandible, tongue, larynx, temporal bone, and cervical spine via different types of muscles or ligaments. The tongue, mandible, and hyoid system play a crucial role in swallowing function. This within subject study aimed to evaluate the impact of mandibular implant overdentures on the displacement of the hyoid bones during the swallowing process. Methods: Twenty five healthy edentulous subjects were selected for participating in the study. New complete dentures were constructed for all the participants. Subsequently two dental implants were inserted in the canine regions of the participant's mandibular arch. In order to retain the mandibular prosthesis in place, ball attachments were incorporated into the mandibular dentures to convert them into implant overdentures. Using 10 ml of thin liquid bolus, videofluoroscopy swallowing examination was performed in three different oral conditions: without complete dentures (WCD), with complete denture (CDs), and with a mandibular implant overdenture (IODs). ANOVA with Bonferroni test was used to analyze the data in order to determine how the hyoid displacement varied throughout different oral conditions. Results: Compared to complete dentures, mandibular implant overdentures showed a significant decrease (P < 0.05) in both anterior hyoid displacement and duration of hyoid maximum anterior excursion (DOHMAE). However, there was a non-significant difference (P > 0.05) between the two oral circumstances in terms of superior hyoid displacement or duration for hyoid maximum elevation (DOHME). There is no penetration or aspiration for both complete denture and implant overdenture oral conditions. Conclusion: Implant retained overdentures have a positive effect on hyoid displacement during swallowing of thin liquid bolus consistency relative to conventional complete dentures. Trial registration: Retrospectively registered (NCT06187181) 02/1/2024. [ABSTRACT FROM AUTHOR]

Objective: The management of length-unstable femoral shaft fractures(LUFSFs) in pediatric patients is still controversial. This study aims to explore the clinical efficacy of ultrasound-guided closed reduction combined with external fixation for treating LUFSFs in children. Methods: We conducted a retrospective analysis of clinical data from 19 pediatric patients with LUFSFs who underwent ultrasound-guided closed reduction and external fixation between January 2018 and January 2023. Ultrasound was employed not only to facilitate closed reduction of the fracture but also to guide real-time insertion of Schanz pins and monitor pin length as it traversed the opposite cortex. Surgical time, intraoperative fluoroscopy count, hospital stay length, fracture fixation duration, complication incidence, fracture reduction quality at the final follow-up were recorded. Results: The patients' average age was 7.5 years(range: 5 to 11 years). The mean surgical duration was 70.4 min (range: 48–105 min), and the average intraoperative fluoroscopy count was 6.5 (range: 2–16). Fracture fixation lasted an average of 10.9 weeks (range: 7–20 weeks). All patients were followed up for more than one year. 6 cases of superficial pin tract infection occurred, which resolved with oral antibiotics and enhanced needle tract care. No deep infections were observed. Temporary stiffness of the knee joint was observed in 2 patients. According to Flynn's efficacy evaluation system, fracture reduction quality at the final follow-up was rated as excellent in 11 cases and satisfactory in 8 cases, yielding a combined success rate of 100% (19/19). Conclusions: The technique of ultrasound-guided closed reduction combined with external fixation offers favorable outcomes for children aged 5 to 11 years with LUFSFs, reducing reliance on fluoroscopic guidance. [ABSTRACT FROM AUTHOR]

Purpose: Dysphagia is a leading cause of morbidity in people with amyotrophic lateral sclerosis (PwALS). Previous videofluoroscopic swallowing studies (VFSS) in PwALS do not account for the influence of senescence. We aimed to compare swallowing in PwALS and an age- and sex-matched control group using healthy reference data to define typical and atypical values. Method: We conducted retrospective analysis of VFSS data from 19 PwALS (10 male, Mage = 63 years, range: 47-82) compared to control data from a cohort of healthy adults. Participants swallowed 20% w/v liquid barium from thin to extremely thick consistency. Blinded duplicate VFSS analysis using the ASPEKT (Analysis of Swallowing Physiology: Events, Kinematics and Timing) method yielded descriptive statistics for 16 quantitative VFSS parameters by consistency. Mann-Whitney U tests were used to identify significant cohort differences. Additionally, the frequencies of atypical values (in the 25% tails of the reference distribution) were tabulated by cohort and compared using odds ratios. Results: PwALS showed increased frequencies of multiple swallows per bolus, incomplete laryngeal vestibule closure, and reduced hyoid speed across consistencies. By contrast, similar frequencies of atypical values for pharyngeal constriction and residue in both cohorts suggest that age-related changes may contribute to the presence of these features in PwALS. Conclusions: This analysis builds on previous descriptions of swallowing pathophysiology in amyotrophic lateral sclerosis (ALS) by clarifying the extent to which aging may account for some of the atypical findings seen in this patient population. Longitudinal studies are recommended to further differentiate the effects of ALS from age-related changes in swallowing over the course of disease progression. [ABSTRACT FROM AUTHOR]

Dose optimization in computed tomography (CT) is crucial, especially in CT fluoroscopy (fluoro-CT) used for real-time navigation, affecting both patient and operator safety. This study evaluated the impact of spectral X-ray filtering using a tin filter (Sn filter), and a method called partial-angle computed tomography (PACT), which involves segmentally switching off the X-ray tube current at the ambient dose rate H ˙ * (10) at the interventional radiologist's (IR) position. Measurements were taken at two body regions (upper body: head/neck; lower body: lower legs/feet) using a 120 kV X-ray tube voltage, 3 × 5.0 mm CT collimation, 0.5 s rotation speed, and X-ray tube currents of 43 Eff.mAs (without Sn filter) and 165 Eff.mAs (with Sn filter). The study found significant dose reductions in both body regions when using the Sn filter and PACT together. For instance, in the upper body region, the combination protocol reduced H ˙ * (10) from 11.8 µSv/s to 6.1 µSv/s (p < 0.0001) compared to the protocol without using these features. Around 8% of the reduction (about 0.5 µSv/s) is attributed to the Sn filter (p = 0.0005). This approach demonstrates that using the Sn filter along with PACT effectively minimizes radiation exposure for the IR, particularly protecting areas like the head/neck, which can only be insufficiently covered by (standard) radiation protection material. [ABSTRACT FROM AUTHOR]

Purpose/Method: The videofluoroscopic swallowing study (VFSS) is an instrumental exam for patients with dysphagia. Analysis of images generated during the study leads to diagnosis of swallowing events/physiology and the generation of treatment plans. As critical as the reading of images are to the VFSS, there exist multiple additional considerations for successfully conducting the study with pediatric patients. Due to difficulties inherent in testing infants and children, the pediatric VFSS poses implementation challenges. Speech-language pathologists may facilitate pediatric patients in issues of feeding engagement, crying, volume consumed, bolus size, and method. Results/Conclusion: Facilitative techniques during pediatric VFSS benefit the obtaining of accurate diagnostic results to guide pediatric feeding disorder management and recommendations. [ABSTRACT FROM AUTHOR]

Background: Low-voltage area (LVA) ablation, in addition to pulmonary vein isolation (PVI), has been proposed as a new strategy in patients with atrial fibrillation (AF), but clinical trials have shown conflicting results. We performed a systematic review and meta-analysis to assess the impact of LVA ablation in patient undergoing AF ablation (PROSPERO-registered CRD42024537696). Methods: Randomized clinical trials investigating the role of LVA ablation in addition to PVI in patients with AF were searched on PubMed, Embase, and the Cochrane Library from inception to 22 April 2024. Primary outcome was atrial arrhythmia recurrence after the first AF ablation procedure. Secondary endpoints included procedure time, fluoroscopy time, and procedure-related complication rate. Sensitivity analysis including only patients with LVA demonstration at mapping and multiple subgroups analyses were also performed. Results: 1547 patients from 7 studies were included. LVA ablation in addition to PVI reduced atrial arrhythmia recurrence (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.52–0.81, p < 0.001) with a number needed to treat to prevent recurrence of 10. No difference in procedure time (mean difference [MD] −5.32 min, 95% CI −19.01–8.46 min, p = 0.45), fluoroscopy time (MD −1.10 min, 95% CI −2.48–0.28 min, p = 0.12) and complication rate (OR 0.81, 95% CI 0.40–1.61, p = 0.54) was observed. Consistent results were demonstrated when considering only patients with LVA during mapping and in prespecified subgroups for AF type (paroxysmal vs. persistent), multicentric vs. monocentric trial, and ablation strategy in control group. Conclusions: In patients with AF, ablation of LVAs in addition to PVI reduces atrial arrhythmia recurrence without a significant increase in procedure time, fluoroscopy time, or complication rate. [ABSTRACT FROM AUTHOR]

Introduction: The establishment of venous access is one of the driving factors for complications during implantation of pacemakers and defibrillators (cardiac implantable electronic devices [CIED]). Recently, a novel approach of accessing the cephalic vein for CIED by cephalic vein puncture (CVP) using a modified Seldinger technique has been described, promising high success rates and simplified handling with steeper learning curves. In this single‐center registry, we analyzed the safety and efficiency of CVP to SVP access after defining CVP as the primary access route in our center. Methods: A total of 229 consecutive patients receiving a CIED were included in the registry. Sixty‐one patients were implanted by primary or bail‐out SVP; 168 patients received primary cephalic preparation and CVP was performed when possible, using a hydrophilic transradial sheath. Results: Implantation of at least one lead via CVP was successful in 151 of 168 patients (90%), and implantation of all leads was possible in 122 of 168 patients (72.6%). Total implantation times and fluoroscopy times and doses did not differ between CVP and SVP implantations. Pneumothorax occurred in 0/122 patients implanted via CVP alone, but 8/107 (7.5%) patients received at least one lead via SVP. Conclusion: Our data confirms high success rates of the CVP for CIED implantation. Moreover, this method can be used without significantly prolonging the total procedure time or applying fluoroscopy dose compared to the highly efficient SVP while showing lower overall complication rates. [ABSTRACT FROM AUTHOR]

The application of ultrasound (US) in pain medicine has been a rapidly growing field since the 2000s. Musculoskeletal injections, peripheral nerve blocks, and neuraxial injections under US guidance have been acknowledged for managing chronic pain. Although many studies on US-guided pain procedures have been published, there needs to be a classification system to evaluate which image device, the US or fluoroscopy, is clinically and technically better in various pain interventions. Therefore, this narrative review introduces the classification system for the US-guided pain procedures according to their clinical and technical outcomes and designates US-guided pain procedures into one of the four categories by reviewing previous prospective randomized comparative trials. [ABSTRACT FROM AUTHOR]

In this article, we introduce parallelproj, a novel open-source framework designed for efficient parallel computation of projections in tomography leveraging either multiple CPU cores or GPUs. This framework efficiently implements forward and back projection functions for both sinogram and listmode data, utilizing Joseph's method, which is further extended to encompass time-of-flight (TOF) PET projections. Our evaluation involves a series of tests focusing on PET image reconstruction using data sourced from a state-of-the-art clinical PET/CT system. We thoroughly benchmark the performance of the projectors in non-TOF and TOF, sinogram, and listmode employing multi CPU-cores, hybrid CPU/GPU, and exclusive GPU mode. Moreover, we also investigate the timing of non-TOF sinogram projections calculated in STIR (Software for Tomographic Image Reconstruction) which recently integrated parallelproj as one of its projection backends. Our results indicate that the exclusive GPU mode provides acceleration factors between 25 and 68 relative to the multi-CPUcore mode. Furthermore, we demonstrate that OSEM listmode reconstruction of state-of-the-art real-world PET data sets is achievable within a few seconds using a single consumer GPU. [ABSTRACT FROM AUTHOR]

Purpose: To quantify operator dose in interventional CT fluoroscopy (CTF) procedures and compare to catheterization laboratory and interventional radiology procedures. Methods: Fifteen studies quantifying operator scatter dose for c‐arm fluoroscopy and CTF were reviewed from a literature survey. The dose provided in each study was normalized to skin entrance air kerma and air kerma rate including backscatter. The average air kerma rate and exposure duration were calculated and compared between c‐arm fluoroscopy and CTF. To enable operator scatter dose calculations in CTF procedures, a model was created which scaled the dose from a reference condition. Results: Our literature survey indicated that for CTF relative to c‐arm fluoroscopy: (1) the mean air kerma rate is 3.5 times higher, while (2) the mean exposure duration is 31.6 times lower. On average, a physician would have to perform 9.1 times (i.e., 31.6/3.5) more CTF procedures relative to c‐arm fluoroscopy procedure to receive equal operator scatter doses. Our own experimental measurements provided scaling factors allowing physician scatter dose to be obtained at any rotation time, tube current, beam collimation, or beam energy. Conclusion: Our results shed light onto a currently mis‐understood issue in radiology. Namely, that physicians receive more dose from CT relative to c‐arm fluoroscopy motivating them to retreat from the room during interventional exposures. Our literature review and experimental measurements indicate the opposite it true; interventional CT produces on average nine times less physician dose relative to c‐arm procedures. Our method allows for prospective/retrospective determination of an individual's dose. [ABSTRACT FROM AUTHOR]

Background: Transcatheter edge-to-edge tricuspid valve repair (T-TEER) for tricuspid regurgitation (TR) is always guided by transesophageal echocardiography (TEE). As each patient has unique anatomy and acoustic window, adding transthoracic echocardiography (TTE) and cardiac CT could improve procedural planning and guidance. Objectives: We aimed to assess T-TEER success and outcomes of a personalized guidance approach, based on multimodality imaging (MMI) of patient-tailored four right-sided chamber views (four-right-ch), as depicted by CT, TTE, TEE and fluoroscopy. Methods: Patients were assigned to MMI or classical TEE guidance, depending on TTE acoustic window. In MMI patients, planning included cardiac CT, which determined the fluoroscopic angulations of the specific four-right-ch, while guidance relied heavily on TTE, with minimal intermittent TEE for leaflet grasping and result confirmation. Both TTE and TEE were matched to respective CT and fluoroscopy four-right-ch. TR severity and quality of life (QoL) parameters were assessed from baseline to 12 months. Results: A total of 40 T-TEER patients were included, with 17 procedures guided by MMI and 23 solely by TEE. Baseline characteristics were similar between groups, e.g., age (83.1 ± 4.1 vs. 81 ± 5.3, p = 0.182) or STS-Score (11.1 ± 7.4% vs. 10.6 ± 5.9%, p = 0.813). The primary efficacy endpoint of ≥one-grade TR reduction at 30 days was 94% (16/17) in MMI vs. 91% (21/23) in TEE patients, with two or more TR grade reduction in 65% vs. 52% (p = 0.793). Device success was overall 100%, with no device-related complications, but three TEE-associated cases of gastrointestinal bleeding in the TEE-only group. By 12 months, all 15 MMI and 19 TEE survivors improved NYHA functional class and QoL, e.g., Kansas City Cardiomyopathy Questionnaire Score Δ29.6 ± 6.7 vs. 21.9 ± 5.8 (p = 0.441) pts., 6-min walk distance Δ101.5 ± 36.4 vs. 85.7 ± 32.1 (p = 0.541) meters. Conclusions: In a subset of patients with good TTE acoustic window, MMI guidance of T-TEER is effective and seems to avoid gastroesophageal injuries caused by TEE probe manipulation. TR reduction, irrespective of guidance method, impacts long-term QoL. [ABSTRACT FROM AUTHOR]

Background Complex thoracolumbar fractures require reduction and stabilization. Posterior instrumentation alone and standard cement augmentation may represent undertreatment, while corpectomy has significant morbidity. In a series of unstable thoracolumbar fractures, we assessed the feasibility, safety, and results of 'armed kyphoplasty' (AKP) and surgical posterior stabilization (PS). Methods A total of 24 consecutive patients were treated with combined AKP and PS. Minimally invasive and open surgery techniques were used for PS. AKP was performed with C-arm or biplane fluoroscopic guidance, and screws were placed under navigation or fluoroscopic guidance. A postoperative CT scan and standing plain films were obtained. Patients were followed up according to clinical standards. Kyphosis correction (measured with regional Cobb angle), pain (measured with the Numeric Rating Scale), neurological status (measured with Frankel grade) were assessed. Results A total of 25 fractures of neoplastic (40%), traumatic (32%), and osteoporotic (28%) nature were treated. Open surgery and minimally invasive techniques were applied in 16/24 and 8/24 patients, respectively. Decompressive laminectomy was performed in 13 cases. No intraprocedural complications occurred. Two patients (8%) died due to underlying disease complications and three complications (12%) required re-intervention (one surgical site infection, one adjacent fracture, and one screw pull-out) in the first month. The mean Cobb angle was 20.14±6.19° before treatment and 11.66±5.24° after treatment (P<0.0001). No re-fractures occurred at the treated levels. Conclusions Combined AKP and PS is feasible and effective in the treatment of complex thoracolumbar fractures of all etiologies. AKP avoided highly invasive corpectomy. Anterior and posterior support ensured stability, preventing implant failure and re-fracture. The complication rate was low compared with more invasive traditional 360° open surgical approaches. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to evaluate the mid-term effectiveness and safety of a combined ultrasound (US) and fluoroscopy (FL)-guided approach in comparison to US-guided and FL-guided caudal epidural steroid injections (CESI) for treating unilateral lower lumbar radicular pain. Materials and Methods: A total of 154 patients who underwent CESI between 2018 and 2022 were included. Patients were categorized into three groups based on the guidance method: combined US and FL (n = 51), US-guided (n = 51), and FL-guided (n = 52). The study design was retrospective case-controlled, utilizing patient charts and standardized forms to assess clinical outcomes, adverse events, complications during the procedures. Results: In all groups, Oswestry Disability Index and Verbal Numeric Scale scores improved at 1, 3, and 6 months after the last injection, with no significant differences between groups (p < 0.05). The treatment success rate at all time points was also similar among the groups. Logistic regression analysis showed that injection method, cause, sex, age, number of injections, and pain duration did not independently predict treatment success. Blood was aspirated before injection in 2% (n = 1), 13.5% (n = 7), and 4% (n = 2) of patients in the combined US and FL groups, FL-guided groups, and US-guided groups, respectively. Intravascular contrast spread was detected in one patient in the combined method groups and seven in the FL-guided groups. Conclusions: When comparing pain reduction and functional improvement, there was no significant difference between the three methods. The combined method took less time compared to using FL alone. The combined approach also showed a lower occurrence of intravascular injection compared to using FL alone. Moreover, blood vessels at the injection site can be identified with an ultrasound using the combined method. Given these advantages, it might be advisable to prioritize the combined US- and FL-guided therapy when administering CESI for patients with unilateral lumbar radicular pain. [ABSTRACT FROM AUTHOR]