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PubMed1989

Fluoroscopy in colonoscopy. Who is using it and why?

Use of fluoroscopy during colonoscopy has never been broadly assessed. A survey of 1,864 members of the Society of American Gastrointestinal Endoscopic Surgeons and the American Society of Colon and Rectal Surgeons was carried out to quantify the use of fluoroscopy and to elicit impressions regarding its capabilities, indications, and usefulness. After the establishment of the responding colonoscopist's training, experience, and other background data, impressions of fluoroscopy's role in many issues were obtained using a graded response system. Concluding the two-page survey were open-ended questions addressing the respondent's indications, contraindications, and rationale for using or not using fluoroscopy. Six hundred thirty-one colonoscopists responded. Seventy-five per cent never use fluoroscopy; the most frequently cited reasons were lack of need and inaccessibility of fluoroscopy. For many colonoscopists, fluoroscopy is unavailable (22%) or available outside of the usual endoscopy setting (44%). Fluoroscopy is used by 25 per cent of colonoscopists. Almost three quarters of this group have the capability of performing fluoroscopy in their colonoscopy unit. The indications for fluoroscopy varied with the frequency of its use; frequent users employ fluoroscopy to treat loops, to confirm cecal intubation, and to locate the instrument tip precisely. Infrequent users employ fluoroscopy to apply the sigmoid straightening overtube or because of prior failed colonoscopy. Impressions regarding the impact of fluoroscopy on learning, completing, and safeguarding colonoscopy were obtained. Most colonoscopists are satisfied without using fluoroscopy, although 65 per cent of nonusers believe it would improve colonoscopy performance if it were used. Ninety-two per cent of frequent users of fluoroscopy reported that they would feel significantly impaired without having the capability to perform fluoroscopy.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonoscopy↗

PubMed1998

Reduction of radiation exposure time during catheter ablation with the use of pulsed fluoroscopy.

UNLABELLED: Prolonged exposure to radiation during radiofrequency catheter ablation implies a potential risk of radiodermatitis, neoplasm and genetic defects to the patient and to the operator-physician. The use of pulsed fluoroscopy is thought to reduce such a risk because the radiation dose decreases for the same period of time. The aim of the present study was to compare the radiation exposure time during pulse and continuous radiofrequency catheter ablation. METHODS: Procedures were divided according to the sort of fluoroscopy utilized and the last four cases of atrioventricular (AV) junction ablation, four of atrial flutter, five of atrial tachycardia, 16 of AV node reentrant tachycardia, 16 of AV tachycardia and 10 of ventricular tachycardia in which pulsed and continuous fluoroscopy were utilized were respectively separated into Group I (pulse fluoroscopy) and Group II (continuous fluoroscopy) with 55 patients in each group. Fluoroscopy was generated by the same device in the two groups. Continuous fluoroscopy used 2 mA and automatic kV adjustment (automatic brightness stabilizer) ranging from 70 to 110 kV. Pulsed fluoroscopy was set at 7 squares/s with 25 mA and automatic kV adjustment. Fluoroscopy time was registered by the fluoroscopy device counter. RESULTS: Procedure duration, success rate and complications did not differ between Groups I and II. Fluoroscopy time, however, was 4.4+/-4 min during pulsed fluoroscopy and 27+/-23 min during continuous fluoroscopy (p=0.001). CONCLUSION: During radiofrequency catheter ablation procedures, the use of pulsed fluoroscopy set at 7 squares/s, decreases the radiation exposure time by 80% as compared to continuous fluoroscopy without changing procedure duration and success rate.

Cardiac Catheterization↗

PubMed2005

Intraoperative three-dimensional fluoroscopy-based computerized tomography guidance for percutaneous kyphoplasty.

OBJECT: Percutaneous kyphoplasty is an established method for the treatment of pathological vertebral compression fractures (VCFs). This procedure is usually performed with the aid of biplanar fluoroscopic image guidance. There are currently no published clinical studies in which the use of three-dimensional (3D) image guidance to facilitate this technique has been evaluated. The purpose of this study was to evaluate the efficacy of isocentric fluoroscopy-based navigation for the kyphoplasty procedure, with special reference to operating time and the amount of radiation exposure. METHODS: A prospective clinical study was performed in which 11 consecutive patients with painful pathological VCFs that did not respond to conservative treatment underwent the kyphoplasty procedure. During this procedure, cannulation of the pedicle and vertebral body was performed with the aid of isocentric 3D fluoroscopy visualization. Total operating time and intraoperative fluoroscopy time for this group was compared with a cohort of nine patients who underwent the procedure prior to the availability of isocentric fluoroscopy (only biplanar fluoroscopy was used). Possible complications such as cement extravasations were evaluated during the procedure and on postoperative computerized tomography scans. The mean duration of surgery for the 3D isocentric fluoroscopic guidance group was 60 minutes (range 36-89 minutes) for one-level and 68.5 minutes (range 65-75 minutes) for two-level cases. Because of a learning curve with the equipment, the operating time for the initial cases was significantly longer than with the later ones. Even with the initial cases included, the mean operating time was shorter compared with the biplanar fluoroscopy-assisted procedures, which averaged 69.2 minutes (range 44-113 minutes) for one-level procedures. This difference was not statistically significant. The mean fluoroscopy exposure time was 41.3 seconds (range 25-62 seconds) in the isocentric fluoroscopy-assisted procedures, with an additional 40 seconds of fluoroscopy time used for the 3D fluoroscopy "spin," compared with 293.2 seconds (range 180-400 seconds) in the biplanar fluoroscopy-assisted procedures. The difference was statistically significant (p = 0.02). All pedicles were accessed without difficulty and no complications were encountered in either group of patients. CONCLUSIONS: The main advantage of isocentric fluoroscopy is the significant reduction in radiation exposure for the patient and surgical staff without an increase in the mean operating time. This technique is a significant advancement over biplanar fluoroscopy in this setting.

Adult↗

PubMedDate not supplied

Feasibility of C-arm-supported CT fluoroscopy in percutaneous abscess drainage procedures.

PURPOSE: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures. METHODS: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed. RESULTS: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 +/- 3.7 min versus 14.8 +/- 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test). CONCLUSION: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.

Abscess↗

PubMed1985

Digital subtraction fluoroscopy: a new method of detecting coronary calcifications with improved sensitivity for the prediction of coronary disease.

The association between calcification of the coronary arteries and coronary artery narrowing is well established. However, fluoroscopic visualization of coronary calcifications has been insufficiently sensitive to be useful as a screening test. Since digitization of radiographic images permits the subtraction of noncardiac structures from moving cardiac structures, such subtraction might increase the sensitivity of coronary fluoroscopy. To determine whether coronary calcifications were better visualized with digital subtraction fluoroscopy than with conventional fluoroscopy, we taped diseased human coronary arteries to a pulsating water balloon inside the thorax of a dog cadaver and studied this model with both fluoroscopic techniques. Calcific atherosclerotic plaques were more easily identified with digital subtraction fluoroscopy than with conventional fluoroscopy. We tested the method clinically by submitting 191 subjects without history or electrocardiographic evidence of previous myocardial infarction who were referred for coronary arteriography to both fluoroscopic studies. For at least one, at least two, and three calcified coronary arteries, digital fluoroscopy was more sensitive (92%, 66%, and 40%) than conventional fluoroscopy (63%, 21%, and 2%) (all p less than .001) for the prediction of significant coronary obstructions (greater than 50%). Although digital fluoroscopy was less specific than conventional fluoroscopy (digital: 65%, 89%, and 97%; conventional: 81%, 98%, and 100%) (all but last, p less than .01), receiver operating curve analysis revealed a significantly larger area under the curve, indicating higher accuracy for the digital technique (p = .03). Digital subtraction fluoroscopy was more accurate in younger than in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗

PubMed1996

Fluoroscopy. A valuable ally during difficult colonoscopy.

BACKGROUND: This study determines the pattern of fluoroscopy use during colonoscopy among a group of gastroenterologists and colon and rectal surgeons who have it readily available for each patient. METHODS: One thousand three hundred fifty-seven consecutive patients undergoing colonoscopic examination were studied over a 16-month period. RESULTS: Fluoroscopy was used during 34% of colonoscopic examinations. The frequency of fluoroscopy use was significantly higher for women (41% vs 28%, p < 0.001). Fluoroscopy was most commonly used to precisely locate the colonoscope tip (45%) or during manipulation of troublesome loops of colon (42%), thus accounting for 87% of 677 fluoroscopic checks. The most common location of the colonoscope tip during these fluoroscopic checks was the hepatic flexure (23%) followed by the cecum (20%); 51% involved the right colon. The selective use of fluoroscopy during the more difficult cases was substantiated by the longer procedure time (36 vs 26 min) and significantly lower cecal intubation rate (74% vs 96%, p < 0.002) when fluoroscopy was required. Fluoroscopy also proved to be valuable when precisely locating pathology and teaching colonoscope intubation techniques. CONCLUSIONS: Endoscopists who have fluoroscopy readily available often use it during difficult colonoscopic examinations. Fluoroscopy is most commonly used to maneuver troublesome loops of colon or to precisely locate colonoscope tip position, especially when negotiating the right colon. Although this technology is more frequently required for women, fluoroscopic capability for all colonoscopic examinations is advantageous.

Adolescent↗

PubMed2005

Fluoroscopy radiation safety for spine interventional pain procedures in university teaching hospitals.

BACKGROUND: Fluoroscopic guidance is frequently utilized in performing various types of interventional techniques. The major purpose of fluoroscopy is accurate needle placement to ensure target specificity and accurate delivery of the injected drug. However, radiation exposure may be associated with risks to physician, patient, and personnel. Multiple studies have evaluated the risk of radiation exposure and techniques to reduce the risk in private practice settings. However, the literature is scant in evaluating the risk of radiation exposure in teaching hospitals in university settings. OBJECTIVE: To evaluate safety and duration of radiation exposure for fluoroscopy guided interventional pain procedures in university pain clinics. STUDY DESIGN: Retrospective, case study. METHODS: The data was reviewed from the fluoroscopy machines from March 2004 to April 2004 at two university pain clinics. Mean fluoroscopy time (FT), mean radiation dose per procedure, and utilization of pulsed fluoroscopy were analyzed. RESULTS: Data of a total of 165 cases of spine injection procedures were collected. The mean fluoroscopy time for lumbar epidural steroid injection, facet joint block, sympathetic nerve block, sacroiliac joint injection, and discography were 46.6 +/- 4.2; 81.5 +/- 12.8; 64.4 +/- 11; 50.6 +/- 41.9 and 146.8 + 25.1 seconds respectively. There were significant differences in fluoroscopy exposure times and radiation dosage for epidural steroid injection among different teaching physicians. Pulsed fluoroscopy was used in less than 10% of cases. CONCLUSION: The results of this study show that the fluoroscopy exposure time for various interventional procedures performed in the university settings are significantly higher than the radiation exposure periods in private practice settings. This study also showed significant differences among physicians in the same university setting.

Journal Article↗

PubMed2003

LocaLisa catheter navigation reduces fluoroscopy time and dosage in ablation of atrial flutter: a prospective randomized study.

INTRODUCTION: Catheter ablation has become a well-established therapy for isthmus-dependent right atrial flutter (AFL). Recently, mapping and ablation of AFL have been performed using sophisticated three-dimensional mapping systems, such as electroanatomic and noncontact mapping systems. The LocaLisa system enables nonfluoroscopic navigation of intracardiac electrode catheters based on impedance changes related to catheter movements in transthoracic current fields. The aim of this randomized prospective study was to compare the efficacy of the LocaLisa system with the conventional mapping/ablation approach for radiofrequency ablation of AFL. METHODS AND RESULTS: Fifty consecutive patients with AFL (39 men and 11 women; age 65 +/- 10 years) were studied. The patients were randomly assigned to undergo radiofrequency ablation guided by a conventional fluoroscopy-based approach (24 patients) or by the LocaLisa system (26 patients). Ablation success rate and documentation of bidirectional isthmus block were 100% in both groups. Compared with fluoroscopy-guided approaches, LocaLisa-guided procedures demonstrated a reduction in total fluoroscopy time from 15.9 +/- 10.6 minutes to 7.5 +/- 6.5 minutes (P < 0.005). Total fluoroscopy dosage was reduced from 21.0 +/- 19.8 to 8.7 +/- 9.5 Gycm2 (P < 0.05). Fluoroscopy time required for ablation was significantly shortened in the LocaLisa group (2.6 +/- 2.6 min) compared with the conventional approach group (11 +/- 10 min, P < 0.0005). In 9 (35%) of 26 patients, the ablation could be performed with a fluoroscopy time < or = 1 minute. There were no significant differences with regard to the number of radiofrequency applications, fluoroscopy time needed for diagnostic reasons, total procedure time, or other ablation data. CONCLUSION: Compared with the conventional approach, the LocaLisa system significantly reduces the fluoroscopy times needed for ablation of typical AFL.

Aged↗

PubMed1998

Real-time CT fluoroscopy: usefulness in thoracic drainage.

OBJECTIVE: The purpose of our study was to review the application of real-time CT fluoroscopy in the drainage of localized pleural and mediastinal collections. SUBJECTS AND METHODS: Between July 1996 and August 1997, 20 patients with 10 loculated pleural effusions, two mediastinal fluid collections, and 12 focal pneumothoraces were treated using CT fluoroscopy. The patient population was 25-77 years old and included 14 men and six women. Methods of drainage included using a modified Seldinger technique with a guidewire and serial dilators in 10 patients and a single-stick trocar technique in the remaining 14. Total room time, procedure time, and CT fluoroscopy time were recorded. RESULTS: All 24 collections were successfully evacuated using either real-time or interrupted real-time CT fluoroscopy. The real-time capability of CT fluoroscopy proved particularly useful for rapid placement of drainage tubes in patients who were unable to cooperate with breathing instructions and in patients who had a narrow window of access. Average total room time was 65 min. Average procedure time was 32 min, and average CT fluoroscopy time was 143 sec. CONCLUSION: CT fluoroscopy permits rapid drainage of intrathoracic collections. CT fluoroscopy is a particularly useful treatment for patients who are unable to perform breath-holding or in whom access to the drainage site is difficult.

Drainage↗

PubMed1999

Percutaneous abdominal and pelvic interventional procedures using CT fluoroscopy guidance.

OBJECTIVE: The purpose of our study was to assess the use of low-milliamperage CT fluoroscopy guidance for percutaneous abdominopelvic biopsy and therapeutic procedures. MATERIALS AND METHODS: We reviewed the clinical records and relevant imaging studies of 97 patients who underwent 119 percutaneous CT fluoroscopy-guided abdominal or pelvic procedures: fluid collection aspiration or drainage catheter insertion (n = 59), biopsy (n = 49), hepatocellular carcinoma ethanol ablation (n = 6), chemoneurolysis (n = 4), and brachytherapy catheter insertion (n = 1). These procedures were guided using a helical CT scanner providing real-time fluoroscopy reconstruction at six frames per second. A control panel and video monitor beside the gantry allowed direct operator control during all interventional procedures. RESULTS: One hundred twelve (94.1%) procedures were successfully performed using either a stand-off needle holder and continuous real-time CT fluoroscopy guidance or incremental manual insertion and intermittent CT fluoroscopy to confirm position. Image quality using low milliamperage was adequate for needle or drainage tube placement in all but two low-contrast liver lesions. Two hematomas were accessed but yielded no fluid on aspiration; one drainage procedure was abandoned after the patient developed endotoxic shock. Imaging of ethanol distribution during injection facilitated tumor ablation and neurolytic procedures. CT fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement, especially in nonaxial planes. Average CT fluoroscopy time for biopsy and therapeutic procedures was 133 sec (range, 35-336 sec) and 186 sec (range, 20-660 sec), respectively. CONCLUSION: CT fluoroscopy is a practical clinical tool that facilitates effective performance of percutaneous abdominal and pelvic interventional procedures.

Abdomen↗

PubMed1986

Cost effectiveness of wrist fluoroscopy and arthrography in the evaluation of obscure wrist pain.

The cost effectiveness of wrist fluoroscopy and arthrography was evaluated in patients with obscure wrist pain. Dynamic fluoroscopy was performed in 91 cases and was positive in 54 (59%). Radiocarpal arthrography was performed in 60 of these cases in which further information was desired. Arthrography increased the diagnostic yield to 62 of 91 cases (68%). Diagnoses included ligament and cartilage tears, and dynamic intercarpal instability. The cost per positive examination for fluoroscopy, based on total cost for fluoroscopy in 91 patients divided by number of positive cases, is $126. The cost per positive examination by arthrography alone is $377. When arthrography is done only when fluoroscopy is equivocal or negative, the cost per positive examination (fluoroscopy plus arthrography) drops to $280. Wrist arthrography is only cost effective if done after dynamic fluoroscopy fails to answer the clinical questions. When done together in this setting, the two procedures are most cost effective than arthrography alone. Based on current costs, conservative treatment of carpal instability costs about $1,500, and surgical therapy costs about $4,000. Thus, fluoroscopy and arthrography may further reduce the cost of management of obscure wrist pain by identifying those patients who would not benefit from surgical exploration.

Arthrography↗

PubMed2003

[Multislice CT fluoroscopy: technical principles, clinical applications and dosimetry].

PURPOSE: The aim of this study is describing fluoroscopic techniques with multislice CT during interventional procedures. We emphasize the technical principles of the multislice CT fluoroscopy and the relative advantages in clinical application, in comparison to single slice fluoroCT and conventional CT guided procedures. Other topics are dosimetry and patient's and operator's radioprotection. MATERIALS AND METHODS: We describe our experience in 60 cases of interventional procedures performed with CT fluoroscopy array for the TOSHIBA AQUILION-MULTI TSX-101A scanner that allows a real-time 3 slices simultaneous representation of the target: middle target slice, superior and inferior slices. Thirty nine biopsies, 5 abscess drainage, 12 shoulder arthrocentesis previous to arthro-MR and 4 hepatic neoplasm ablations have been performed during the last 9 months. For each procedure questionnaires have been used to evaluate: target organs, scan parameters, fluoroscopy techniques (continuous or spot) and total time of fluoroCT. Basing on these data and on the measurements made on a body phantom we calculated patient's and operator's radiation dose rate. RESULTS AND DISCUSSION: The real-time simultaneous representation of the middle target slice and the adjacent superior and inferior slices has always allowed an immediate identification of the needle tip and direction. The use of a needle holder has been determined by the needle type, the fluoroscopy technique (continuous or spot), the type of interventional procedure and the target. In our experience freehand spot fluoroscopy approach was easier, faster and with less radiation dose rate. 24 seconds were the mean fluoroscopy time for all different CT fluoroscopy modalities and procedures. The mean absorbed equivalent dose rate to patient's skin was 5300 microSv/s while the dose to operator's body and hand was respectively 0.3 microSv/s and 30 microSv/s. CONCLUSIONS: Multislice CT fluoroscopy, specially if performed by spot technique, leads to an acceptable radiation dose rate to patient and operator, is user friendly and guides interventional procedures with rapidity.

Fluoroscopy↗

PubMed2003

The role of airway fluoroscopy in the evaluation of stridor in children.

OBJECTIVE: To determine the role of airway fluoroscopy in comparison with other diagnostic modalities in diagnosing the site of partial airway obstruction in children with stridor. DESIGN: Prospective study comparing direct laryngoscopy and bronchoscopy with nasopharyngoscopy, airway fluoroscopy, and plain films. Children with stridor or partial airway obstruction were evaluated by the Department of Otolaryngology at Columbus Children's Hospital, Columbus, Ohio. A history review and physical examination, including flexible fiberoptic laryngoscopy, plain films, airway fluoroscopy, and direct laryngoscopy and bronchoscopy, were performed for all children. SETTING: Tertiary care children's hospital. PATIENTS: From November 1996 to September 1999, 64 children aged 1 week to 12 years, with a mean age of 1.8 years and male-female ratio of 3:2, were evaluated for stridor. MAIN OUTCOME MEASURES: The sensitivity and specificity of airway fluoroscopy in diagnosing the site of partial airway obstruction in comparison with nasopharyngoscopy and plain films. RESULTS: Airway fluoroscopy had a sensitivity of 80% for subglottic, 73% for tracheal, and 80% for bronchial sites of obstruction. It was less sensitive for supraglottic and glottic sites-33% and 14%, respectively. Nasopharyngoscopy was more sensitive for supraglottic and glottic sites of obstruction. Overall, airway fluoroscopy was far more sensitive than plain films for diagnosing site of obstruction. CONCLUSIONS: Airway fluoroscopy is a quick, noninvasive, and dynamic study of the entire airway that provides important additional information to the history review and physical examination and is a valuable adjunct to flexible fiberoptic laryngoscopy. It was far superior to plain films and may serve as a cost-effective screening tool in the evaluation of stridor in children, especially for lesions of the lower airway.

Airway Obstruction↗

PubMedDate not supplied

Radiation dose to the radiologist's hand during continuous CT fluoroscopy-guided interventions.

Computed tomography fluoroscopy (CT fluoroscopy) enables real-time image control over the entire body with high geometric accuracy and, for the most part, without significant interfering artifacts, resulting in increased target accuracy, reduced intervention times, and improved biopsy specimens [1--4]. Depending on the procedure being used, higher radiation doses than in conventional CT-supported interventions might occur. Because the radiologist is present in the CT room during the intervention, he is exposed to additional radiation, which is an important aspect. Initial experience with CT fluoroscopically guided interventions is from the work of Katada et al. in 1994 [5] and only relatively few reports on radiation aspects in CT fluoroscopy are found in the literature [1, 2, 6--11]. To date, there are no reported injuries to patients and radiologists occurring with CT fluoroscopy. The time interval since the wide use of CT fluoroscopy is too short to have data on late effects to the operator using CT fluoroscopy on a daily basis. In addition, the spectrum of CT fluoroscopically guided interventional procedures will expand and more sophisticated procedures requiring longer fluoroscopy times will be performed. Thus, effective exposure reduction is very important. The purpose of our study was to assess the radiation dose to the operator's hand by using data from phantom measurements. In addition, we investigated the effect of a lead drape on the phantom surface adjacent to the scanning plane, the use of thin radiation protective gloves, and the use of different needle holders.

Adult↗

PubMed2006

Evaluating mobility for radiotherapy planning of lung tumors: a comparison of virtual fluoroscopy and 4DCT.

PURPOSE: Fluoroscopy is widely used for evaluating tumor mobility in radiotherapy planning. Lung tumor mobility was scored using virtual fluoroscopy, and this was compared to mobility derived from contoured tumors in all phases of a respiration-correlated (or 4D) CT scan. METHODS AND MATERIALS: 4DCT datasets were reviewed and 29 patients were identified in whom tumors were visible on anterior-posterior fluoroscopy views. Mobility in all directions was estimated on fluoroscopy movie loops by four clinicians. These results were compared to mobility measured from contoured tumor volumes in all phases of the same 4DCT. Internal target volumes (ITV) were generated for both approaches. RESULTS: In eight patients, fluoroscopy did not allow for tumor mobility to be assessed in at least one direction. No significant inter-clinician variation was observed with respect to fluoroscopic assessment of mobility. Clinicians systematically overestimated mobility in all three directions (p<0.05). The mean ITVs derived using fluoroscopy were 52.2% larger than those derived using 4DCT contours, but the individual ITVs were smaller in three patients. CONCLUSION: Use of virtual fluoroscopy generally overestimates the mobility of visible lung tumors, and results in irradiation of unnecessarily large target volumes. In contrast, use of 4DCT minimizes the risk of normal tissue toxicity.

Fluoroscopy↗

PubMed1995

Comparison of ultrasound with fluoroscopy in the assessment of suspected hemidiaphragmatic movement abnormality.

A comparative study of quantitative hemidiaphragmatic ultrasound with fluoroscopy was undertaken in 30 patients referred for investigation of suspected hemidiaphragmatic movement abnormality. The aim of this study was to determine whether assessment with ultrasound or fluoroscopy differed, and which technique appeared more suitable in the investigation of hemidiaphragmatic movement disorder. There were four technical failures using fluoroscopy (13%), compared with none using ultrasound. Using the normal ranges of right to left ratio of maximal excursion (0.5-2.0 for fluoroscopy and 0.5-1.6 for ultrasound) there was concordance in 21 out of 26 (81%) patients. All cases of abnormality on fluoroscopy were seen on ultrasound. Four of the discordant cases had excursions on the lesser side in the normal range on ultrasound suggesting a milder movement abnormality detected by ultrasound than by fluoroscopy. Sniff testing conferred no advantage over quantitative testing. Ultrasound has technical, qualitative and quantitative advantages over fluoroscopy and should be the method of choice in the investigation of suspected hemidiaphragmatic movement abnormality.

Adult↗

PubMedDate not supplied

Hepatic cavernous hemangiomas: patterns of contrast enhancement on MR fluoroscopy imaging.

PURPOSE: The purpose of this study was to assess the patterns of contrast enhancement of hepatic hemangiomas on gadolinium-enhanced MR fluoroscopy imaging prospectively. METHOD: Investigation was performed on a 0.3-T open MR unit. Gadolinium-enhanced MR fluoroscopy images were obtained in 24 patients with 28 hepatic hemangiomas. Each MR fluoroscopy image was obtained in 2 s and MR fluoroscopy lasted for 10-25 min for each investigation. RESULTS: Three patterns of contrast enhancement were observed in 24 patients on MR fluoroscopy images. Four small lesions were not detected on MR fluoroscopy images. Uniform enhancement was seen in nine lesions (29%), peripheral nodular enhancement progressing centripetally to uniform enhancement was seen in nine lesions (29%), and peripheral nodular enhancement with persistent central hypointensity was seen in six lesions (22%). CONCLUSION: Enhanced MR fluoroscopy technique could obtain dynamic images of hepatic hemangiomas. It can be suggested as a useful technique for the showing of enhancement of hepatic hemangiomas, keeping in mind its low sensitivity in the diagnosis of small hemangiomas.

Adult↗

PubMed2000

Cost comparison of electrocardiography versus fluoroscopy for central venous line positioning in children.

BACKGROUND: Although most central venous lines in children are positioned using fluoroscopy, electrocardiography (ECG) has been shown to be accurate, and avoids unnecessary radiation exposure. We studied whether ECG may also have cost advantages. STUDY DESIGN: All ports and Hickman/Broviac catheters placed during a 2.5-year period were reviewed. Two surgeons routinely used fluoroscopy, and two used ECG. Costs included surgeon and anesthesia fees, operating room use, and fluoroscopy equipment and personnel. RESULTS: There were 287 cases with sufficient data to be included in the study (167 fluoroscopy and 120 ECG). In the ECG group, 12 (10%) were converted to fluoroscopy because an adequate tracing could not be obtained, but they were kept in the ECG group for data analysis. The groups were similar with regard to age, gender, indication, previous catheters, and intraoperative or postoperative complications. Time for surgical placement of the line was not significantly affected by the positioning technique. Ports placed using ECG were less costly than those placed fluoroscopically ($2,880+/-408 versus $3,595+/-357, p<0.001), and the same was true for tunneled external catheters ($2,249 +/- 435 versus $2,923+/-350, p<0.001). CONCLUSIONS: The ECG technique was less costly than fluoroscopy, despite a 10% conversion rate. At our center, the savings were approximately $700 per procedure. Because operating room time used is similar, the additional cost of fluoroscopy can be attributed to the need for x-ray equipment and personnel.

Anesthesiology↗