PURPOSE: Point detectors are frequently used to measure patient's maximum skin dose (MSD) in fluoroscopically-guided interventional procedures (IP). However, their performance and ability to detect the actual MSD are rarely evaluated. The present study investigates the sampling uncertainty associated with the use of grids of point detectors to measure MSD in IP. METHOD: Chemoembolisation of the liver (CE), percutaneous coronary intervention (PCI) and neuroembolisation (NE) procedures were studied. Spatial dose distributions were measured with XR-RV3 Gafchromic(®) films for 176 procedures. These distributions were used to simulate measurements performed using grids of detectors such as thermoluminescence detectors, with detector spacing from 1.4 up to 10 cm. RESULTS: The sampling uncertainty was the highest in PCI and NE procedures. With 40 detectors covering the film area (36 cm × 44 cm), the maximum dose would be on average 86% and 63% of the MSD measured with Gafchromic(®) films in CE and PCI procedures, respectively. In NE procedures, with 27 detectors covering the film area (14 cm × 35 cm), the maximum dose measured would be on average 82% of the MSD obtained with the Gafchromic(®) films. CONCLUSION: Thermoluminescence detectors show good energy and dose response in clinical beam qualities. However the poor spatial resolution of such point-like dosimeters may far outweigh their good dosimetric properties. The uncertainty from the sampling procedure should be estimated when point detectors are used in IP because it may lead to strong underestimation of the MSD.

• Klíčová slova
• Fluoroscopically-guided procedures, Maximum skin dose, Point detectors, Sampling uncertainty, TLD,
• MeSH
• chemoembolizace metody   MeSH
• dávka záření * MeSH
• fluoroskopie MeSH
• koronární angioplastika metody   MeSH
• kůže účinky záření   MeSH
• nejistota MeSH
• termoluminiscenční dozimetrie MeSH
• Publikační typ
• časopisecké články MeSH

Intracardiac echocardiography (ICE) is the most practical method for online imaging during electrophysiological procedures. It allows guiding of complex catheter ablation procedures together with electroanatomical mapping systems, either with minimal or with zero fluoroscopy exposure. Besides safe and reproducible transseptal puncture, ICE helps to assess location and contact of the tip of the ablation catheter relative to specific anatomical structures. Another option is visualization of the arrhythmogenic substrate in patients with ventricular arrhythmias. This article describes the clinical utility of ICE in non-fluoroscopic electrophysiology procedures more in detail.

• Klíčová slova
• Electroanatomic mapping, Electrophysiology procedures, Fluoroscopy, Intracardiac echocardiography,
• MeSH
• chirurgie s pomocí počítače metody   MeSH
• echokardiografie metody   MeSH
• elektrofyziologické techniky kardiologické metody   MeSH
• fluoroskopie MeSH
• katetrizační ablace metody   MeSH
• lidé MeSH
• srdce diagnostické zobrazování   MeSH
• srdeční arytmie diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

BACKGROUND: Recent advances in 3D mapping systems, such as simultaneous visualization of multiple catheters and contact force measurement, have allowed a significant reduction in fluoroscopic times during radiofrequency (RF) ablation (RFA) procedures. The objective was to investigate whether RFA of paroxysmal atrial fibrillation (PAF) using the CARTO 3 system (Biosense Webster, Diamond Bar, CA, USA) and intracardiac echocardiography (ICE) can be performed safely without fluoroscopy. METHODS AND RESULTS: Eighty patients with PAF were randomized in a 1:1 ratio to undergo either fluoroscopically guided pulmonary vein isolation (PVI) (X+) or PVI without fluoroscopy (X-). In the X- fluoroscopy group, catheter placement, transseptal puncture, left atrial geometry reconstruction, and PVI were accomplished solely using ICE imaging and CARTO mapping. The total procedure duration and RF application time in both the X- and X+ groups were comparable (92.5 ± 22.9 minutes vs 99.9 ± 15.9 minutes, P = 0.11 and 1785 ± 548 seconds vs 1755 ± 450 seconds, P = 0.79, respectively). Zero fluoroscopic time was achieved in all patients in the X- group with the exception of one patient, where 8 seconds of fluoroscopy was needed to assess proper position of the guide-wire in the femoral vein. No serious procedure-related complications were recorded and no differences in arrhythmia-free survival at 12 months were found between the groups. CONCLUSION: RFA using ICE imaging and the CARTO 3 mapping system with contact force measurement is capable of eliminating fluoroscopy in patients undergoing PVI. Exclusion of fluoroscopic imaging does not seem to compromise patient safety and does not affect overall procedure duration, RF application time, or mid-term efficacy.

• Klíčová slova
• atrial fibrillation, catheter ablation, contact force, pulmonary vein isolation, radiation, zero fluoroscopy,
• MeSH
• chirurgie s pomocí počítače přístrojové vybavení   MeSH
• fibrilace síní diagnóza   chirurgie   MeSH
• fluoroskopie MeSH
• katetrizační ablace přístrojové vybavení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mapování potenciálů tělesného povrchu přístrojové vybavení   MeSH
• reprodukovatelnost výsledků MeSH
• senzitivita a specificita MeSH
• výsledek terapie MeSH
• zobrazování trojrozměrné přístrojové vybavení   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The goal of this study was to analyze total procedural and fluoroscopic time during initial experience with implantation of LV lead in a single center, and to assess the performance of electrophysiologically-guided approach for cannulation of the coronary sinus (CS) in a subsequent period. Over an initial period of 29 months, a total of 46 attempts to implant biventricular pacing system were revised. During the first phase, only one type of LV electrode was available for three implanters (11 attempts). The second phase covered their early experience with other stylet-controlled LV leads (10 attempts). Additional LV leads including the over-the-wire design were available in the third phase and 25 attempts were done by he most experienced implanter. In a period of advanced experience, 92 implant procedures performed by four implanters using an electrophysiologically-guided approach to CS cannulation were revised. In the first period, success rates for different phases reached 70%, 90%, and 96%, respectively. Significant decrease in both procedural and fluoroscopic times was achieved with increased experience (Phase I: 247.1 +/- 104.5 minutes and 31.2 +/- 34.3 minutes, Phase II: 219.4 +/- 85.6 minutes, and 22.9 +/- 19.1 minutes, Phase III: 116.4 +/- 89.9 minutes and 6.6 +/- 4.4 minutes, respectively, P < 0.05). Advanced experience with electrophysiologically-guided approach to CS cannulation allowed achievement of this target within a reasonable amount of time (15.4 +/- 16.3 minutes) and with minimum fluoroscopic time (2.1 +/- 2.9 minutes). In conclusion, both individual learning curve and technical advances significantly influence success rate, procedural, and fluoroscopic times for biventricular system implantation. Electrophysiologically-guided approach makes cannulation of the CS a highly reproducible procedure that requires minimum fluoroscopic time.

• MeSH
• analýza rozptylu MeSH
• dospělí MeSH
• elektrokardiografie * MeSH
• fluoroskopie MeSH
• implantované elektrody * statistika a číselné údaje   MeSH
• kardiostimulátor * statistika a číselné údaje   MeSH
• klinické kompetence MeSH
• lidé středního věku MeSH
• lidé MeSH
• reprodukovatelnost výsledků MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční selhání patofyziologie   terapie   MeSH
• statistika jako téma MeSH
• studie pohybu a času MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

BACKGROUND: Percutaneous rhizotomy of the Gasserian ganglion is a well-established intervention for patients suffering from refractory trigeminal pain, not amenable to pharmacological management or microvascular decompression. Traditionally conducted under fluoroscopic guidance using Hartel's technique, this study investigates a modified approach employing low-dose CT guidance to achieve maximal procedural precision and safety with the emphasis on minimizing radiation exposure. METHODS: A retrospective analysis of patients undergoing percutaneous rhizotomy of the Gasserian ganglion at our institution was undertaken. Procedures were divided into fluoroscopy and CT-guided foramen ovale (FO) cannulation cohorts. Radiation doses were assessed, excluding cases with incomplete data. The study included 32 procedures in the fluoroscopy group and 30 in the CT group. RESULTS: In the CT-guided group, the median effective dose was 0.21 mSv. The median number of CT scans per procedure was 4.5, and the median procedure time was 15 min. Successful FO cannulation was achieved in all 30 procedures (100%). In the fluoroscopy group, the median effective dose was 0.022 mSv, and the median procedure time was 15 min. Cannulation of FO was successful in 31 of 32 procedures (96.9%). The only complications in the CT-guided group were three minor cheek hematomas. Immediate pain relief in the CT-guided group was reported in 25 of 30 procedures (83.3%), 22 of 30 (73.3%) provided relief at one month, and 10 of 18 (55.6%) procedures resulting in pain relief at one month continued to provide relief after two years. CONCLUSION: Low-dose CT-guided percutaneous rhizotomy conducted in the radiology suite carries negligible radiation exposure for patients and eliminates it for personnel. This method is fast, simple, precise, and carries a very low risk of complications.

• MeSH
• dávka záření MeSH
• dospělí MeSH
• fluoroskopie metody   MeSH
• ganglion trigeminale chirurgie   diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuralgie trigeminu * chirurgie   diagnostické zobrazování   radioterapie   MeSH
• počítačová rentgenová tomografie * metody   MeSH
• radiační expozice * prevence a kontrola   MeSH
• retrospektivní studie MeSH
• rizotomie * metody   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: The objective of this study was to evaluate the accuracy and complication rate of CT fluoroscopy-guided percutaneous core biopsies of the pancreas in patients with a suspected pancreatic neoplasm. MATERIALS AND METHODS: Sixty-three CT-guided biopsies were performed in 57 consecutive patients over a period of 20 months. Forty-nine of the 57 patients had a malignant lesion (85.9%). All procedures were done under CT fluoroscopic guidance. A high-speed biopsy gun with 14, 16, or 18 gauge cutting-type needles was used. Based on final pathologic diagnosis as the standard of reference, the diagnostic efficacy was determined. Complications during and afterward up to the patient's discharge from hospital (mean, 8.1 days; range, 1-48 days) were noted. RESULTS: Core biopsy of the pancreas resulted in a correct diagnosis in 51 of 63 biopsies, yielding a sensitivity for malignancy of 78.1%, a specificity of 100%, a positive predictive value of 100%, and an overall accuracy of 81.0%. One patient of 57 developed an acute pancreatitis related to the biopsy (1.6%). CONCLUSION: CT fluoroscopic-guided core biopsy is a safe and reliable tool for the pretherapeutic evaluation of pancreatic lesions.

• MeSH
• biopsie metody   MeSH
• dospělí MeSH
• fluoroskopie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory slinivky břišní diagnostické zobrazování   patologie   MeSH
• pankreas diagnostické zobrazování   patologie   MeSH
• počítačová rentgenová tomografie * škodlivé účinky   metody   MeSH
• reprodukovatelnost výsledků MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: The aim of this study was to define the optimal fluoroscopic viewing angles of both coronary ostia and important coronary bifurcations by using 3-dimensional multislice computed tomographic data. BACKGROUND: Optimal fluoroscopic projections are crucial for coronary imaging and interventions. Historically, coronary fluoroscopic viewing angles were derived empirically from experienced operators. METHODS: In this analysis, 100 consecutive patients who underwent computed tomographic coronary angiography (CTCA) for suspected coronary artery disease were studied. A CTCA-based method is described to define optimal viewing angles of both coronary ostia and important coronary bifurcations to guide percutaneous coronary interventions. RESULTS: The average optimal viewing angle for ostial left main stenting was left anterior oblique (LAO) 37°, cranial (CRA) 22° (95% confidence interval [CI]: LAO 33° to 40°, CRA 19° to 25°) and for ostial right coronary stenting was LAO 79°, CRA 41° (95% CI: LAO 74° to 84°, CRA 37° to 45°). Estimated mean optimal viewing angles for bifurcation stenting were as follows: left main: LAO 0°, caudal (CAU) 49° (95% CI: right anterior oblique [RAO] 8° to LAO 8°, CAU 43° to 54°); left anterior descending with first diagonal branch: LAO 11°, CRA 71° (95% CI: RAO 6° to LAO 27°, CRA 66° to 77°); left circumflex bifurcation with first marginal branch: LAO 24°, CAU 33° (95% CI: LAO 15° to 33°, CAU 25° to 41°); and posterior descending artery and posterolateral branch: LAO 44°, CRA 34° (95% CI: LAO 35° to 52°, CRA 27° to 41°). CONCLUSIONS: CTCA can suggest optimal fluoroscopic viewing angles of coronary artery ostia and bifurcations. As the frequency of use of diagnostic CTCA increases in the future, it has the potential to provide additional information for planning and guiding percutaneous coronary intervention procedures.

• Klíčová slova
• computed tomography, coronary angiography, coronary arteries, fluoroscopy, percutaneous coronary intervention,
• MeSH
• CT angiografie * MeSH
• fluoroskopie MeSH
• koronární angiografie MeSH
• lidé MeSH
• multidetektorová počítačová tomografie * MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Unstable pelvic fractures are usually associated with high impact energy trauma. As to surgical procedures the most frequently used methods are open reduction and inner fixation (ORIF), the other methods of stabilizing the unstable posterior pelvic ring are percutaneous iliosacral screw fixation under fluoroscopic control and CT-guided percutaneous fixation. The last mentioned procedure eliminates some of the problems associated with surgical treatment: prevents excessive blood loss during manipulation of the fracture hematom, lowers the possibility of infection, allows more accurate screw placement with direct measuring of the screw length and decreases the possibility of nerve injury. The CT-guided fixation is a delicate procedure and its result depends among others on the cooperation between operating room and CT room personnel. The radiologist and CT technologist have to know the operation technique and have to understand surgeon's requirements. In the available literature only a little was written and mentioned about the exact role of radiologist and CT technologist in the team. The aim of this article is to present the operation technique according to authors' own experience with two operated patients and to mention the surgeon's requirements on CT team.

• MeSH
• fraktury kostí diagnostické zobrazování   chirurgie   MeSH
• intervenční radiografie * MeSH
• lidé středního věku MeSH
• lidé MeSH
• pánevní kosti diagnostické zobrazování   zranění   MeSH
• počítačová rentgenová tomografie * MeSH
• vnitřní fixace fraktury * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY: The variability in width, height, and orientation of spinal pedicles makes pedicle screw insertion a delicate operation. Fluoroscopic guidance often exposes the patient and especially surgeons to relatively high doses of ionising radiation. The use of pulsed fluoroscopy is safer, as compared to continuous fluoroscopy, because of reduced radiation exposure. There are increasing numbers of literature reports regarding the high doses of radiation to which orthopaedic and spine surgeons are exposed during surgical procedures. Spine surgery can be associated with significant radiation exposure to the surgical staff. The purpose of this prospective study was to compare a computer-assisted navigation with a conventional procedure in order to assess if it is possible to reduce radiation exposure while preserving the accuracy of screw placement. MATERIAL AND METHODS: The first "conventional" group consisted of 30 patients, with an average of 1.9 segments of the lumbar spine stabilised. Screws were inserted transpedicularly under image intensifier guidance. In the second "navigated" group of 30 patients, stabilisation of 1,8 segments was performed on average. A CT-free fluoroscopic 2D spinal navigation system (VectorVision, Brain LAB, Germany) was used intra-operatively. It combines image-guided surgery with C-arm fluoroscopy. For each surgery (navigated or not), the duration of irradiation was recorded. The irradiation duration was collected from the X-ray image intensifier. In both groups the screw positioning accuracy was controlled intra-operatively according to Learch's, Acikbas's, and Whitecloud's methods from AP and lateral images and by meticulous pedicle palpation. RESULTS: The irradiation duration calculated to one vertebra (two screws) was significantly shorter in the second (navigated) group (3.4 s) than in the first (conventional) group (14.4 s). The mean duration of data registration was 6.0 minutes (range, 3 to 11 minutes). The mean ratio according to Acikbas's calculation method was 43.2 % (range, 32 % to 74 %) in the first (conventional) group and 44.1 % (range, 35 % to 76 %) in the second (navigated) group. DISCUSSION: During a conventional surgical procedure many X-ray images are made to control the accuracy of screw insertion. If the trajectory is not satisfying, it must be corrected or the pedicle is drilled again, always with a new fluoroscopic control. The process is repeated until satisfactory orientation is achieved. This is the explanation for a much longer duration of irradiation in conventional procedures. Navigation facilitates the surgical act, enabling us to acquire the right position of all screws, with only an AP image and a lateral image at the beginning of instrumentation for data registration; prolongation of the operative time is irrelevant. CONCLUSIONS: Navigation allows us to keep the same accuracy of pedicle screw placement while reducing radiation exposure of the surgeons and operating room staff by about one quarter. In multiple-level vertebral instrumentations this reduction is more pronounced. In centres where many procedures involving spine instrumentation are done every day, the "saved" exposure time can amount to hours.

• MeSH
• bederní obratle chirurgie   MeSH
• chirurgie s pomocí počítače * MeSH
• dávka záření * MeSH
• dospělí MeSH
• fluoroskopie * metody   MeSH
• hrudní obratle chirurgie   MeSH
• intervenční radiografie * MeSH
• kostní šrouby * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE: Surgical Gastrostomy has been around since the 19th century but in 1980 the first successful percutaneous endoscopic gastrostomy was reported. A year later the first successful percutaneous gastrostomy was performed using fluoroscopic guidance. The technique for percutaneous insertion and the equipment used has been refined since then and it is now considered the gold standard for gastrostomy insertion. Here we present guidelines for image-guided enteral feeding tubes in adults. MATERIAL AND METHOD: We performed a review and analysis of the scientific literature, other national and international guidelines and expert opinion. RESULTS: Studies have shown fluoroscopic techniques have consistently higher success rates with lower rates of major complications than endoscopic techniques. However, the Achilles' heel of many fluoroscopic techniques is the requirement for smaller gastrostomy tube sizes resulting in them being more prone to blockages and thus requiring further intervention. CONCLUSION: Radiological feeding tube insertion is a safe and effective procedure. Success rates are higher, and complication rates lower than PEG or surgical gastrostomy tube placement and innovative techniques for gastric and jejunal access mean that there are very few cases in which RIG is not possible. The principal weakness of radiologically inserted gastrostomies is the limitiation on tube size which leads to a higher rate of tube blockage. Per-oral image-guided gastrostomies have to an extent addressed this but have not been popularised. Currently many centres still consider endoscopic gastrostomies as the first line unless patients are too unwell to undergo this procedure or previous attempts have failed, in which case radioloically inserted gastrostomies are the technique of choice.

• Klíčová slova
• Disease, Enteral feeding, Gastrointestinal, Gastrojejunostomy/percutaneous endoscopic gastrostomy (PEG), Non-vascular interventions, Organ, Per-oral image-guided gastrostomy (PIG), Radiologically inserted gastrostomy (RIG), Specialty, Stroke, Sub-specialty/technique, Subspecialty/technique,
• MeSH
• dospělí MeSH
• gastrostomie metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• směrnice pro lékařskou praxi MeSH