Search

Objectives Fenestrated endovascular aneurysm repair (FEVAR) exposes operators and patients to considerable amounts of radiation. Introduction of fusion of three-dimensional (3D) computed tomography (CT) with intraoperative fluoroscopy puts new focus on advanced imaging techniques in the operating environment and has been found to reduce radiation and facilitate faster repair. The aim of this study is to evaluate the radiation dose effect of introducing a team-based approach to complex aortic repair. Methods Procedural details for a cohort of 21 patients undergoing FEVAR after fusion-guided (Modern Group) imaging was introduced are compared with 21 patients treated in the immediate 12 months prior to implementation (Historic Group) at a centre with expertise in FEVAR. Non-parametric tests were used to compare procedure time (PT), air kerma, dose-area product (DAP), fluoroscopy time (FT), estimated blood loss (EBL) and pre- and post-operative estimated glomerular filtration rate (eGFR) between the groups. Results Change in operative approach resulted in a significant reduction in PT for the Modern group (median 285 mins; interquartile range 268–322) compared with the Historic group (450 mins; IQR 360–540 p = <0.001). There were reductions in skin dose for the Modern group (1.6 Gy; IQR 1.09–2.1) compared with the Historic group (4.4 Gy; 3.2–7.05 p = <0.001), and DAP (Modern 159 Gy.cm 2 ; IQR 123–226 vs 264.93 Gy.cm 2 ; 173.3–366.8 for Historic ( p = 0.006). There were no significant differences in FT, and pre- and post-operative eGFR between the two groups. Weight and height were distributed equally across both groups. Structured dose reports including the changes in frame rate were not available for analysis. Conclusions Implementation of a team-based approach to radiation reduction significantly reduces radiation dose. These findings suggest that the radiation safety awareness that accompanies the introduction of fusion imaging may improve the overall radiation safety profile of FEVAR for patients and providers. [ABSTRACT FROM AUTHOR]

Abstract: Aerosol transport simulations within Europe were performed with the regional transport model COSMO-MUSCAT for two different time periods, July 19–26, 2006 and February 16–26, 2007. Simulated PM 2.5, backscatter profiles and aerosol optical depths (AODs) were compared to observations, showing good agreements in magnitude, shape and day-to-day variations. Maximum AODs (>0.4) were found over Middle Europe and minimum AODs (<0.13) over the ocean during both time periods, corresponding to regions of high (PM 2.5 > 10 μg m−3) and low (PM 2.5 < 4.0 μg m−3) concentration near the surface. Vertical aerosol distributions were evaluated with lidar measurements from the EARLINET ground network and CALIPSO satellite retrievals. The characteristic vertical distribution and the differences for the summer and the winter cases were represented well by the regional model. Mean differences between −5.0 × 10−7 to−2.0 × 10−7 m−1 sr−1 (summer case) and −2.3 × 10−6 to 1.0 × 10−6 m−1 sr−1 (winter case) from 0.0 to 2.5 km altitude were found between observed (space-based lidar) and simulated backscatter coefficients. For the cases that were investigated in this study different prescriptions of the vertical distribution at the lateral model boundaries resulted in only small differences in aerosol distributions within the interior of the model region. [Copyright &y& Elsevier]

B Background: b Use of augmented reality (AR) based image guidance systems (IGS) has been proposed as a method to improve anatomical orientation during laparoscopic liver surgery (LLS) with potential benefits for patients. In addition enhanced visualisation methods with the potential to improve mental integration between surgeons and AR environment will be presented. During surgery a 3D liver model was manually overlayed onto the laparoscopic screen (registration) to create an AR environment. [Extracted from the article]