• The Korean Journal of Pain
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• v.25 no.2
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• pp.81-88
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• 2012

Background: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. Methods: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. Results: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. Conclusions: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.

• Korean Journal of Radiology
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• v.22 no.7
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• pp.1124-1131
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• 2021

Objective: To evaluate the feasibility, safety, and effectiveness of CT-guided microcoil localization of solitary pulmonary nodules (SPNs) for guiding video-assisted thoracoscopic surgery (VATS). Materials and Methods: Between June 2016 and October 2019, 454 consecutive patients with 501 SPNs who received CT-guided microcoil localization before VATS in our institution were enrolled. The diameter of the nodules was 0.93 ± 0.49 cm, and the shortest distance from the nodules to the pleura was 1.41 ± 0.95 cm. The distal end of the microcoil was placed less than 1 cm away from the nodule, and the proximal end was placed outside the visceral pleura. VATS was performed under the guidance of implanted microcoils without the aid of intraoperative fluoroscopy. Results: All 501 nodules were marked with microcoils. The time required for microcoil localization was 12.8 ± 5.2 minutes. Microcoil localization-related complications occurred in 179 cases (39.4%). None of the complications required treatment. A total of 463 nodules were successfully resected under the guidance of implanted microcoils. VATS revealed 38 patients with dislocated microcoils, of which 28 underwent wedge resection (21 cases under the guidance of the bleeding points of pleural puncture, 7 cases through palpation), 5 underwent direct lobectomy, and the remaining 5 underwent a conversion to thoracotomy. In 4 cases, a portion of the microcoil remained in the lung parenchyma. Conclusion: CT-guided microcoil localization of SPNs is safe and reliable. Marking the nodule and pleura simultaneously with microcoils can effectively guide the resection of SPNs using VATS without the aid of intraoperative fluoroscopy.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.247-256
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• 2014

Purpose : To assess target motion during radiotherapy by quantifying daily setup errors and inter-fractional and intra-fractional movements of pancreatic fiducials. Materials and Methods : Eleven patients were treated via stereotactic body radiotherapy (SBRT) with volumetric modulated arc therapy. Bony setup errors were calculated using cone beam computed tomography (CBCT). Inter-fractional and intrafractional fiducial (seed) motion was determined via cone beam computed tomography (CBCT) projections and orthogonal fluoroscopy. Results : Using an off-line correction protocol, setup errors were 0.0 (-1.7-4.0), 0.3 (-0.5-3.0), and 0.0 (-4.1-6.6) mm for the left-right, anterior-posterior, and superior-inferior directions respectively. Random inter-fractional setup errors in the mean fiducial positions were -0.1, -1.1, and -2.3 mm respectively. Intra-fractional fiducial margins were 9.9, 7.8, and 12.5 mm, respectively. Conclusion : Online inter-fractional and intra-fractional corrections based on daily kV images and CBCT expedites SBRT of pancreatic cancer. Importantly, inter-fractional and intra-fractional motion needs to be measured regularly during treatment of pancreatic cancer to account for variations in patient respiration.

• Journal of Chest Surgery
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• v.53 no.4
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• pp.211-216
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• 2020

Esophageal fistulas may occur in an advanced stage or as a potentially life-threatening complication of treatment. They can be divided into esophageal-respiratory and esophageal-aorta fistulas. The diagnosis is confirmed with fluoroscopy using dilute barium oral contrast, followed by thin-section computed tomography, which defines the precise location and extent of the fistula. Flexible esophagoscopy and bronchoscopy are required for confirmation and anatomic assessment of the suspected fistula and provide additional information for treatment planning. Contamination is traditionally controlled by surgical exclusion, along with a jejunal feeding tube. Currently, fully covered self-expanding metal stents are the primary treatment option.

• Tuberculosis and Respiratory Diseases
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• v.84 no.4
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• pp.282-290
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• 2021

Background: Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) has improved the diagnostic yield of bronchoscopic biopsy of peripheral pulmonary lesions (PPLs). The diagnostic yield and complications of RP-EBUS-TBLB for PPLs vary depending on the technique, such as using a guide sheath (GS) or fluoroscopy. In this study, we investigated the utility of RP-EBUS-TBLB using a GS without fluoroscopy for diagnosing PPLs. Methods: We retrospectively reviewed data from 607 patients who underwent RP-EBUS of PPLs from January 2019 to July 2020. TBLB was performed using RP-EBUS with a GS without fluoroscopy. The diagnostic yield and complications were assessed. Multivariable logistic regression analyses were used to identify factors affecting the diagnostic yields. Results: The overall diagnostic accuracy was 76.1% (462/607). In multivariable analyses, the size of the lesion (≥20 mm; odds ratio [OR], 2.06; 95% confidence interval [CI], 1.27-3.33; p=0.003), positive bronchus sign in chest computed tomography (OR, 2.30; 95% CI, 1.40-3.78; p=0.001), a solid lesion (OR, 2.40; 95% CI, 1.31-4.41; p=0.005), and an EBUS image with the probe within the lesion (OR, 6.98; 95% CI, 4.38-11.12; p<0.001) were associated with diagnostic success. Pneumothorax occurred in 2.0% (12/607) of cases and chest tube insertion was required in 0.5% (3/607) of patients. Conclusion: RP-EBUS-TBLB using a GS without fluoroscopy is a highly accurate diagnostic method in diagnosing PPLs that does not involve radiation exposure and has acceptable complication rates.

• Journal of the Korean Society of Radiology
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• v.81 no.4
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• pp.770-793
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• 2020

Newborn gastrointestinal tract emergency diseases include various disorders that occur anywhere along the digestive tract. Most of them are congenital malformations, not acquired diseases. Many of them cannot be confirmed on prenatal examination, and consequently, postnatal evaluation is required. Unlike adults, in newborn babies, detailed evaluations with computed tomography (CT) and magnetic resonance imaging (MRI) are often limited, so making the diagnosis based on early abdominal radiography is most important. Therefore, it is necessary to be familiar with the radiologic findings that may be seen on imaging studies. In addition, it is important to understand abdominal ultrasound and fluoroscopy findings, which can be used in addition to simple radiography and indications that can be used for further diagnosis and appropriate treatment. Therefore, this study describes and organizes the various imaging findings that may occur in neonatal gastrointestinal emergencies.

• Journal of Veterinary Clinics
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• v.34 no.5
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• pp.318-324
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• 2017

The objective of this study was to establish kinematic reference ranges for the femorotibial (FT) joint and the patellofemoral (PF) joint in healthy small-breed dogs by measuring 3D kinematics at the walk. Single-plane fluoroscopy was used to image the stifle joints of five healthy beagle dogs while the dogs were walking. 3D bone models of the femur, patella, and tibia were reconstructed by computed tomography scanning of the beagle dogs' hind limbs. The shape-matching technique was used to measure kinematic data from the fluoroscopic images and the 3D bone models. The cranial translation of the tibia during walking was inversely proportional to the FT joint flexion. There were significant correlations between the patellar motion and the tibial motion. The FT joint flexion had a strong correlation with the patellar proximodistal translation and flexion. Additionally, the tibial mediolateral translation had a strong correlation with the patellar shift and tilt. In this study, normal in vivo 3D FT joint and PF joint kinematics were demonstrated, and the average kinematic parameters were determined in walking beagle dogs.

• Journal of Korean Neurosurgical Society
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• v.56 no.4
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• pp.330-333
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• 2014

Objective : To identify the accuracy and efficiency of the computed tomographic (CT)-based navigation system on upper cervical instrumentation, particularly C1 lateral mass and C2 pedicle screw fixation compared to previous reports. Methods : Between May 2005 and March 2014, 25 patients underwent upper cervical instrumentation via a CT-based navigation system. Seven patients were excluded, while 18 patients were involved. There were 13 males and five females; resulting in four degenerative cervical diseases and 14 trauma cases. A CT-based navigation system and lateral fluoroscopy were used during the screw instrumentation procedure. Among the 58 screws inserted as C1-2 screws fixation, their precise positions were evaluated by postoperative CT scans and classified into three categories : in-pedicle, non-critical breach, and critical breach. Results : Postoperatively, the precise positions of the C1-2 screws fixation were 81.1% (47/58), and 8.6% (5/58) were of non-critical breach, while 10.3% (6/58) were of critical breach. Most (5/6, 83.3%) of the critical breaches and all of non-critical breaches were observed in the C2 pedicle screws and there was only one case of a critical breach among the C1 lateral mass screws. There were three complications (two vertebral artery occlusions and a deep wound infection), but no postoperative instrument-related neurological deteriorations were seen, even in the critical breach cases. Conclusion : Although CT-based navigation systems can result in a more precise procedure, there are still some problems at the upper cervical spine levels, where the anatomy is highly variable. Even though there were no catastrophic complications, more experience are needed for safer procedure.

• The Korean Journal of Pain
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• v.30 no.1
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• pp.66-70
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• 2017

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

• Journal of Korean Neurosurgical Society
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• v.57 no.5
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• pp.376-378
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• 2015

Cervical epidural steroid injection is indicated for radicular symptoms with or without axial neck pain. Complications are rare but can be serious. Here, we report the case of a 54-year-old man with cervical radicular pain who was treated with cervical epidural steroid injection. Injection was administered twice under fluoroscopic guidance with the loss-of-resistance technique using air to confirm the epidural space. After the second procedure, the patient complained of severe persistent headache and was diagnosed with pneumocephalus on brain computed tomography. The patient returned home without any neurological complication, after a few days of conservative treatment. Though, a fluoroscopic guidance cervical epidural injection is also known to diminish the risk of complications. Physicians should always keep in mind that it does not guarantee safety, particularly in the cervical region, related to its anatomical considerations.