Efficacy of portable X-ray in identifying retained suture needles in ophthalmologic cases

Abstract

Aims To evaluate the role and efficacy of portable X-ray in reliably identifying retained suture needles in ophthalmologic surgical cases. Methods Ophthalmologic 10À0 nylon suture needles were placed into 10 of 20 porcine eyes positioned within the orbit of a human skull. Portable, plain film radiographs were taken of all eyes with a C-arm fluoroscopy machine. The films were reviewed by six ophthalmologists and six radiologists who were blinded to the presence or absence of needles, as well as the number of needles used in the protocol. The sensitivity and specificity of identifying retained suture needles by plain film radiographs were then analysed based on the results of the physicians' interpretations of the films. Results The overall sensitivity and specificity for physicians reviewing radiographs with suspected intraoperative suture needles were 54 and 77%, respectively. When looking separately at radiologists reviewing the films, the sensitivity was 57% and the specificity was 87%. Ophthalmologists reviewing the films identified retained needles less reliably with a sensitivity of 51% and a specificity of 67%. Conclusions Significant controversy exists regarding the reliability and utility of plain film radiography in identifying intraocular foreign bodies. This study demonstrates that the use of plain film radiographs to rule-out the presence of an intraocular surgical needle is neither a sensitive nor specific imaging modality.

Clinical Issues—March 2022

“…Yes, there is evidence identifying which suture needle lengths can be located on radiographic images but it is conflicting 1‐7 . Additionally, the evidence is limited by several factors, including a focus on abdominal imaging, the use of acrylic torsos and animals, the placement of the needles (eg, blinded, nonblinded), inconsistencies among the personnel reviewing the images, differences in reporting of needle length or suture size (eg, 10‐mm, 9‐0), and publication before 2016.…”

“…In a study of the use of a portable x‐ray device as a means to identify retained suture needles, researchers found low levels of sensitivity and specificity when both ophthalmologists and radiologists reviewed the radiographs for retained needles from 10‐0 suture placed in porcine eyes 5 . Small needles (eg, from a 10‐0 suture) used during ophthalmology procedures may be lost during transfer to and from the operative site.…”

“…The researchers suggested the following. When a small needle is seen falling outside the operative site during transfer from the sterile field and cannot be located by the surgical team, an ophthalmologist exploring the surgical site may be more effective than radiographic imaging. When retainment of a small needle is suspected in ophthalmology procedures, a computerized tomography scan or ultrasound evaluation may be more effective in locating a suture needle than radiologic imaging 5 …”

Assessment of x‐ray efficacy for intraoperative microneedle retrieval using a cadaveric model

“…Institutions, including our own, enforce a retrieval protocol that utilizes intra-operative x-ray imaging to detect RSIs (Kieval et al, 2009;…”

“…The incidence of retained surgical items (RSI) is estimated to be one in every 1000–18,000 surgeries (Weprin, Crocerossa, et al, 2021). Institutions, including our own, enforce a retrieval protocol that utilizes intra‐operative x‐ray imaging to detect RSIs (Kieval et al, 2009; Macilquham et al, 2003; McCombe et al, 2021; Yanagawa et al, 2018). Our institution's protocol requires the operating surgeon to pause wound closure and proceed with close examination of the wound, whereas the operating room (OR) staff search the nonsterile field.…”