Vorstellung eines neuen mobilen C-Bogen-/CT-Kombinationsgerät (ISO-C-3D)

Rock, C.; Linsenmaier, Ulrich; Brandl, Richard; Kotsianos, D.; Wirth, Stéfan; Kaltschmidt, R.; Euler, Ekkehard; Mutschler, Wolf; Pfeifer, K. J.

doi:10.1007/s001130170053

Cited by 86 publications

(21 citation statements)

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“…Meanwhile mobile 3D image intensifiers that provide multiplanar reconstructions of the scanned body section from isocentrically acquired conventional X-ray images are available [22]. They could be used as a pure diagnostic tools and in combination with a navigation system.…”

Section: Introductionmentioning

confidence: 99%

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

et al. 2009

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Internal fixation is the established dorsal standard procedure for the treatment of thoracolumbar fractures. The main problem of the procedure is the false positioning of the pedicle screws. The exact determination of pedicle screws has up to now only been possible through postoperative computed tomography. This study was intended to clarify the diagnostic value of intraoperative 3D scans after pedicle screw implantation in thoracolumbar spine surgery. The direct intraoperative consequences of the 3D scans are reported and the results of the 3D scans are compared with the postoperative computed tomography images. Intraoperative 3D scans were prospectively carried out from June 2006 to October 2008 on 95 patients with fractures of the thoracolumbar spine that have been treated with internal fixation. Screws positions were categorised intraoperatively, screws in relevant malposition were repositioned immediately. A computed tomography of the involved spinal section was carried out postoperatively for all patients. The positions of the pedicle screws were determined and compared in the axial reconstructions of both procedures. Four hundred and fourteen pedicles with enclosed screws were evaluated by the 3D scans. The time needed for carrying out the 3D scan amounts to an average of 8.2 min. Eleven screws (2.7%) in ten patients were primarily intraoperatively repositioned on the basis of the 3D scan evaluation. Two of 95 patients had to have false positions of the screws revised secondarily following evaluation of the computed tomographies. The secondary postoperative revision rate of the patients amounts to 2.1%. In relation to the number of screws, this is a revision rate of 0.5%. The postoperative computed tomographies showed 323 pedicles without cortical penetration by the screws (78.0%). Ninety-one screws penetrated the pedicle wall (22%). It was possible to postoperatively compare the position classifications of 406 pedicle screws. The CT showed 378 correct screw positions, while 28 screws were positioned falsely. On the basis of the 3D scans, 376 of 378 correct positions were correctly assessed. Twenty-one of 28 false positions could be correctly classified. The sensitivity of all 3D scans reached 91.3% and the specificity 98.2%. The position of 97.8% of the pedicle screws was correctly recognised by the intraoperative 3D scan. Nine screws were classified falsely (2.2%). The comparison of the classification results showed significantly higher error findings by the 3D scan in the spinal section T1-10 (P = 0.014). The image quality of the 3D scan correlates significantly with the width of the scanned pedicle, with the body mass index, the scanned spinal section and the extent of the fixation assembly. 3D scans showed a high accuracy in predicting pedicle screw position. Primary false placement of screws and primary neurovascular damage cannot be avoided. But intraoperative evaluation of the 3D scans resulted in a primary revision rate of 2.7% of the pedicle screws and we could lower the secondary revis...

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Section: Introductionmentioning

confidence: 99%

Benefit and accuracy of intraoperative 3D-imaging after pedicle screw placement: a prospective study in stabilizing thoracolumbar fractures

et al. 2009

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“…Mit einem Prototyp des Siremobil Iso-C 3D -Bildwandlergerä tes wurden die Hochkontrastauflö sung ermittelt und Dosismessungen vorgenommen [2,5]. Weiterhin wurden an verstorbenen Unfallopfern und anatomischen Leichen dreidimensionale C-Bogen-Untersuchungen und vergleichende Spiral-CT-Untersuchungen der Extremitä tengelenke durchgefü hrt.…”

Section: Material Methodeunclassified

“…Ein unbefriedigendes Rekonstruktionsergebnis bei dislozierten Gelenkfrakturen oder eine Schraubenfehllage werden daher vielleicht erst in einer postoperativen Kontroll-Computertomographie (CT) sichtbar. In der Wirbelsäu-lenchirurgie wurden deshalb fü r die Pedikelschrauben-Platzierung Navigationssysteme auf der Basis prä operativ angefertigter CT-Datensä tze entwickelt [5], mit deren Hilfe die Rate der Fehlplatzierung erheblich gesenkt werden konnte [3]. Bei diesen Systemen wird, vergleichbar den in der KFZ-Industrie realisierten GPS-Navigationssystemen, die Position des chirurgischen Instruments (KFZ-GPS: Fahrzeug) ü ber ein Kamerasystem (KFZ-GPS: Satelliten) in das prä operative CT-Bild oder das intraoperative C-BogenBild (KFZ-GPS: Stadtplan, Landkarte) ü bertragen (virtuelle Realitä t).…”

Section: Zusammenfassungunclassified

“…Die Hochkontraststudien zur Ermittlung der Bildauflö sung zeigten mit einer Hochkontrastauflö sung von 9 LP/cm eine der CT vergleichbare Detailerkennbarkeit [5]. Die Strahlendosen (Dosislän-genprodukte, Flä chendosisprodukte) des Iso-C 3D waren bei Verwendung der Standardeinstellung fü r kleine Extremitä tengelenke (100 Einzelbilder) mit denen einer Spiral-CT vergleichbar, bei der Einstellung fü r große Gelenke lag sie hö her.…”

Section: Ergebnisseunclassified

See 1 more Smart Citation

Dreidimensionale C-Bogen-Darstellung im Experiment und Klinik

Euler¹,

Heining²,

Fischer³

et al. 2002

OP-Journal

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“…Die Möglichkeit zur zweidimensionalen Projektionsradiographie war somit im Operationssaal anwendbar. Durch die isozentrische Anordnung und Motorisierung des C-Bogens war es erstmals möglich, mit Röntgenröhre und Detektor orbital und automatisiert um den zu untersuchenden Bereich zu rotieren [1]. Während der Bewegung werden je nach Einstellung 50 bis 100 Bilder gemacht, die mit einem Algorithmus ähnlich der Computertomographie zu einem dreidimensionalen Datensatz zusammengefügt werden.…”

Section: Was Ist 3-d-bildgebung?unclassified