Download Novel Use of an Image Enhancement Device to Reduce

Novel Use of an Image Enhancement Device to Reduce Fluoroscopic Radiation Exposure during
Ureteroscopic Lithotripsy: A Randomized, Prospective Clinical Evaluation of Lessray™
Ashley J. Brandon, Michael D. Fabrizio, Arjun Poddar and Shaun E.L. Wason
Department of Urology, Eastern Virginia Medical School, Norfolk, Virginia
Introduction
Patients and Methods
 Intraoperative exposure to ionizing
radiation is a growing concern for the
safety of both patient and OR staff
 Efforts to reduce the amount of
radiation during fluoroscopic
procedures often result in decreased
image quality
 LessRay™ is a device used to
digitally enhance images obtained
from a C-arm using a low-dose pulse
setting allowing for reduction in
radiation dose while maintaining
image quality
 After IRB approval, a randomized
prospective trial of 23 patients
undergoing ureteroscopic lithotripsy
for unilateral obstructing ureteral
stones was performed comparing
standard fluoroscopy to LessRay™
 Inclusion criteria:
• Adult, non-pregnant patients
• No anatomic GU abnormalities
• BMI <45
 Patient demographics, stone
parameters and operative
characteristics were recorded in
addition to total radiation dose, total
fluoroscopy time and images
obtained
 Dosimetry badges worn by OR
personnel estimated radiation
exposure to operating room staff
Lessray™ Technology
 The Lessray™ system is a standalone computer display system
interfaced to a fluoroscope with a
video cable and combines the current
image with a prior baseline image of
the same anatomy
 An algorithm provides for digitally
enhanced images (higher resolution)
using the low dose-pulse setting snf
incorporates tracking and alternating
features
 Used exclusively in orthopedic
surgery to date
Results
Discussion
 Average patient radiation dose was
decreased from 1003 to 373 mRAD
(p = 0.008) per case, along with total
fluoroscopy time (43.32 vs. 16.2 sec,
p= 0.006) and average dose per
image (23.6 vs. 10.3 mRAD/image,
p= 0.002) using LessRay™
compared to standard fluoroscopy
intraoperatively (table 2)
 A statistically significant reduction in
radiation exposure to the surgeon
was also noted (p= 0.03). Image
quality was not compromised
substantively and no conversion from
low radiation imaging to standard
fluoroscopy was needed in any case
due to inadequate visualization
 A 63% reduction in average patient
radiation exposure was achieved using the
LessRay™ device compared to standard
fluoroscopy in ureteroscopic procedures
performed for solitary obstructing ureteral
stones
 LessRay™ allowed for a greater than 4x
reduction in the amount of radiation to the
urologist during a single procedure
 A significant limitation of this study includes
the inability to blind the surgeon to the
intervention due to the nature of the device
which may have introduced a bias
Conclusion
 LessRay™ offers an innovative and novel
technique for significantly reducing
intraoperative radiation exposure from
fluoroscopic imaging for both patients and
surgeons. It has never been previously
described in the urologic literature
 Image resolution is superior to low-dose
pulse fluoroscopy and additional features
enhance standard fluoroscopy. In addition
to ureteroscopy, future applications in
urology may include PCNL or any
procedure where fluoroscopy is utilized
Shaun E. L. Wason, MD: [email protected]