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Fluoroscopy Bundle Curbs Radiotherapy Exposure

By MedImaging International staff writers
Posted on 05 Oct 2017

Image: A novel system reduces fluoroscopy times during spine surgery (Photo courtesy of NuVasive).

A system comprised of propriety software algorithm and hardware components helps address over exposure to radiation in hospital operating rooms (OR), particularly in the case of minimally invasive spine surgery.

The NuVasive (San Diego, CA, USA) LessRay software system uses proprietary image enhancement technology in order to improve low-dose, low-radiation fluoroscopy (or x-ray) images, so that they have similar diagnostic capabilities as those of conventional full-dose fluoroscopy images, thus reducing radiation emission and exposure. Other features that reduce radiation exposure time include C-arm tracking, which simplifies localization and target anatomy quickly, accurately, and without the unnecessary scouting images. Economic benefits include no disruption to current surgical workflow and no additional surgery time needed.

An angle finder minimizes the number of OR steps required in order to obtain crisp endplate shots, with fewer fluoroscopic images than traditional C-arm scouting, and Alternate view, a feature that improves visualization by making metal instruments invisible or semi-transparent by fading out their obstruction. And image-stitching software minimizes surgical workflow interruption by rapidly stitching fluoroscopic images of any spine segment. A recent study demonstrated that radiation exposure of OR healthcare staff was 62-84% lower with LessRay, compared to conventional fluoroscopy.

“With LessRay's ability to dramatically reduce radiation exposure, as well as its enhanced imaging capability, we are now executing on our imaging and navigation strategy to improve spine surgery productivity, and ultimately predictability,” said Gregory Lucier, chairman and CEO of NuVasive. “Given the healthy pipeline of interest from customers already, the strong demand demonstrates a critical need for a solution like LessRay to address a major safety issue related to radiation facing surgeons and hospital administrators.”

“LessRay's ability to reduce radiation usage is so compelling because it benefits not only the surgeon but also the patient and everyone in the operating room,” said neurosurgeon Stephen Ryu, MD, of Palo Alto Medical Foundation (CA, USA). “Additional features that augment the capability of conventional fluoroscopy provide really useful tools for even the simplest surgeries. LessRay's capability to assist accurate localization of spine levels alone is worth it.”

Studies show spine and orthopedic surgeons can receive their lifetime occupational radiation limit within the first 10 years of their career. As a result, subsequent cancer rates and contraction of cataracts associated with radiation exposure are nearly double that of other surgery practices. Surgeons and support staff can use lead aprons and gloves, thyroid shields and protective glasses to try to minimize this, but this can have an impact on image quality, making it grainy and harder to interpret.

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69 (180.00602722168): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

70 (334.02442932129): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 2194.881439209): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (!!!!! 3782.0339202881): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (220.06034851074): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (679.01611328125): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (235.08071899414): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (212.9077911377): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (626.80244445801): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (177.86026000977): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 4395.9617614746): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (85.115432739258): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (33.855438232422): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (65.088272094727): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (27.894973754883): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (30.994415283203): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (25.033950805664): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

106 (51.975250244141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (43.869018554688): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (139.95170593262): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

109 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

110 (48.87580871582): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (474.92980957031): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (530.00450134277): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (369.07196044922): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (84.161758422852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

116 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

117 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

118 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

119 (40.054321289062): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

120 (263.92936706543): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 38821.935653687): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (316.85829162598): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

123 (175.95291137695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

124 (!!!!! 1441.9555664062): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294770994 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294770994 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 550516.84379578): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 666330.09910583): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (61.988830566406): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (30.994415283203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (43.869018554688): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (597.00012207031): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (394.82116699219): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (203.13262939453): SELECT name FROM jos_deeppockets WHERE id=213

136 (42.915344238281): SELECT name FROM jos_deeppockets WHERE id=213

137 (509.97734069824): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (456.09474182129): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (959.15794372559): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

140 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

141 (!!!!! 17343.997955322): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 4377.8419494629): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (!!!!! 2073.0495452881): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294770994 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (809.90791320801): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

147 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

148 (!!!!! 1387.1192932129): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (66.995620727539): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

150 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

151 (46.968460083008): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294770994 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294770994 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (34.093856811523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

153 (38.862228393555): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

154 (36.001205444336): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (901.93748474121): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

156 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294770994 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294770994 AND published='1' LIMIT 1

157 (!!!!! 2042.0551300049): select jos_twitters.link from jos_twitters where cat=10

158 (429.15344238281): select jos_facebook.link from jos_facebook where cat=10

159 (41.007995605469): select jos_google_plus.link from jos_google_plus where cat=10

160 (29.802322387695): select jos_linkedin.link from jos_linkedin where cat=10

161 (501.15585327148): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1392.126083374): insert into jos_banners_delta values (14615,'2025-04-30 13:56:43','3.128.29.244','view'),(14202,'2025-04-30 13:56:43','3.128.29.244','view'),(14203,'2025-04-30 13:56:43','3.128.29.244','view')

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