SummaryFollowing recent rapid advances in devices and treatment technology, indications for percutaneous peripheral intervention (PPI) have been expanded to include complex lesions (long-segment lesions, completely obstructed chronic lesions, etc.) and even lesions of the superficial femoral artery and arteries distal to the popliteal artery. However, when PPI is used for treatment of complete obstruction, treatment can take a long time or its outcome can be less satisfactory for reasons such as difficulty in assessing the vascular distribution/arrangement or the direction of calcification in the obstructed area or excessively long lesions. In the present study, we conducted threedimensional image processing of CT data from leg arteries conventionally used for preoperative diagnosis. Using this processing technique, we created virtual images of the blood vessels of the completely obstructed area and mapped these virtual vessel images onto the fluoroscopic monitor image during catheter treatment. The usefulness of this technique for PPI was then evaluated. We succeeded in creating virtual vessel images of the completely obstructed parts of leg arteries with the use of preoperative CT images of leg arteries that we then mapped onto the fluoroscopic monitor images during treatment. We were successful in mapping virtual images onto the abdominal aorta in 96.8% of cases and in 95.7% with the common iliac artery. This technique is thus able to supply reliable information on vascular distribution/arrangement, suggesting that it can enable the surgeon to advance the treatment device precisely along the vessels, making it useful for treatment with PPI. The study additionally showed that differences in the angle of imaging affect the manual mapping of the CT images onto angiograms.
Pediatric patients are especially sensitive to radiation, and when scanning their heads with CT, it is necessary to do so with a low dose and pay very close attention. However, there are many problems when scanning pediatric patients, and it is often confusing to set the conditions for scanning. To do a survey and comparison, we issued a questionnaire to 23 pediatric hospitals and 89 university hospitals, asking about their usage of sedation, studied disorders, as well as how and under what conditions they scan their patients. The percentage of response was 40% in total. Based on the questionnaire results, we could not see much difference in the conditions for scanning. However, there was a significant difference in the usage of sedation and studied disorders between pediatric hospitals and university hospitals. The most studied disorders at pediatric hospitals were convulsion and consciousness disorders, and low-contrast areas such as the albocinereous, which requires images without movement artifacts. In order to obtain clear images, the patient was put under sedation. On the other hand, university hospitals often deal with external injuries, which usually involve danger in using sedation, and patients are usually examined without it. In addition, the usage of sedation is rare because bleeding brings up high-contrast images, and it is easy to make a diagnosis even if there is some movement artifact. Also to aim at setting a standard for medical technology, from here on, guidelines of examining methods and setting conditions should be made depending on how the different disorders should be treated.
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