Left Behind: Unintentionally Retained Surgically Placed Foreign Bodies and How to Reduce Their Incidence—Pictorial Review

Abstract

Despite various systems and safeguards available, unintentionally retained surgically placed foreign bodies remain difficult to eliminate completely. Developing a standardized approach to the request, "intraoperative film, rule out foreign body," is essential to reduce the adverse outcomes associated with this problem.

Radiopaque Medical Devices Improve Patient Safety

“…For example, surgical gauze can be impregnated with radiopaque stitches or a surgical sponge can be soaked with a contrast agent or have a radiopaque strip attached. 4 In other medical devices, such as catheters and stents, selecting and adding the appropriate radiopacifier are more complicated tasks.…”

Intraoperative Radiography for Evaluation of Surgical Miscounts

“…Standard recommendations for improving effectiveness of intraoperative radiography have not been broadly adopted [19]. Some institutions routinely screen for retained items, imaging every postoperative patient.…”

Modified Map-Seeking Circuit: Use of Computer-Aided Detection in Locating Postoperative Retained Foreign Bodies

“…Our modifications to this algorithm have reduced the computing time required to identify an RFB in an X-ray and have resulted in an RFB search technique that might improve the radiologist's RFB detection rate of 30% for small needles (<10 mm in diameter) [2]. It may also reduce the risk for false-negative/ positive findings, which is significant, even in recent studies [9,10].…”

“…However, such tools have not gained wide acceptance because of the increased risk of radiation exposure while using the former modalities and the excessive diagnosis time that is required when the latter modality is applied [7,15]. Most importantly, sponges and equipment are not consistently visualized [10,16]. CAD may be suitable for avoiding all of these issues by improving the accuracy of detection from an intra-operative X-ray and, therefore, reducing the associated risk for mortality and morbidity.…”