Use of the flat panel detector fluoroscope reduces radiation exposure during periacetabular osteotomy.

The Periacetabular Osteotomy is a technically demanding procedure that requires precise intraoperative evaluation of pelvic anatomy. Fluoroscopic images pose a radiation risk to operating room staff, scrubbed personnel, and the patient. Most commonly, a Standard Fluoroscope with an Image Intensifier is used. Our institution recently implemented the novel Fluoroscope with a Flat Panel Detector. The purpose of this study was to compare radiation dosage and accuracy between the two fluoroscopes. A retrospective review of a consecutive series of patients who underwent Periacetabular Osteotomy for symptomatic hip dysplasia was completed. The total radiation exposure dose (mGy) was recorded and compared for each case from the standard fluoroscope (n = 27) and the flat panel detector (n = 26) cohorts. Lateral center edge angle was measured and compared intraoperatively and at the six-week postoperative visit. A total of 53 patients (96% female) with a mean age and BMI of 17.84 (± 6.84) years and 22.66 (± 4.49) kg/m2 (standard fluoroscope) and 18.23 (± 4.21) years and 21.99 (± 4.00) kg/m2 (flat panel detector) were included. The standard fluoroscope averaged total radiation exposure to be 410.61(± 193.02) mGy, while the flat panel detector averaged 91.12 (± 49.64) mGy (p < 0.0001). The average difference (bias) between intraoperative and 6-week postoperative lateral center edge angle measurement was 0.36° (limits of agreement: - 3.19 to 2.47°) for the standard fluoroscope and 0.27° (limits of agreement: - 2.05 to 2.59°) for the flat panel detector cohort. Use of fluoroscopy with flat panel detector technology decreased the total radiation dose exposure intraoperatively and produced an equivalent assessment of intraoperative lateral center edge angle. Decreasing radiation exposure to young patients is imperative to reduce the risk of future comorbidities.

Quick Guide: Programming a Gaming Keyboard for PACS to Optimize Radiology Workflow.

The surging demand for diagnostic imaging has highlighted inefficiencies with traditional input devices. Radiologists, using conventional mice and keyboards, grapple with cumbersome shortcuts leading to fatigue, errors, and possible injuries. Gaming keyboards, designed for gamers' precision and adaptability, feature customizable keys that simplify complex tasks into single-touch actions, offering radiologists a more efficient workflow with less physical and mental strain. Incorporating these keyboards could revolutionize radiologists' engagement with PACS. The customizable feature significantly trims time spent searching, ushering in swifter, ergonomic interactions. This manuscript delineates a guide for adapting a Logitech gaming keyboard to radiology needs, from profile creations and shortcut mapping to intricate macro setups. Although the guide uses a Logitech gaming keyboard for demonstration, it is designed to be intuitive, helping users adapt to their unique needs across different modalities, subspecialties, and various radiology viewer software. Furthermore, its fundamental concepts are transferrable to other mouse brands or models with similar customization software. As radiology pivots toward utmost efficiency, gaming keyboards emerge as invaluable assets, promising significant workflow enhancements.

Quick Guide: Programming a Gaming Mouse for PACS to Optimize Radiology Workflow.

The increasing demand for diagnostic imaging has added to the radiologists' workload, highlighting the shortcomings of conventional computer mice. Radiologists grapple with inefficiencies from frequent mouse clicks and keyboard shortcuts required for various PACS functions. These inefficiencies contribute to cognitive strain, errors, and repetitive strain injuries. High-performance gaming mice, known for their precision in the gaming world, offer multiple custom buttons and superior tracking. These features can streamline radiology tasks. Utilizing a gaming mouse tailored for radiology tasks can substantially enhance efficiency. Our guide offers a step-by-step approach to harnessing the gaming mouse's capabilities for radiology tasks, ensuring radiologists can enhance their workflow and minimize injury risks. Although the guide uses a Logitech gaming mouse for demonstration, it is designed to be intuitive, helping users adapt to their unique needs across different modalities, subspecialties, and various radiology viewer software. Importantly, its fundamental concepts are transferrable to other mouse brands or models with similar customization software.

A Retrospective Review of Opioid Prescribing Practices for At-Risk Pediatric Populations Undergoing Ambulatory Surgery.

OBJECTIVE: Pediatric patients with sleep-disordered breathing (SDB) and obesity are at risk for opioid-induced respiratory depression. Although monitoring in the inpatient setting allows for early recognition of opioid-related adverse events, there is far less vigilance after ambulatory surgery as patients are discharged home. Guidelines for proper opioid dosing in these pediatric subsets have not been established. We sought to determine if at-risk children were more likely to receive doses of opioids outside the recommended range. METHODS: Baseline opioid prescribing data for all outpatient surgery patients receiving an opioid prescription between January 2019 and June 2020 were retrospectively reviewed. Patients with SDB or obesity were identified. To obtain more information about prescribing practices, we analyzed patient demographics, size descriptors used for calculations, and prescription characteristics (dose, duration, and prescribing surgical service). RESULTS: A total of 4674 patients received an opioid prescription after outpatient surgery. Of those, 173 patients had SDB and 128 were obese. Surgical subspecialties rendering most of the opioid prescriptions included otolaryngology and orthopedics. Obese patients were more likely (64%) to be prescribed opioids using ideal weight at higher mg/kg doses (>0.05 mg/kg; 83.3%; p < 0.0001). When providers used actual body weight, lower mg/kg doses were more likely to be used (53.7%; p < 0.0001). No prescriptions used lean body mass. CONCLUSIONS: Overweight/obese children were more likely to receive opioid doses outside the recommended range. Variability in prescribing patterns demonstrates the need for more detailed guidelines to minimize the risk of opioid-induced respiratory complications in vulnerable pediatric populations.

Making it Complicated: Does Disparity in Access to Care Lead to More Perforated Appendicitis?

INTRODUCTION: Delays in obtaining care may lead to perforated appendicitis, increasing risk of morbidity and mortality. We previously explored the role of social determinants in patients undergoing cholecystectomy, finding that emergent presentation is associated with neighborhood Social Vulnerability Index (SVI). We hypothesize that social vulnerability is associated with increased incidence of perforated appendicitis. METHODS: We retrospectively identified patients presenting to our urban, academic hospital with acute appendicitis during a 9-month timeframe (11/2019 - 7/2020). Patients were classified as perforated or non-perforated. Patient SVI was determined using geocoding at the census tract level. Because rates of perforation were higher in older patients, we performed a subset analysis of patients ≥ 40 years. RESULTS: 190 patients were included. Patients with perforated appendicitis (n = 48, 25%) were older and were more likely to present to a clinic versus the emergency department (P = 0.009). Perforated patients had longer delay before seeking care (56% versus 6% with > 72 hours of symptoms, P < 0.001). However, there were no differences between groups in terms of sex, race/ethnicity, insurance type, language barrier, having a primary care physician, or any of the SVI subscales. Of patients ≥ 40 years, a higher proportion were perforated (28/80, 35%) despite similar rates of delayed care. In this cohort, higher overall SVI as well as the socioeconomic status and household composition/disability subscales were associated with perforation. CONCLUSIONS: Contrary to our hypothesis, while perforation was associated with delayed care in this population, we did not find overall that social vulnerability or individual social determinants accounted for this delay.