Skip to main content
SpringerLink
Log in

Image intensifier distortion influences a surgeon’s ability to aim guidewires during orthopaedic procedures

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

Accurate insertion of a guidewire under image intensifier guidance is a fundamental skill required by orthopaedic surgeons. This study investigated how image intensifier distortion, which is composed of pin-cushion and sigmoidal components, changed the apparent trajectory of a guidewire, and the resulting deviation between the intended and actual guidewire tip position.

Materials and methods

Intraoperative image intensifier images for 220 consecutive patients with hip fractures were retrospectively corrected for distortion using a global polynomial method. The deviation between the intended and actual guidewire tip positions was calculated. Additional distortion parameters were tested using an image intensifier produced by a different manufacturer, and a flat-panel c-arm.

Results

Deviation was approximately 1 cm if the guidewire was aimed from the extremity of the image and almost 0 if the entry point was only 20% from the centre (p < 0.001). The direction of deviation was different for left and right hips, with average deviations measuring 3 mm proximal and 5 mm distal respectively (p < 0.001). The flat-panel c-arm almost completely eliminated distortion.

Conclusions

Image intensifier distortion significantly altered the intended trajectory of a guidewire, with guidewires aimed from the image periphery more affected than guidewires aimed from the centre. Furthermore, for right hips, guidewires should be aimed distal to their intended position, and for left hips they should be aimed proximal to achieve their desired position. The flat-panel c-arm eliminated the effect of distortion; hence, it may be preferable if precision in guidewire positioning is vital.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Froelich JM, Milbrandt JC, Novicoff WM, Saleh KJ, Allan DG. Surgical simulators and hip fractures: a role in residency training? J Surg Educ. 2011;68(4):298–302.

    Article  PubMed  Google Scholar 

  2. Altintas B, Biber R, Bail HJ. The learning curve of proximal femoral nailing. Acta Orthop Traumatol Turc. 2014;48(4):396–400.

    Article  PubMed  Google Scholar 

  3. Mayman D, Vasarhelyi EM, Long W, Ellis RE, Rudan J, Pichora DR. Computer-assisted guidewire insertion for hip fracture fixation. J Orthop Trauma. 2005;19(9):610–5.

    Article  CAS  PubMed  Google Scholar 

  4. Bjorgul K, Novicoff WM, Saleh KJ. Learning curves in hip fracture surgery. Int Orthop. 2011;35(1):113–9.

    Article  PubMed  Google Scholar 

  5. Gronenschild E. Correction for geometric image distortion in the x-ray imaging chain: local technique versus global technique. Med Phys. 1999;26(12):2602–16.

    Article  CAS  PubMed  Google Scholar 

  6. Gronenschild E. The accuracy and reproducibility of a global method to correct for geometric image distortion in the x-ray imaging chain. Med Phys. 1997;24(12):1875–88.

    Article  CAS  PubMed  Google Scholar 

  7. Wallace WA, Johnson F. Detection and correction of geometrical distortion in x-ray fluoroscopic images. J Biomech. 1981;14(2):123–5.

    Article  CAS  PubMed  Google Scholar 

  8. Baltzopoulos V. A videofluoroscopy method for optical distortion correction and measurement of knee-joint kinematics. Clin Biomech (Bristol, Avon). 1995;10(2):85–92.

    Article  CAS  Google Scholar 

  9. Fantozzi S, Cappello A, Leardini A. A global method based on thin-plate splines for correction of geometric distortion: an application to fluoroscopic images. Med Phys. 2003;30(2):124–31.

    Article  PubMed  Google Scholar 

  10. Nickoloff EL. AAPM/RSNA physics tutorial for residents: physics of flat-panel fluoroscopy systems: survey of modern fluoroscopy imaging: flat-panel detectors versus image intensifiers and more. Radiographics. 2011;31(2):591–602.

    Article  PubMed  Google Scholar 

  11. Wong JM, Bewsher S, Yew J, Bucknill A, de Steiger R. Fluoroscopically assisted computer navigation enables accurate percutaneous screw placement for pelvic and acetabular fracture fixation. Injury. 2015;46(6):1064–8.

    Article  PubMed  Google Scholar 

  12. Muller MC, Belei P, Pennekamp PH, Kabir K, Wirtz DC, Burger C, et al. Three-dimensional computer-assisted navigation for the placement of cannulated hip screws. A pilot study. Int Orthop. 2012;36(7):1463–9.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Parker M, Johansen A. Hip fracture. BMJ. 2006;333(7557):27–30.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gutierrez LF, Ozturk C, McVeigh ER, Lederman RJ. A practical global distortion correction method for an image intensifier based x-ray fluoroscopy system. Med Phys. 2008;35(3):997–1007.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Trauma and Orthopaedic Research Unit, Canberra Hospital, Building 6 Level 1, PO Box 11, Woden, ACT, 2606, Australia

    Thomas R. Ward & Paul N. Smith

  2. St George Hospital and The Sutherland Hospital, Sydney, Australia

    Ben Schwarz, Brian T. N. Le, Geoffrey C. S. Smith & Robert B. Molnar

  3. The Australian National University, Canberra, Australia

    Paul N. Smith

Authors
  1. Thomas R. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ben Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brian T. N. Le
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Geoffrey C. S. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Robert B. Molnar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paul N. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas R. Ward.

Ethics declarations

Conflicts of interest

The authors report that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ward, T.R., Schwarz, B., Le, B.T.N. et al. Image intensifier distortion influences a surgeon’s ability to aim guidewires during orthopaedic procedures. Skeletal Radiol 48, 1393–1398 (2019). https://doi.org/10.1007/s00256-019-03171-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-019-03171-7

Keywords

Search

Navigation