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Proceedings Paper

Minimizing cotton retention in neurosurgical procedures: which imaging modality can help?
Author(s): Raphael Bechtold; Niki Tselepidakis; Benjamin Garlow; Sean Glaister; William Zhu; Renee Liu; Alexandra Szwec; Arushi Tandon; Zachary Buono; James Pitingolo; Cristina Madalo; Isabella Ferrara; Collin Shale; Thomas Benassi; Micah Belzberg; Noah Gorelick; Brian Hwang; Camilo A. Molina; George Coles; Betty Tyler; Ian Suk; Judy Huang; Henry Brem; Amir Manbachi
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Paper Abstract

Cotton balls are used in neurosurgical procedures to assist with hemostasis and improve vision within the operative field. Although the surgeon can reshape pieces of cotton for multiple intraoperative uses, this customizability and scale also places them at perpetual risk of being lost, as blood-soaked cotton balls are visually similar to raw brain tissue. Retained surgical cotton can induce potentially life-threatening immunologic responses, impair postoperative imaging, lead to a textiloma or misdiagnosis, and/or require reoperation. This study investigated three imaging modalities (optical, acoustic, and radiographic) to find the most effective method of identifying foreign bodies during neurosurgery. First, we examined the use of dyes to increase contrast between cotton and surrounding parenchyma (optical approach). Second, we explored the ability to distinguish surgical cotton on or below the tissue surface from brain parenchyma using ultrasound imaging (acoustic approach). Lastly, we analyzed the ability of radiography to differentiate between brain parenchyma and cotton. Our preliminary testing demonstrated that dark-colored cotton is significantly more identifiable than white cotton on the surface level. Additional testing revealed that cotton has noticeable different acoustic characteristics (eg, speed of sound, absorption) from neural tissue, allowing for enhanced contrast in applied ultrasound imaging. Radiography, however, did not present sufficient contrast, demanding further examination. These solutions have the potential to significantly reduce the possibility of intraoperative cotton retention both on and below the surface of the brain, while still providing surgeons with traditional cotton material properties without affecting the surgical workflow.

Paper Details

Date Published: 28 February 2020
PDF: 8 pages
Proc. SPIE 11317, Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging, 1131704 (28 February 2020); doi: 10.1117/12.2548847
Show Author Affiliations
Raphael Bechtold, Johns Hopkins Univ. (United States)
Niki Tselepidakis, Johns Hopkins Univ. (United States)
Benjamin Garlow, Johns Hopkins Univ. (United States)
Sean Glaister, Johns Hopkins Univ. (United States)
William Zhu, Johns Hopkins Univ. (United States)
Renee Liu, Johns Hopkins Univ. (United States)
Alexandra Szwec, Johns Hopkins Univ. (United States)
Arushi Tandon, Johns Hopkins Univ. (United States)
Zachary Buono, Johns Hopkins Univ. (United States)
James Pitingolo, Johns Hopkins Univ. (United States)
Cristina Madalo, Johns Hopkins Univ. (United States)
Isabella Ferrara, Johns Hopkins Univ. (United States)
Collin Shale, Johns Hopkins Univ. (United States)
Thomas Benassi, Johns Hopkins Univ. (United States)
Micah Belzberg, Johns Hopkins Univ. (United States)
Noah Gorelick, Johns Hopkins Univ. (United States)
Brian Hwang, Johns Hopkins Univ. (United States)
Camilo A. Molina, Johns Hopkins Univ. (United States)
George Coles, Johns Hopkins Univ. Applied Physics Lab., LLC (United States)
Betty Tyler, Johns Hopkins Univ. (United States)
Ian Suk, Johns Hopkins Univ. (United States)
Judy Huang, Johns Hopkins Univ. (United States)
Henry Brem, Johns Hopkins Univ. (United States)
Amir Manbachi, Johns Hopkins Univ. (United States)

Published in SPIE Proceedings Vol. 11317:
Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging
Andrzej Krol; Barjor S. Gimi, Editor(s)

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