And you kinda see in, in real time, in fluoro, this is at the same point and time, but from different projections
that these different contours actually project differently based on how the detector is rotated, so that you can kind of have, in a real time feedback as to where the edges of your intended ablation or cement fill are.
And sometimes again, and this can be very hard to tell, using just fluoroscopy in a pelvis or a bone that's had extensive destruction. Where you don't have good cortico kind of markers under fluoroscopy. Registration is really a key to all this,
and a big part of where the technologist come into play. This is really the process of aligning one data set with another. There's different ways you can do this. Two dimensional, three dimensional,
or three dimensional, three dimensional registration. What this allows you to do is potentially draw those objects of overlays on a separate 3D data set, so maybe a pre-procedural imaging study that has contrast, where you can actually see your targets a little bit clearer.
And then be able to fuse or register this with you know, real time, time of procedure, cone-beam CT. So that you can kind of then stack and fuse those objects that you've drawn on a more detailed study before.
All right, the other reason we use radial access, coagulopathies, with radial access, as long as your INR count is normal,
and normal for us can be two, below two, or around two, platelets are 50, as long as one of those are above that threshold, if the other one is abnormal, we go radial. So we use this a lot in patients
who have severe liver disease, trauma patients that they're unable to get their blood numbers back up, even with blood product infusion. So we're not waiting four, six, and eight hours to do a case.
And in the past, that's what we're doing. The other thing it helps with is we don't have to fix these coagulopathies, we're saving money on blood product infusion. Did any of us see our blood product reperfusion critical is one, one, one.
So for every pack of red blood cells, we do a platelet, and we do an FFP, and that's the policy that we're trying to do right now. And our normal time was about a four hour delay. We knew we had to do the procedure, we'd have to wait for them to order the blood,
we'd have to wait for them to do the blood, we'd have to wait for them to redraw the labs if we were gonna go femoral. With radial, what we can do is say okay, send them down with some platelets, we're gonna start. We'll work on correcting those things
as we're doing the procedure. And if we're doing the procedure for an embolization or something, we're gonna correct the problem. So this one here, just to give you an example, she started on thrombocytopenic at 16,000 platelets. Four hours later, after four packets in platelets,
she was only at 22,000. She had hypersplenism, that is what we kind of refer to as Pac-Man syndrome, the spleen is just gonna eat the platelets, we're never gonna catch up with those, we can give it all day long. The first physician that came on did not do radial access.
Another physician was then consulted, we were like it's four hours later, people would like to go home tonight. Let's get moving on this. He said what's their INR, and I think it was like 1.6, 1.8, he's like bring the patient, let's go.
That is for femoral access. So as long as they were normal, that's her after the case, she has a successful embolization with radial access, and that was after we removed her compression band.
So now we move from a potential case like this
where the patient has a large renal mass and a metastasis into their left femur, and that patient underwent a surgical resection here, replacement of that, a big operation for a patient with metastatic disease, now we take a similar kind of patient
with a left renal cell carcinoma and has two metastases, one in a rib and a small one in the acetabular region. And they undergo the nephrectomy and then ablation of these two areas. That may be the new model.