Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery

Yuan-Dong Zhuang; Rui-Jin Li; Jia-Jun Wu; Xue-Wei He; Wen-Bin Zou; Xu-Chu Xu; Si-Qi Lu; Chun-Mei Chen

doi:10.1371/journal.pone.0299273

Peer Review History

Original SubmissionOctober 3, 2023
19 Dec 2023 Decision Letter - Sabata Martino, Editor PONE-D-23-30166Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgeryPLOS ONE Dear Dr. Chen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Feb 02 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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If your ethics statement is written in any section besides the Methods, please move it to the Methods section and delete it from any other section. Please ensure that your ethics statement is included in your manuscript, as the ethics statement entered into the online submission form will not be published alongside your manuscript. 5. Please include a copy of Tables 1-3 which you refer to in your text on page 20. Additional Editor Comments: no comments [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ******** 2. 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PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The manuscript titled “Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery” by Yuan-Dong ZHUANG1#, Rui-Jin LI2# et al. investigates the use of multi-angle laser device (MLD) for C-arm fluoroscopy to assist novice learners during lumbar spine surgery. The findings of the authors suggest that the MLD significantly improves novice learning of C-arm fluoroscopy during lumbar spine surgery. The study's findings are intriguing and valuable for potential therapeutic applications of MLD in lumbar spine surgery; however, the sections in the introduction and results are not clearly presented, explained, or discussed. Some improvements should be added to the manuscript to make it more accurate and coherent. Major points: - In order to enhance the manuscript's quality, I recommend adding a section in the introduction that explains why surgical treatment for adult lumbar spinal disorders carries a considerable risk of intraoperative and perioperative complications. The relationship between these complications and different risk factors, such as the patient's age, medical comorbidities, and the extent of the fusion up to the sacrum should also be elaborated upon. - In section 3.2 of the paper, the authors discuss the analysis of participants' operational data. However, the presentation of the data in Figures 5 and 6 is imprecise, unclear, and inaccurate. Although each graph shows the value per Anteroposterior (AP), Lateral (Lat), Normal Position (N), and Rotated Position (CR), they are not discussed individually. To better understand the authors' conclusions on the shorter operation time (13.66±5.61 vs 25.63±8.17 min), fewer imaging attempts (15.05±7.84 vs 32.50±7.24), and smaller initial deviation (22.9±8.9% vs 61.5±15.7%), I suggest revising the paragraph and providing a more detailed description of the data presented in those figures. - The manuscript lacks Tables 1, 2, and 3. Although the authors claim that all relevant data is included in the manuscript and its supporting information files, the tables are missing and only their captions are present. As a result, it was not possible to verify the data contained within the tables. Minor points: - I suggest revising the English form of the manuscript (e.g., line 68: change the "A questionnaire assessed the learning experience" to "A questionnaire was used to assess the learning experience") - In the manuscript, some mistakes are present (e.g., line 93: change “C-arm fluoroscopy is critical in precise surgical localization” to “C-arm fluoroscopy is critical for precise surgical localization”. Line 108: Change “We hypothesized the MLD” to “We hypothesized that the MLD”). - In the manuscript, some typos are present. I suggest a spell-check of the text. (e.g., line 254: “guidance[9, 10]”. Line 189: “imaging[11]”. -Authors utilize many abbreviations in the manuscript, so I suggest adding a list of abbreviations that can facilitate the reading and understanding of the text. -When an acronym is used for the first time in the manuscript, it should be spelled out in full (e.g., OEC One CFD). ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: Manuscript # PONE-D-23-30166 revision.docx https://doi.org/10.1371/journal.pone.0299273.r001
Revision 1
25 Jan 2024 Author Response Response letter Dear Dr. Sabata Martino, Ph.D Academic Editor Thanks for your comments on our manuscript (PONE-D-23-30166- " Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery”) and providing us with this opportunity of revision. We have carefully revised the manuscript. We hope this revision can make our manuscript acceptable for publication in your journal. The following are point by point responses to the reviewers and editor’s comments. Reviewer #1: The manuscript titled “Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery” by Yuan-Dong ZHUANG1#, Rui-Jin LI2# et al. investigates the use of multi-angle laser device (MLD) for C-arm fluoroscopy to assist novice learners during lumbar spine surgery. The findings of the authors suggest that the MLD significantly improves novice learning of C-arm fluoroscopy during lumbar spine surgery. The study's findings are intriguing and valuable for potential therapeutic applications of MLD in lumbar spine surgery; however, the sections in the introduction and results are not clearly presented, explained, or discussed. Some improvements should be added to the manuscript to make it more accurate and coherent. In order to enhance the manuscript's quality, I recommend adding a section in the introduction that explains why surgical treatment for adult lumbar spinal disorders carries a considerable risk of intraoperative and perioperative complications. The relationship between these complications and different risk factors, such as the patient's age, medical comorbidities, and the extent of the fusion up to the sacrum should also be elaborated upon. Response: We appreciate the reviewer's recommendation to expand the introduction on risks of lumbar spinal surgery and associated factors. A paragraph has been added discussing higher complications with increased age, comorbidities, and fusion extent, therefore emphasizing the value of precise surgical localization enabled by C-arm fluoroscopy to improve outcomes. We agree these details significantly enhance the framing and rationale of our study. Additional relevant citations were included as suggested. We are grateful for guidance to strengthen the manuscript background and significance through a more comprehensive literature foundation. - In section 3.2 of the paper, the authors discuss the analysis of participants' operational data. However, the presentation of the data in Figures 5 and 6 is imprecise, unclear, and inaccurate. Although each graph shows the value per Anteroposterior (AP), Lateral (Lat), Normal Position (N), and Rotated Position (CR), they are not discussed individually. To better understand the authors' conclusions on the shorter operation time (13.66±5.61 vs 25.63±8.17 min), fewer imaging attempts (15.05±7.84 vs 32.50±7.24), and smaller initial deviation (22.9±8.9% vs 61.5±15.7%), I suggest revising the paragraph and providing a more detailed description of the data presented in those figures. Response: Thank you for your valuable feedback on improving the clarity of data presentation in Figures 5 and 6. We fully agree that we should have analyzed the results for each imaging view instead of only reporting the overall values. Following your recommendation, we have substantially revised section 3.2 to individually discuss the anteroposterior (AP), lateral (LAT), normal position (N) and rotated position (CR) data displayed per figure. The new descriptions compare the multi-angle laser device (MLD) group versus the traditional C-arm group regarding imaging time, number of shots, and initial deviation per view. We also interpreted the evolving pattern of deviations across attempts. We sincerely apologize for the previously imprecise data portrayal. Your feedback has compelled us to significantly enhance the level of detail, accuracy, and transparency through a view-specific narrative on our key results. We believe this improved discussion better supports the conclusions on the benefits of the MLD technology. Please advise if any parts need further clarification or expansion to sufficiently meet presentation standards. Your guidance has been invaluable for identifying our oversights and pushing us towards higher precision. We are truly grateful for your dedication and insights in strengthening the integrity of our analysis. - The manuscript lacks Tables 1, 2, and 3. Although the authors claim that all relevant data is included in the manuscript and its supporting information files, the tables are missing and only their captions are present. As a result, it was not possible to verify the data contained within the tables. Response: We deeply appreciate the reviewer identifying that Tables 1-3 were missing from the initial manuscript submission. This was an unintentional oversight on our part. We sincerely apologize for this critical error and have conducted a thorough review to ensure complete and accurate data is now included in the revised manuscript. Specific tables with all relevant data have been provided to validate the findings. We understand the imperative of meeting rigorous academic standards, and this experience has taught us the importance of meticulous quality checks before submission. We will implement additional protocols to prevent such oversights going forward. Please note we welcome any further feedback to continue improving this manuscript. Your dedication and guidance have made this a stronger paper. We again appreciate you taking the time to highlight this issue - it will undoubtedly enforce more diligent practices on our end. Please accept our gratitude for your assistance in upholding scientific integrity. Minor points: - I suggest revising the English form of the manuscript (e.g., line 68: change the "A questionnaire assessed the learning experience" to "A questionnaire was used to assess the learning experience") Response: We thank the reviewer for the insightful suggestions to improve the English presentation of our manuscript. Following the specific recommendation on line 68, we have revised sentences throughout the paper to enhance clarity and accuracy of language. We highly value the reviewer's guidance to meet linguistic standards for international publication and will continue refining readability and flow. - In the manuscript, some mistakes are present (e.g., line 93: change “C-arm fluoroscopy is critical in precise surgical localization” to “C-arm fluoroscopy is critical for precise surgical localization”. Line 108: Change “We hypothesized the MLD” to “We hypothesized that the MLD”). Response: Thank you for noting areas in need of correction. Following your suggestions, we have revised line 93 to state "C-arm fluoroscopy is critical for precise surgical localization" and line 108 to "We hypothesized that the MLD." Additional proofreading has been done to identify and fix any other errors in language or formatting. We appreciate you highlighting specifics to improve manuscript quality. - In the manuscript, some typos are present. I suggest a spell-check of the text. (e.g., line 254: “guidance [9, 10]”. Line 189: “imaging [11]”. Response: Thank you for catching the typographical errors present in our initial draft. Per your recommendation, we have thoroughly spell-checked the entire manuscript to identify and correct any similar oversights. We have also amended the specific examples you noted on lines 254 and 189. Additional proofreading will help us further improve quality control going forward. We appreciate you taking the time to point out these details to enhance accuracy. -Authors utilize many abbreviations in the manuscript, so I suggest adding a list of abbreviations that can facilitate the reading and understanding of the text. Response： Thank you for the suggestion to add an abbreviations list. We agree this will improve readability of the manuscript. A list defining all abbreviations in their first appearance has been included. We appreciate guidance on enhancing clarity for readers and are happy to make any other changes recommended. -When an acronym is used for the first time in the manuscript, it should be spelled out in full (e.g., OEC One CFD). Response: Thank you for catching our oversight in fully defining terminology on first use. We have edited the manuscript to spell out OEC One CFD as " OEC One CFD (CMOS flat detector) mobile X-ray system (GE HealthCare Inc.)" when it is initially introduced in the text. Additional acronyms have been clearly expanded as well per your recommendation to enhance clarity for readers. We appreciate you emphasizing the importance of properly explaining technical language and will apply this convention throughout. Attachments Attachment Submitted filename: renamed_d0c04.docx https://doi.org/10.1371/journal.pone.0299273.r002
8 Feb 2024 Decision Letter - Sabata Martino, Editor Multi-angle laser device improves novice learning of C-arm fluoroscopy for lumbar spine surgery PONE-D-23-30166R1 Dear Dr. Chen, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Sabata Martino, Ph.D Academic Editor PLOS ONE Additional Editor Comments (optional): No comments Reviewers' comments: https://doi.org/10.1371/journal.pone.0299273.r003
Formally Accepted
27 Feb 2024 Acceptance Letter - Sabata Martino, Editor PONE-D-23-30166R1 PLOS ONE Dear Dr. Chen, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Sabata Martino Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0299273.r004

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