Novel "No-Lo" imaging techniques to minimize intraoperative radiation exposure in vascular and endovascular surgery

The rapid expansion in endovascular techniques has placed vascular surgeons among those most exposed to occupational medical radiation. There are a number of emerging novel no-radiation and low-radiation ("'No-Lo") imaging techniques in various stages of development within vascular surgery, which may significantly reduce occupational radiation exposure during endovascular procedures. This scoping review aims to identify, evaluate, and discuss these emerging technologies.

A systematic search of the literature published from March 2009 to May 2025 was performed using the following databases: PubMed, Embase, and Scopus. To identify novel "No-Lo" vascular imaging techniques, articles were limited only to those relating to vascular surgery. Well-established modalities such as magnetic resonance imaging and intravascular ultrasound examination were not included. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).

A total of 87 studies were included in this scoping review. Seven predominant categories of "No-Lo" radiation imaging techniques were identified: movement tracking, electromagnetic navigation, image fusion, augmented reality, fiber optic technology, optical coherence tomography, magnetic particle imaging, and robotic surgery. Each modality demonstrated the potential to reduce radiation exposure in vascular and endovascular surgery but presented limitations with regard to cost, scalability, ergonomics, and accessibility.

Many promising "No-Lo" techniques are still in various trial stages and require further results from real clinical settings to elucidate their full potential and identify possible limitations. However, their emergence in clinical use in the near future may have profound implications. It is hoped that ongoing innovation and development of "No-Lo" technologies may one day unshackle endovascular surgery from the unwanted, but currently necessary, dependence on ionizing radiation.