Table 1.

Strategies for prevention and management

METHOD TO PREVENT AND/OR MANAGE RSI	PROS	CONS	WAYS TO IMPROVE METHOD
Manual counting	RSI 100 times more likely if there is a count discrepancy [17] When combined with technological advancements, this can improve its accuracy [37, 38]	RSI can still occur with a correct count [39]	Quiet OR and reduce multi-tasking during count [40, 41] Change focus of count to RSI prevention rather than checklist [41]
Intraoperative Radiography	Quick and cheap [32, 42] Low radiation dose [32, 42] CT does not appear to be superior to intraoperative X-ray [4]	False negative rate increases as needle size becomes smaller [23, 43] needles smaller than 13 mm are not detectable [22, 34, 44] Dependent on radiologist’s knowledge of the lost needle and its last location [23, 45]	Development of standard policy of indications for radiography Education for all members of the team to improve communication between radiology and surgical team [31]
Computer-aided Detection (CAD)	Automatic detection rate as high as 86% [33, 46] Potential of faster and more cost-efficient solution than radiography [33, 46]	Currently in developmental phase [36] Unable to identify small needles [36] Relies on large dataset of needles and images to train the system [33, 36] Requires confirmation of results by surgeon and/or radiologist [6, 47]	Continued development of database and system
Magnetic Retrievers	Allows surgeon to follow metallic objects in real time, thereby expediting their removal [48] Reduces search time for small and medium sized needles [48]	Risk of injury to organs during retrieval [16, 48] Not FDA approved for sharps retrieval	Continued development to ensure patient safety.
Sharps Finder Device	Able to detect needles not visualized by x-ray [49] May act as a rule out mechanism preventing unnecessary radiation exposure. Expedites the identification of surgical sharps [49]	Only used to identify the location of a surgical sharp [49]	More clinical trials needed to determine degree of efficacy
METHOD TO PREVENT AND/OR MANAGE RSI	PROS	CONS	WAYS TO IMPROVE METHOD
Manual counting	RSI 100 times more likely if there is a count discrepancy [17] When combined with technological advancements, this can improve its accuracy [44, 45]	RSI can still occur with a correct count [39]	Quiet OR and reduce multi-tasking during count [37, 42] Change focus of count to RSI prevention rather than checklist [42]
Intraoperative Radiography	Quick and cheap [32, 47] Low radiation dose [32, 47] CT does not appear to be superior to intraoperative X-ray [4]	False negative rate increases as needle size becomes smaller [23, 49] needles smaller than 13 mm are not detectable [22, 34, 50] Dependent on radiologist’s knowledge of the lost needle and its last location [23, 41]	Development of standard policy of indications for radiography Education for all members of the team to improve communication between radiology and surgical team [31]
Computer-aided Detection (CAD)	Automatic detection rate as high as 86% [33, 51] Potential of faster and more cost-efficient solution than radiography [33, 51]	Currently in developmental phase [36] Unable to identify small needles [36] Relies on large dataset of needles and images to train the system [33, 36] Requires confirmation of results by surgeon and/or radiologist [6, 52]	Continued development of database and system
Magnetic Retrievers	Allows surgeon to follow metallic objects in real time, thereby expediting their removal [53] Reduces search time for small and medium sized needles [53]	Risk of injury to organs during retrieval [16, 53] Not FDA approved for sharps retrieval	Continued development to ensure patient safety.
Sharps Finder Device	Able to detect needles not visualized by x-ray [54] May act as a rule out mechanism preventing unnecessary radiation exposure. Expedites the identification of surgical sharps [54]	Only used to identify the location of a surgical sharp [54]	Need clinical trials to determine degree of efficacy