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Vulasala SS, Sutphin P, Shyn P, Kalva S. Intraoperative Imaging Techniques in Oncology. Clin Oncol (R Coll Radiol) 2024; 36:e255-e268. [PMID: 38242817 DOI: 10.1016/j.clon.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/05/2024] [Indexed: 01/21/2024]
Abstract
Imaging-based procedures have become well integrated into the diagnosis and management of oncological patients and play a significant role in reducing morbidity and mortality rates. Here we describe the established and upcoming surgical oncological imaging techniques and their impact on cancer management.
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Affiliation(s)
- S S Vulasala
- Department of Radiology, University of Florida College of Medicine, Jacksonville, Florida, USA.
| | - P Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - P Shyn
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - S Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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2
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Liu Q, Guo X, Wang Z, Xu H, Huang W, Liu J, Wang Z, Yan F, Wu Z, Ding X. Computed Tomography-guided Percutaneous Lung Biopsy With Electromagnetic Navigation Compared With Conventional Approaches: An Open-label, Randomized Controlled Trial. J Thorac Imaging 2024; 39:247-254. [PMID: 37982518 DOI: 10.1097/rti.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this study was to assess the efficiency and safety of computed tomography (CT)-guided percutaneous biopsy of lung lesions with electromagnetic (EM) navigation and compare them with those of conventional approaches. MATERIALS AND METHODS Seventy-nine patients with lung or liver lesions who needed biopsies were enrolled in this trial. All patients were randomly assigned to the E group underwent CT-guided percutaneous biopsies with the EM navigation system or to the C group treated with conventional approaches. RESULTS In total, 27 patients with lung lesions were assigned to the E group, and 20 patients were assigned to the C group. The diagnostic success rate was 92.6% and 95% in both groups, respectively ( P >0.9999). The median number of needle repositions in the E group was less than that in the C group (2.0 vs. 2.5, P =0.03). The positioning success rate with 1 or 2 needle repositions for the E group was significantly higher than the C group (81.5% vs. 50%, P =0.03). The median accuracy of the puncture location in the E group was better than that in the C group (2.0 vs. 6.6 mm, P <0.0001). The total procedure time lengthened in the E group compared with the C group (30.5±1.6 vs. 18.3±1.7 min, P <0.0001), but the number of CT acquisitions was not significantly different ( P =0.08). There was no significant difference in complication incidence between the 2 groups ( P =0.44). CONCLUSION The EM navigation system is an effective and safe auxiliary tool for CT-guided percutaneous lung biopsy, but lengthen the procedure time. TRIAL REGISTRATION ChiCTR2100043361, registered February 9, 2021-retrospectively registered ( http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=7591 ).
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Affiliation(s)
- Qin Liu
- Departments of Interventional Radiology
| | | | | | - Hao Xu
- Departments of Interventional Radiology
- Department of Vascular Surgery and Interventional Radiology, Suzhou DuShu Lake Hospital, Soochow University, Suzhou, China
| | - Wei Huang
- Departments of Interventional Radiology
| | | | | | - Fuhua Yan
- Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Bale R, Laimer G, Schullian P, Alzaga A. Stereotactic ablation: A game changer? J Med Imaging Radiat Oncol 2023; 67:886-894. [PMID: 37401185 DOI: 10.1111/1754-9485.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
For both primary and metastatic liver cancer, thermal ablation represents an interesting alternative to surgery. However, except for a small fraction of patients, conventional ultrasound- and CT-guided single-probe approaches have not achieved oncologic outcomes comparable with surgery. In this overview, we describe our stereotactic ablation workflow and discuss the short- and long-term results of stereotactic radiofrequency ablation (SRFA) and stereotactic microwave ablation (SMWA) for the treatment of primary and secondary liver tumours. The advantages of this method are discussed together with a summary of the existing stereotactic techniques for thermal ablation and the clinical data that support them. Stereotactic ablation is based on an optical navigation system and a specialized aiming tool. The workflow includes advanced three-dimensional planning, precise needle/probe placements according to the plan and intraoperative image fusion to check the needle positions and the ablation margins. Stereotactic ablation offers all the advantages of a minimally invasive procedure while producing oncological results comparable with surgery. The number of locally treatable liver cancers may be significantly expanded with these cutting-edge instruments and methods. We firmly believe that it can become a cornerstone in the treatment of liver cancers.
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Affiliation(s)
- Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Klein C, Cazalas G, Margue G, Piana G, DE Kerviler E, Gangi A, Puech P, Nedelcu C, Grange R, Buy X, Michiels C, Jegonday MA, Rouviere O, Grenier N, Marcelin C, Bernhard JC. Percutaneous tumor ablation versus image guided robotic-assisted partial nephrectomy for cT1b renal cell carcinoma: a comparative matched-pair analysis (UroCCR 80). Minerva Urol Nephrol 2023; 75:559-568. [PMID: 37728492 DOI: 10.23736/s2724-6051.23.05274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the gold standard treatment for cT1b renal tumors. Percutaneous guided thermal ablation (TA) has proven oncologic efficacy with low morbidity for the treatment of small renal masses (<3 cm). Recently, 3D image-guided robot-assisted PN (3D-IGRAPN) has been described, and decreased perioperative morbidity compared to standard RAPN has been reported. Our objective was to compare two minimally invasive image-guided nephron-sparing procedures (TA vs. 3D-IGRAPN) for the treatment of cT1b renal cell carcinomas (4.1-7 cm). METHODS Patients treated with TA and 3D-IGRAPN for cT1b renal cell carcinoma, prospectively included in the UroCCR database (NCT03293563), were pair-matched for tumor size, pathology, and RENAL score. The primary endpoint was the local recurrence rate between the two groups. Secondary endpoints included metastatic evolution, perioperative complications, decrease in renal function, and length of hospitalization. RESULTS A total of 198 patients were included and matched into two groups of 72 patients. The local recurrence rate was significantly higher in the TA group than that in the 3D-IGRAPN group (4.2% vs. 15.2%, P=0.04). Metastatic evolution and perioperative outcomes such as major complications, eGFR decrease, and length of hospitalization did not differ significantly between the two groups. CONCLUSIONS 3D-IGRAPN resulted in a significantly lower local recurrence rate and comparable rates of complications and metastatic evolution compared with thermal ablation.
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Affiliation(s)
- Clément Klein
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France -
| | - Grégoire Cazalas
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gaëlle Margue
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Gilles Piana
- Department of Radiology, Paoli-Calmettes Institute, Marseille, France
| | | | - Afshin Gangi
- Department of Interventional Radiology, Strasbourg University Hospital, Strasbourg, France
| | - Phillipe Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - Cosmina Nedelcu
- Department of Radiology, Angers University Hospital, Angers, France
| | - Remi Grange
- Department of Radiology, Saint-Etienne University Hospital, Saint Etienne, France
| | - Xavier Buy
- Department of Interventional Radiology, Bergonié Institute, Bordeaux, France
| | - Clément Michiels
- Department of Urology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | | | | | - Nicolas Grenier
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
| | - Clément Marcelin
- Department of Radiology, Bordeaux Pellegrin University Hospital, Bordeaux, France
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Albano D, Messina C, Gitto S, Chianca V, Sconfienza LM. Bone biopsies guided by augmented reality: a pilot study. Eur Radiol Exp 2023; 7:40. [PMID: 37468652 PMCID: PMC10356701 DOI: 10.1186/s41747-023-00353-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/09/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE To test the technical feasibility of an augmented reality (AR) navigation system to guide bone biopsies. METHODS We enrolled patients subjected to percutaneous computed tomography (CT)-guided bone biopsy using a novel AR navigation system. Data from prospectively enrolled patients (AR group) were compared with data obtained retrospectively from previous standard CT-guided bone biopsies (control group). We evaluated the following: procedure duration, number of CT passes, patient's radiation dose (dose-length product), complications, and specimen adequacy. Technical success was defined as the ability to complete the procedure as planned, reaching the target center. Technical efficacy was assessed evaluating specimen adequacy. RESULTS Eight patients (4 males) aged 58 ± 24 years (mean ± standard deviation) were enrolled in the AR group and compared with 8 controls (4 males) aged 60 ± 15 years. No complications were observed. Procedure duration, number of CT passes, and radiation dose were 22 ± 5 min, 4 (median) [4, 6 interquartile range] and 1,034 ± 672 mGy*cm for the AR group and 23 ± 5 min, 9 [7.75, 11.25], and 1,954 ± 993 mGy*cm for controls, respectively. No significant differences were observed for procedure duration (p = 0.878). Conversely, number of CT passes and radiation doses were significantly lower for the AR group (p < 0.001 and p = 0.021, respectively). Technical success and technical efficacy were 100% for both groups. CONCLUSIONS This AR navigation system is safe, feasible, and effective; it can decrease radiation exposure and number of CT passes during bone biopsies without increasing duration time. RELEVANCE STATEMENT This augmented reality (AR) navigation system is a safe and feasible guidance for bone biopsies; it may ensure a decrease in the number of CT passes and patient's radiation dose. KEY POINTS • This AR navigation system is a safe guidance for bone biopsies. • It ensures decrease of number of CT passes and patient's radiation exposure. • Procedure duration was similar to that of standard CT-guided biopsy. • Technical success was 100% as in all patients the target was reached. • Technical efficacy was 100% as the specimen was adequate in all patients.
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Affiliation(s)
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, 20122, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, 20122, Italy
| | - Vito Chianca
- Clinica Di Radiologia EOC IIMSI, Lugano, Switzerland
- Ospedale Evangelico Betania, Via Argine 604, Naples, 80147, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, 20161, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, 20122, Italy
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Graham T, Hamidizadeh R, Wright C, Wong JK, Brown A, Menard A, Mujoomdar A. Looking Into the Future: The Current and Future State of IR in Canada. Can Assoc Radiol J 2023; 74:211-216. [PMID: 36065604 DOI: 10.1177/08465371221118518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This review explores the priorities and future opportunities of interventional radiology in Canada.
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Affiliation(s)
- Tara Graham
- Medical Imaging, 5543Trillium Health Partners, Mississauga, ON, Canada
| | - Ramin Hamidizadeh
- Diagnostic Imaging, 70401University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Chris Wright
- 26634Foothills Medical Centre, Calgary, AB, Canada
| | - Jason K Wong
- 26634Foothills Medical Centre, Calgary, AB, Canada
| | - Andrew Brown
- 37195St. Michael's Hosptial , Toronto, ON, Canada
| | - Alexandre Menard
- Department of Radiology, 71459Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Amol Mujoomdar
- Medical Imaging, Western University/London Health Sciences Centre, London, ON, Canada
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Becker LS, Ringe KI, Dewald CLA, Canstein C, Hinrichs JB, Wacker FK, Meyer BC. Fully Integrated Laser Guidance for CT-Based Punctures: A Study in Phantoms and Patients. J Vasc Interv Radiol 2023; 34:130-138. [PMID: 36162623 DOI: 10.1016/j.jvir.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/09/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To test the hypothesis of equal or even superior applicability and accuracy of a fully integrated, laser-based computed tomography (CT) navigation system compared with conventional CT guidance for percutaneous interventions. MATERIALS AND METHODS CT-guided punctures were first performed in phantoms. Four radiologists with different experience levels (2 residents (L.B., C.D.) and 2 board-certified radiologists (B.M., K.R.) performed 48 punctures using both conventional image-guided and laser-guided approaches. Subsequently, 12 punctures were performed in patients during a clinical pilot trial. Phantom targets required an in-plane or a single-/double-angulated, out-of-plane approach. Planning and intervention time, control scan number, radiation exposure, and accuracy of needle placement (measured by deviation of the needle tip to the designated target) were assessed for each guidance technique and compared (Mann-Whitney U test and t test). Patient interventions were additionally analyzed for applicability in a clinical setting. RESULTS The application of laser guidance software in the phantom study and in 12 human patients in a clinical setting was both technically and clinically feasible in all cases. The mean planning time (P = .009), intervention time (P = .005), control scan number (P < .001), and radiation exposure (P = .013) significantly decreased for laser-navigated punctures compared with those for conventional CT guidance and especially in punctures with out-of-plane-trajectories. The accuracy significantly increased for laser-guided interventions compared with that for conventional CT (P < .001). CONCLUSIONS Interventional radiologists with differing levels of experience performed faster and more accurate punctures for out-of-plane trajectories in the phantom models, using a new, fully integrated, laser-guided CT software and demonstrated excellent clinical and technical success in initial clinical experiments.
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Affiliation(s)
- Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Cornelia L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Singh BS, Cazacu IM, Deza CA, Rigaud BS, Saftoiu A, Gruionu G, Guionu L, Brock KK, Koay EJ, Herman JM, Bhutani MS. Image Fusion Involving Real-Time Transabdominal or Endoscopic Ultrasound for Gastrointestinal Malignancies: Review of Current and Future Applications. Diagnostics (Basel) 2022; 12:diagnostics12123218. [PMID: 36553225 PMCID: PMC9777678 DOI: 10.3390/diagnostics12123218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Image fusion of CT, MRI, and PET with endoscopic ultrasound and transabdominal ultrasound can be promising for GI malignancies as it has the potential to allow for a more precise lesion characterization with higher accuracy in tumor detection, staging, and interventional/image guidance. We conducted a literature review to identify the current possibilities of real-time image fusion involving US with a focus on clinical applications in the management of GI malignancies. Liver applications have been the most extensively investigated, either in experimental or commercially available systems. Real-time US fusion imaging of the liver is gaining more acceptance as it enables further diagnosis and interventional therapy of focal liver lesions that are difficult to visualize using conventional B-mode ultrasound. Clinical studies on EUS guided image fusion, to date, are limited. EUS-CT image fusion allowed for easier navigation and profiling of the target tumor and/or surrounding anatomical structure. Image fusion techniques encompassing multiple imaging modalities appear to be feasible and have been observed to increase visualization accuracy during interventional and diagnostic applications.
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Affiliation(s)
- Ben S. Singh
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Irina M. Cazacu
- Department of Oncology, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
| | - Carlos A. Deza
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Bastien S. Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Adrian Saftoiu
- Faculty of Medicine, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania
- Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
- Department of Gastroenterology, Ponderas Academic Hospital, 014142 Bucharest, Romania
| | - Gabriel Gruionu
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lucian Guionu
- Department of Mechanics, University of Craiova, 200585 Craiova, Romania
| | - Kristy K. Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Eugene J. Koay
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Joseph M. Herman
- Department of Radiation Medicine, Zucher School of Medicine, Hempstead, NY 11549, USA
| | - Manoop S. Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Som A, Rosenboom JG, Chandler A, Sheth RA, Wehrenberg-Klee E. Image-guided intratumoral immunotherapy: Developing a clinically practical technology. Adv Drug Deliv Rev 2022; 189:114505. [PMID: 36007674 PMCID: PMC10456124 DOI: 10.1016/j.addr.2022.114505] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 07/14/2022] [Accepted: 08/17/2022] [Indexed: 02/07/2023]
Abstract
Immunotherapy has revolutionized the contemporary oncology landscape, with durable responses possible across a range of cancer types. However, the majority of cancer patients do not respond to immunotherapy due to numerous immunosuppressive barriers. Efforts to overcome these barriers and increase systemic immunotherapy efficacy have sparked interest in the local intratumoral delivery of immune stimulants to activate the local immune response and subsequently drive systemic tumor immunity. While clinical evaluation of many therapeutic candidates is ongoing, development is hindered by a lack of imaging confirmation of local delivery, insufficient intratumoral drug distribution, and a need for repeated injections. The use of polymeric drug delivery systems, which have been widely used as platforms for both image guidance and controlled drug release, holds promise for delivery of intratumoral immunoadjuvants and the development of an in situ cancer vaccine for patients with metastatic cancer. In this review, we explore the current state of the field for intratumoral delivery and methods for optimizing controlled drug release, as well as practical considerations for drug delivery design to be optimized for clinical image guided delivery particularly by CT and ultrasound.
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Affiliation(s)
- Avik Som
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States
| | - Jan-Georg Rosenboom
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States; Department of Gastroenterology, Brigham and Women's Hospital, United States
| | - Alana Chandler
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, United States; Department of Gastroenterology, Brigham and Women's Hospital, United States
| | - Rahul A Sheth
- Department of Interventional Radiology, M.D. Anderson Cancer Center, United States
| | - Eric Wehrenberg-Klee
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, United States.
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Sassatelli R, Grillo S, Ottone M, Besutti G, Cecinato P, Sereni G, Mirante VG, Iori V, Pattacini P, Rossi PG. Fusion radiology in interventional endoscopy (FRIend): a new approach for pancreatic fluid collections. Endosc Int Open 2022; 10:E622-E633. [PMID: 35571478 PMCID: PMC9106435 DOI: 10.1055/a-1797-8681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background and study aims Fusion imaging consists of overlaying preoperative imaging over live fluoroscopy, providing an augmented live guidance. Since 2017, we have been using a new hybrid operating room (Discovery IGS 740 OR, GE Healthcare) for biliopancreatic endoscopy, combining fusion imaging with traditional endoscopic ultrasound (EUS). This study aimed to assess the advantages that fusion imaging could bring to EUS-guided drainage of post-pancreatitis fluid collections. Patients and methods Thirty-five drainage procedures performed between 2012 and 2019 with traditional guidance and fusion imaging were retrospectively compared, assessing the overall treatment success rate - i. e. symptom improvement with complete PFC emptying - as a primary outcome. Secondary outcomes included technical success rate, time to resolution, hospital stay length, adverse events, recurrence rate, and procedure time. Results Patients treated with standard EUS (n = 17) and with fusion imaging (n = 18) were homogeneous in age, gender, pancreatitis etiology, and indication for drainage; the second group had larger PFCs, more frequently walled-off necrosis than pseudocysts, and were treated more emergently, indicating higher case complexity in this group. During the period when fusion imaging was adopted, procedures had a higher overall treatment success rate than during the period when standard EUS was adopted (83.3 % vs. 52.9 %, P = 0.075), and complete emptying was reached in less time (61.1 % vs. 23.6 % complete emptying within 90 days, P = 0.154), differences compatible with random fluctuations. Conclusions This study suggests that fusion imaging in combination with EUS might improve clinical and procedural outcomes of PFC drainage.
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Affiliation(s)
- Romano Sassatelli
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Simone Grillo
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Marta Ottone
- Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Giulia Besutti
- Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
| | - Paolo Cecinato
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Giuliana Sereni
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | | | - Veronica Iori
- Azienda USL, IRCCs di Reggio Emilia, Epidemiology Unit, Reggio Emilia, Emilia-Romagna, Italy
| | - Pierpaolo Pattacini
- Azienda USL, IRCCs di Reggio Emilia, Radiology Unit Reggio Emilia, Emilia-Romagna, Italy
| | - Paolo Giorgi Rossi
- Azienda USL, IRCCs di Reggio Emilia, Gastroenterology and Digestive Endoscopy Unit, Reggio Emilia, Emilia-Romagna, Italy
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Wilson DJ, Allen G, Bullock S, Denton J. Lumbar nerve root blocks using MRI - the effectiveness and safety of ultrasound/MRI fusion image guidance. Br J Radiol 2022; 95:20210599. [PMID: 34928177 PMCID: PMC9153711 DOI: 10.1259/bjr.20210599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the outcome of nerve root injection guided by ultrasound/MRI fusion with radiofrequency needle tracking (eTRAX©) and the same procedure undertaken by fluoroscopic guidance. METHODS This is a retrospective audit of anonymised clinical records from before and after a change in the imaging technique used to perform nerve root blocks.We studied 181 consecutive patients who had undergone a nerve root block, the first 124 guided by fluoroscopic technique and the next 57 guided by ultrasound/MRI fusion with radiofrequency needle guidance.Using pain diaries, we reviewed the outcome scores at 24 h and 2 weeks. We recorded the use of analgesia, the patient's satisfaction, complications and the duration of the procedures. RESULTS Completed pain diaries were returned by 61% in the fluoroscopy group and 67% in the fusion imaging group.The visual analogue pain score was reduced at 24 h by 3.29 [standard deviation (SD) 2.35] for the fluoroscopy group and by 3.69 (SD 2.58) in the fusion group (p 0.399).At two weeks the pain reduction was 3.27 (SD 2.57) for the fluoroscopic group and 4.21 (SD 2.95) for the fusion group (p 0.083). There was no statistically significant difference between the groups.The patient's satisfaction scores were similar for both groups.The procedure by the two guidance methods took a similar time to perform.There were no serious complications in either group. One patient in the fusion-guided nerve root block group experienced paraesthesia in the nerve distribution for 2 h. CONCLUSION Ultrasound/MRI fusion imaging with needle tracking is an effective alternative to fluoroscopic image-guided injection. ADVANCES IN KNOWLEDGE Fusion imaging guidance provides the same outcome as fluoroscopic guidance.Fusion imaging guidance avoids the need for ionising radiation.
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Affiliation(s)
| | | | | | - Jon Denton
- Manor Hospital, Beach Road, Headington, Oxford, United Kingdom
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Thermal Ablation of Liver Tumors Guided by Augmented Reality: An Initial Clinical Experience. Cancers (Basel) 2022; 14:cancers14051312. [PMID: 35267620 PMCID: PMC8909771 DOI: 10.3390/cancers14051312] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Over the last two decades, augmented reality (AR) has been used as a visualization tool in many medical fields in order to increase precision, limit the radiation dose, and decrease the variability among operators. Here, we report the first in vivo study of a novel AR system for the guidance of percutaneous interventional oncology procedures. Methods: Eight patients with 15 liver tumors (0.7−3.0 cm, mean 1.56 + 0.55) underwent percutaneous thermal ablations using AR guidance (i.e., the Endosight system). Prior to the intervention, the patients were evaluated with US and CT. The targeted nodules were segmented and three-dimensionally (3D) reconstructed from CT images, and the probe trajectory to the target was defined. The procedures were guided solely by AR, with the position of the probe tip was subsequently confirmed by conventional imaging. The primary endpoints were the targeting accuracy, the system setup time, and targeting time (i.e., from the target visualization to the correct needle insertion). The technical success was also evaluated and validated by co-registration software. Upon completion, the operators were assessed for cybersickness or other symptoms related to the use of AR. Results: Rapid system setup and procedural targeting times were noted (mean 14.3 min; 12.0−17.2 min; 4.3 min, 3.2−5.7 min, mean, respectively). The high targeting accuracy (3.4 mm; 2.6−4.2 mm, mean) was accompanied by technical success in all 15 lesions (i.e., the complete ablation of the tumor and 13/15 lesions with a >90% 5-mm periablational margin). No intra/periprocedural complications or operator cybersickness were observed. Conclusions: AR guidance is highly accurate, and allows for the confident performance of percutaneous thermal ablations.
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Li C, Zhao W, Guo J, Li H, Cai L, Duan Y, Hou X, Du H, Shao X, Diao Z. Safety and efficacy of percutaneous microwave ablation using combined computed tomography and ultrasound-guided imaging in patients with hepatocellular carcinoma: A retrospective study. J Cancer Res Ther 2022; 18:418-425. [DOI: 10.4103/jcrt.jcrt_546_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pohlman RM, Hinshaw JL, Ziemlewicz TJ, Lubner MG, Wells SA, Lee FT, Alexander ML, Wergin KL, Varghese T. Differential Imaging of Liver Tumors before and after Microwave Ablation with Electrode Displacement Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:2138-2156. [PMID: 34011451 PMCID: PMC8243838 DOI: 10.1016/j.ultrasmedbio.2021.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 05/17/2023]
Abstract
Liver cancer is a leading cause of cancer-related deaths; however, primary treatment options such as surgical resection and liver transplant may not be viable for many patients. Minimally invasive image-guided microwave ablation (MWA) provides a locally effective treatment option for these patients with an impact comparable to that of surgery for both cancer-specific and overall survival. MWA efficacy is correlated with accurate image guidance; however, conventional modalities such as B-mode ultrasound and computed tomography have limitations. Alternatively, ultrasound elastography has been used to demarcate post-ablation zones, yet has limitations for pre-ablation visualization because of variability in strain contrast between cancer types. This study attempted to characterize both pre-ablation tumors and post-ablation zones using electrode displacement elastography (EDE) for 13 patients with hepatocellular carcinoma or liver metastasis. Typically, MWA ablation margins of 0.5-1.0 cm are desired, which are strongly correlated with treatment efficacy. Our results revealed an average estimated ablation margin inner quartile range of 0.54-1.21 cm with a median value of 0.84 cm. These treatment margins lie within or above the targeted ablative margin, indicating the potential to use EDE for differentiating index tumors and ablated zones during clinical ablations. We also obtained a high correlation between corresponding segmented cross-sectional areas from contrast-enhanced computed tomography, the current clinical gold standard, when compared with EDE strain images, with r2 values of 0.97 and 0.98 for pre- and post-ablation regions.
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Affiliation(s)
- Robert M Pohlman
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | - James L Hinshaw
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Timothy J Ziemlewicz
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Meghan G Lubner
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shane A Wells
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Fred T Lee
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Marci L Alexander
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kelly L Wergin
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tomy Varghese
- Department of Electrical and Computer Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Advanced Techniques in the Percutaneous Ablation of Liver Tumours. Diagnostics (Basel) 2021; 11:diagnostics11040585. [PMID: 33805107 PMCID: PMC8064108 DOI: 10.3390/diagnostics11040585] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 02/07/2023] Open
Abstract
Percutaneous ablation is an accepted treatment modality for primary hepatocellular carcinoma (HCC) and liver metastases. The goal of curative ablation is to cause the necrosis of all tumour cells with an adequate margin, akin to surgical resection, while minimising local damage to non-target tissue. Aside from the ablative modality, the proceduralist must decide the most appropriate imaging modality for visualising the tumour and monitoring the ablation zone. The proceduralist may also employ protective measures to minimise injury to non-target organs. This review article discusses the important considerations an interventionalist needs to consider when performing the percutaneous ablation of liver tumours. It covers the different ablative modalities, image guidance, and protective techniques, with an emphasis on new and advanced ablative modalities and adjunctive techniques to optimise results and achieve satisfactory ablation margins.
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Fong AJ, Stewart CL, Lafaro K, LaRocca CJ, Fong Y, Femino JD, Crawford B. Robotic assistance for quick and accurate image-guided needle placement. Updates Surg 2021; 73:1197-1201. [PMID: 33394359 DOI: 10.1007/s13304-020-00956-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) image-guided procedures including biopsy, drug delivery, and ablation are gaining increasing application in medicine. Robotic technology holds the promise for allowing surgeons, and other proceduralists, access to such CT-guided procedures by potentially shortening training, improving accuracy, decreasing needle passes, and reducing radiation exposure. We evaluated surgeon learning and proficiency for image-guided needle placement with an FDA-cleared robotic arm. Five out of six surgeons had no prior CT-guided procedural experience, while one had prior experience with freehand CT-guided needle placement. All surgeons underwent a 60-min training with the MAXIO robot (Perfint Healthcare, Redmond, WA). The robot was used to place needles into three different pre-specified targets on a spine model. Performance time, procedural errors, and needle placement accuracy were recorded. All participants successfully placed needles into the targets using the robotic arm. The average time for needle placement was 3:44 ± 1:43 min. Time for needle placement decreased with subsequent attempts, with average third placement taking 2:29 ± 1:51 min less than the first attempt. The average vector distance from the target was 2.3 ± 1.2 mm. One error resulted in the need for reimaging by CT scan. No errant needle placement occurred. Surgeons (attending fellows and residents) without previous experience and minimal training could successfully place percutaneous needles under CT guidance quickly, accurately, and reproducibly using a robotic arm. This suggests that robotic technology may be used to facilitate surgeon adoption of CT image-guided needle-based procedures in the future.
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Affiliation(s)
- Abigail J Fong
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Camille L Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Christopher J LaRocca
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Joseph D Femino
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
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Robotic-assisted computed tomography-guided 18F-FDG PET/computed tomography-directed biopsy for diagnosis of intra thoracic lesions: An experience from a tertiary care centre in North India. Nucl Med Commun 2020; 41:246-251. [PMID: 31939902 DOI: 10.1097/mnm.0000000000001148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic yield of robotic-assisted computed tomography (CT)-guided F-FDG PET/CT-directed biopsy for the evaluation of intrathoracic space occupying lesions. METHODS Twenty-four patients being evaluated for intrathoracic masses were included in the study. The indications were patients with unknown/likely primary detected from PET-CT, suspicious lesions identified from PET-CT in a known primary disease and fine needle aspiration cytology/CT-guided biopsy negative lesions with a high index of suspicion for malignancy. Biopsies were carried out with the help of automated radiology arm (ROBIO-EX) which is essentially a needle positioning and holding device. A two-day protocol was followed in which PET-CT scan was done on the first day, biopsy procedure was done on the next scheduled day. PET images were refused with the CT images done on the second day in the console by using manual alignment and then a biopsy was carried out with the help of a robotic arm. Primary outcome was histopathological yield from the obtained specimens. RESULTS Tissue yield was 100% (n = 24) and histopathological diagnosis rate was 96% (n = 23). Out of the 24 lesions biopsied 30% (n = 8) were benign and 70% (n = 16) turned out to be malignant. The complication rates were pneumothorax 4% (n = 1) and haemothorax 4% (n = 1). CONCLUSION Robotic-assisted CT-guided F-FDG PET/CT-directed biopsy is a useful and accurate technique for diagnostic evaluation of intrathoracic neoplasms with minimal complications rates as compared with conventional imaging techniques.
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O'Shea A, Tam AL, Kilcoyne A, Flaherty KT, Lee SI. Image-guided biopsy in the age of personalised medicine: strategies for success and safety. Clin Radiol 2020; 76:154.e1-154.e9. [PMID: 32896425 DOI: 10.1016/j.crad.2020.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/04/2020] [Indexed: 12/28/2022]
Abstract
Oncology has progressed into an era of personalised medicine, whereby the therapeutic regimen is tailored to the molecular profile of the patient's cancer. Determining personalised therapeutic options is achieved by using tumour genomics and proteomics to identify the specific molecular targets against which candidate drugs can interact. Several dozen targeted drugs, many for multiple cancer types are already widely in clinical use. Molecular profiling of tumours is contingent on high-quality biopsy specimens and the most common method of tissue sampling is image-guided biopsy. Thus, for radiologists performing these biopsies, the paradigm has now shifted away from obtaining specimens simply for histopathological diagnosis to acquiring larger amounts of viable tumour cells for DNA, RNA, or protein analysis. These developments have highlighted the central role now played by radiologists in the delivery of personalised cancer care. This review describes the principles of molecular profiling assays and biopsy techniques for optimising yield, and describes a scoring system to assist in patient selection for percutaneous biopsy.
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Affiliation(s)
- A O'Shea
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - A L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - A Kilcoyne
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - K T Flaherty
- Department of Medicine, Division of Oncology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - S I Lee
- Department of Radiology, Division of Abdominal Imaging, Massachusetts General Hospital, Boston, MA, 02114, USA
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Gao Y, Wu WJ, Zheng L, Huang MW, Liu SM, Zhang JG. Diagnostic value of navigation-guided core needle biopsy in deep regions of the head and neck with focal FDG uptake on 18F-FDG PET/CT. J Craniomaxillofac Surg 2020; 48:508-513. [PMID: 32143863 DOI: 10.1016/j.jcms.2020.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 01/29/2020] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and diagnostic accuracy of core needle biopsy (CNB) in patients with focal fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) in deep regions of the head and neck, with the guidance of infrared navigation integrated with PET. MATERIALS AND METHODS Patients with suspected primary or recurrent malignancies of the head and neck on PET/CT, from June 2016 to December 2018, were included. Before CNB, the region of interest was delineated and the ideal needle entry points, target sites, and a number of trajectories were designed on iPlan CMF 3.0. CNB was performed with the guidance of infrared navigation integrated with PET, according to the pre-plan. Sensitivity and diagnostic accuracy were analyzed by comparing the biopsy results with the final diagnosis. RESULTS Thirty-one consecutive patients were included. Among the 31 lesions, 18 were skull base, six were infratemporal fossa, and seven were maxillary region. The median values for SUVmax, SUVmean, and MTV were 6.09 (range: 1.43-24.67), 3.41 (range: 0.38-20.96), and 25.83 (range: 3.54-361.94) for the 31 lesions, respectively. Combined needle approaches were employed, including temporal (nine), subzygomatic (19), paramaxillary (11), and retromandibular (16) approaches. The depths of the 31 deep-region lesions, measured from the needle entry site on the skin to the target point, ranged from 1.33 cm to 7.82 cm (median 4.25 cm). There were three non-diagnostic lesions resulting from CNB, and these were all skull base. The diagnostic accuracy was 90.3%, while the sensitivity was 88%. According to the binary logistic regression for the final diagnosis, the only significant parameter was SUVmax. CONCLUSION With the guidance of navigation integrated with PET, CNB is a feasible and accurate diagnostic modality, which is also an alternative to open biopsy in patients with suspected primary or recurrent malignancies in deep regions of the head and neck on PET/CT.
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Affiliation(s)
- Ya Gao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lei Zheng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Shu-Ming Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian-Guo Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
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Smartphone Augmented Reality CT-Based Platform for Needle Insertion Guidance: A Phantom Study. Cardiovasc Intervent Radiol 2020; 43:756-764. [DOI: 10.1007/s00270-019-02403-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/21/2019] [Indexed: 01/06/2023]
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21
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Percutaneous Lung Tumor Biopsy Under CBCT Guidance with PET-CT Fusion Imaging: Preliminary Experience. Cardiovasc Intervent Radiol 2019; 42:1644-1648. [DOI: 10.1007/s00270-019-02270-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 06/13/2019] [Indexed: 12/11/2022]
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Davrieux CF, Giménez ME, González CA, Ancel A, Guinin M, Fahrer B, Serra E, Kwak JM, Marescaux J, Hostettler A. Mixed reality navigation system for ultrasound-guided percutaneous punctures: a pre-clinical evaluation. Surg Endosc 2019; 34:226-230. [DOI: 10.1007/s00464-019-06755-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
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Kobe A, Zadory M, Hamie QM, Froehlich JM, Klarhöfer M, Elsässer T, Pfammatter T, Guggenberger R. Development of an anthropomorphic spine phantom suitable for fusion of MR neurography with interventional flat-panel CT. Eur J Radiol 2019; 112:153-160. [PMID: 30777205 DOI: 10.1016/j.ejrad.2019.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/12/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To design a spine phantom suitable for fusion of MR neurography (MRN) with interventional flat panel computed tomography (FPCT) images from tissue-equivalent agarose gels and artificial nerves in MRI, including material with equal attenuation to bone in computed tomography (CT). METHODS T1-/T2-relaxation times of target tissue were determined in vivo (n = 5) using MR mapping-techniques. Serial dilution of castor oil lipogels was performed ex vivo in order to define correct composition for tissue-equivalent relaxation times. Similarly, serial dilution series of calcium carbonate (CaCO3) and barium sulphate (BaSO4) in synthetic resin were used to adjust radiodensity of selected vertebral bodies (L1-L5) and sacrum in CT. Nerve tissue was simulated with agarose-impregnated polyethylene fibers. Spine phantom was assembled using respective components in anthropomorphic geometry. A fat-saturated, T2-weighted 3D SPACE STIR sequence was acquired for MRN and subsequently fused with an on-site FPCT scan of the phantom. RESULTS In vivo T1-/T2-values for fat tissue were found to be at 394 ± 16 ms and 161 ± 16 ms, corresponding to a castor oil concentration of 50%. Analogously, bone marrow-equivalent values were measured at 822 ± 21 ms and 67 ± 6 ms, simulated with 40% castor oil. Cortical bone-like radiodensity of 1'115 ± 80 HU was achieved for artificial bone with 30% CaCO3 and 1.5% BaSO4. Simulated nerves were successfully depicted in MRN and fused with FPCT, combining optimal contrasts for nerves and bones on-site. CONCLUSIONS The customized phantom showed analogous tissue contrasts to in vivo conditions in both MRN and FPCT, facilitating simulations of fusion-image guided spine interventions.
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Affiliation(s)
- Adrian Kobe
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Qeumars M Hamie
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | | | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Roman Guggenberger
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
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Kumar R, Mittal BR, Bhattacharya A, Singh H, Bal A, Prakash G, Singh N. 18F-FDG PET/CT-Guided Real-Time Automated Robotic Arm-Assisted Needle Navigation for Percutaneous Biopsy of Hypermetabolic Bone Lesions: Diagnostic Performance and Clinical Impact. AJR Am J Roentgenol 2019; 212:W10-W18. [PMID: 30383406 DOI: 10.2214/ajr.18.19698] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
OBJECTIVE The purpose of this study is to establish the feasibility, safety, diagnostic performance, and clinical impact of real-time intraprocedural 18F-FDG PET/CT-guided automated robotic arm-assisted biopsy of hypermetabolic marrow or bone lesions. SUBJECTS AND METHODS This prospective study included 73 patients (47 male patients and 26 female patients) who underwent PET/CT-guided biopsy of accessible hypermetabolic marrow or bone lesions. The biopsy needle was inserted into the target lesion with automated robotic arm assistance, and tissue sampling was performed at the site with the highest metabolic activity, after the needle position was confirmed using PET/CT. The results of histopathologic examination and clinical and imaging follow-up examinations were reviewed. The referring physicians were interviewed to assess the clinical impact of interventions on treatment planning. RESULTS Of the 73 patients assessed, 34 were oncology patients with suspected metastasis or residual disease. The pathologic diagnosis was not known for 38 patients with clinically suspected benign (n = 7) or malignant (n = 31) disease. The remaining patient was suspected of having skeletal sarcoidosis. Thirty-nine marrow lesions and 34 bone lesions were targeted. All procedures were technically successful and safe, and no major complication was observed. Pathologic diagnosis was confirmed for 72 patients, for a diagnostic yield of 98.6%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of malignancy (n = 54) were 98.2%, 100%, 100%, 94.7%, and 98.6%, respectively. The procedure was helpful in determining the treatment plan for 91.7% of patients. CONCLUSION Automated robotic arm-assisted FDG PET/CT-guided real-time bone biopsy is a feasible and safe intervention with a very high diagnostic yield. It had a major clinical impact on patients with minimal residual FDG uptake on end-of-treatment PET/CT and isolated suspected metastatic lesions.
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Affiliation(s)
- Rajender Kumar
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Gaurav Prakash
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- 1 Department of Nuclear Medicine and PET/CT, Nehru Hospital, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
- 2 Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 3 Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
- 4 Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar R, Mittal BR, Bhattacharya A, Singh H, Bal A, Vadi SK, Sood A, Prakash G, Singh H, Sharma A. Diagnostic performance of real-time robotic arm-assisted 18F-FDG PET/CT-guided percutaneous biopsy in metabolically active abdominal and pelvic lesions. Eur J Nucl Med Mol Imaging 2018; 46:838-847. [PMID: 30167803 DOI: 10.1007/s00259-018-4133-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the feasibility and diagnostic performance of 18F-FDG PET/CT-guided biopsy of abdominal and pelvic lesions with automated robotic arm (ARA) assistance. METHODS This prospective study included 114 patients (75 men, 39 women; mean age 51.3 ± 14.7 years, range: 18-90 years) who underwent PET/CT-guided biopsy of FDG-avid abdominal and pelvic lesions from October 2014 to December 2017. Of these patients, 54 had a prior inconclusive CT-guided biopsy. The biopsies were done with ARA assistance, and a real-time sample was obtained after confirming the position of the needle tip within the target lesion on PET/CT. Histopathology reports were reviewed to evaluate the diagnostic performance of the procedure. Clinical or imaging follow-up was done to confirm negative results. RESULTS The lesions were successfully targeted in 110 of the 114 patients (96.5%) and yielded a pathological diagnosis. Pathological diagnoses were confirmed in 50 of the 54 patients with a prior inconclusive biopsy. Of the 110 lesions, 82 were malignant, 20 were benign, and 8 showed minimal residual FDG uptake at the end of treatment and had no active disease even on clinical and imaging follow-up of at least 3 months. Findings were true-positive in 102 lesions, false-positive in none, true-negative in eight and false-negative in four. The procedure showed sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 96.2%, 100%, 100%, 66.7 and 96.5%, respectively. No immediate complications or delayed life-threatening events were observed. CONCLUSION Percutaneous biopsy of metabolically active abdominal and pelvic lesions with ARA assistance is a technically feasible, safe and accurate method for pathological diagnosis with high diagnostic performance. PET-guided biopsy is highly practical and useful in patients, especially in those with a previous inconclusive biopsy.
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Affiliation(s)
- Rajender Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Anish Bhattacharya
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Harmandeep Singh
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Amanjit Bal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shelvin Kumar Vadi
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Ashwani Sood
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Gaurav Prakash
- Department of Hemato-Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harjeet Singh
- Department of Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Department of Rheumatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Post-therapy lesions in patients with non-Hodgkin's lymphoma characterized by 18F-FDG PET/CT-guided biopsy using automated robotic biopsy arm. Nucl Med Commun 2018; 39:74-82. [PMID: 29189443 DOI: 10.1097/mnm.0000000000000780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE The aim of this study was to analyse the positive predictive value (PPV) of post-therapy fluorine-18-fluorodeoxyglucose (F-FDG) PET/CT performed for response or recurrence evaluation in patients with non-Hodgkin's lymphoma (NHL) and to appraise the diagnostic utility of F-FDG PET/CT-guided biopsy in this setting. PATIENTS AND METHODS A total of 17 patients with NHL showing F-FDG avid lesions in F-FDG PET/CT performed for response or recurrence assessment underwent F-FDG PET/CT-guided biopsy using automated robotic biopsy arm needle navigation technique. The objectives were analysed in reference to histopathology. RESULTS In all, 15 of the 17 (88.5%) procedures yielded adequate representative tissue samples. Nine out of 15 lesions were positive for residual disease and the remaining revealed benign findings on histopathology. One patient with inconclusive biopsy underwent surgical resection and histopathology confirmed the presence of residual disease. PPV of theF-FDG PET/CT was observed to be 62.5% (10/16). CONCLUSION F-FDG PET/CT for response evaluation in NHL possesses a low PPV and hence warrants histopathological correlation when F-FDG PET/CT findings influence management decision. Diagnostic yield of F-FDG PET/CT-guided biopsy is high and has the potential to reduce sampling errors.
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Tsapaki V, Balter S, Cousins C, Holmberg O, Miller DL, Miranda P, Rehani M, Vano E. The International Atomic Energy Agency action plan on radiation protection of patients and staff in interventional procedures: Achieving change in practice. Phys Med 2018; 52:56-64. [PMID: 30139610 DOI: 10.1016/j.ejmp.2018.06.634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 05/22/2018] [Accepted: 06/15/2018] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The International Atomic Energy Agency (IAEA) organized the 3rd international conference on radiation protection (RP) of patients in December 2017. This paper presents the conclusions on the interventional procedures (IP) session. MATERIAL AND METHODS The IAEA conference was conducted as a series of plenary sessions followed by various thematic sessions. "Radiation protection of patients and staff in interventional procedures" session keynote speakers presented information on: 1) Risk management of skin injuries, 2) Occupational radiation risks and 3) RP for paediatric patients. Then, a summary of the session-related papers was presented by a rapporteur, followed by an open question-and-answer discussion. RESULTS Sixty-seven percent (67%) of papers came from Europe. Forty-four percent (44%) were patient studies, 44% were occupational and 12% were combined studies. Occupational studies were mostly on eye lens dosimetry. The rest were on scattered radiation measurements and dose tracking. The majority of patient studies related to patient exposure with only one study on paediatric patients. Automatic patient dose reporting is considered as a first step for dose optimization. Despite efforts, paediatric IP radiation dose data are still scarce. The keynote speakers outlined recent achievements but also challenges in the field. Forecasting technology, task-specific targeted education from educators familiar with the clinical situation, more accurate estimation of lens doses and improved identification of high-risk professional groups are some of the areas they focused on. CONCLUSIONS Manufacturers play an important role in making patients safer. Low dose technologies are still expensive and manufacturers should make these affordable in less resourced countries. Automatic patient dose reporting and real-time skin dose map are important for dose optimization. Clinical audit and better QA processes together with more studies on the impact of lens opacities in clinical practice and on paediatric patients are needed.
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Affiliation(s)
- V Tsapaki
- Konstantopoulio General Hospital, Agias Olgas 3-5, 14233 Nea Ionia, Greece.
| | - S Balter
- Department of Radiology and Medicine, Columbia University, New York, USA.
| | - C Cousins
- FRCP, FRCR, Chair ICRP, 280 Slater Street, Ottawa, Ontario K1P 5S9, Canada.
| | - O Holmberg
- Radiation Protection of Patients Unit, International Atomic Energy Agency, Vienna International Center, Vienna, Austria.
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, 10903 New Hampshire Avenue, Silver Spring, MD, USA.
| | - P Miranda
- Hemodynamic Department, Cardiovascular Service, Luis Calvo Mackenna Hospital, Santiago, Chile.
| | - M Rehani
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - E Vano
- Radiology Department, Medical School, Complutense University, 28040 Madrid, Spain.
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Puijk RS, Ruarus AH, Scheffer HJ, Vroomen LGPH, van Tilborg AAJM, de Vries JJJ, Berger FH, van den Tol PMP, Meijerink MR. Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control. Can Assoc Radiol J 2018; 69:51-62. [PMID: 29458955 DOI: 10.1016/j.carj.2017.11.001] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 02/06/2023] Open
Abstract
Liver tumour ablation nowadays represents a routine treatment option for patients with primary and secondary liver tumours. Radiofrequency ablation and microwave ablation are the most widely adopted methods, although novel techniques, such as irreversible electroporation, are quickly working their way up. The percutaneous approach is rapidly gaining popularity because of its minimally invasive character, low complication rate, good efficacy rate, and repeatability. However, matched to partial hepatectomy and open ablations, the issue of ablation site recurrences remains unresolved and necessitates further improvement. For percutaneous liver tumour ablation, several real-time imaging modalities are available to improve tumour visibility, detect surrounding critical structures, guide applicators, monitor treatment effect, and, if necessary, adapt or repeat energy delivery. Known predictors for success are tumour size, location, lesion conspicuity, tumour-free margin, and operator experience. The implementation of reliable endpoints to assess treatment efficacy allows for completion-procedures, either within the same session or within a couple of weeks after the procedure. Although the effect on overall survival may be trivial, (local) progression-free survival will indisputably improve with the implementation of reliable endpoints. This article reviews the available needle navigation techniques, evaluates potential treatment endpoints, and proposes an algorithm for quality control after the procedure.
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Affiliation(s)
- Robbert S Puijk
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
| | - Alette H Ruarus
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Hester J Scheffer
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Laurien G P H Vroomen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Aukje A J M van Tilborg
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jan J J de Vries
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ferco H Berger
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Martijn R Meijerink
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
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Gao Y, Han Y, Nan G, Hu M, Zhou X, Hu X. Value of CT-MRI fusion in iodine-125 brachytherapy for high-grade glioma. Oncotarget 2017; 8:112883-112892. [PMID: 29348874 PMCID: PMC5762559 DOI: 10.18632/oncotarget.22844] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/13/2017] [Indexed: 11/25/2022] Open
Abstract
Purposes To develop a fast, accurate and robust method of fusing Computed Tomography (CT) with pre-operative Magnetic Resonance Imaging (MRI) and evaluate the impact of using the fused data on the implantation of Iodine-125 (125I) seeds for brachytherapy of high-grade gliomas (HGG). Methods A study was performed on a cohort of 10 consecutive patients with HGG were treated by 125I brachytherapy with CT-MRI fusion image guided (CMGB), and 10 patients treated with CT alone guided (CGB). Statistical analysis was performed to compare (1) the planning target volume, (2) the accuracy of location of catheters, (3) the target volume covered by 150% prescribe dose (V150), (4) the target volume covered by 200% prescribe dose (V200), and (5) the conformity index (CI) with or without fused data. Results The median planning target volume was 50.1 cm3 in CGB, and 56.25 cm3 in CMGB with significant difference (p = 0.005). The accuracy of catheter insertion was 94.4% with CMGB and 78.9% with CGB. The median V150 and V200 was 45.32% vs 64.24% and 32.81% vs 53.17% in CGB and CMGB, respectively. There was significant difference for CI (83.5% vs. 74.5%, p < 0.05) in the two groups for the post-operative verification. Conclusions The proposed MRI-CT fusion method enables a quantitative assessment of impact on HGG brachytherapy. The additional information obtained from the fused images can be utilized for more accurate delineation of lesion boundaries and targeting of catheters. Experimental results show that the fusion algorithm is robust and reliable in clinical practice.
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Affiliation(s)
- Yang Gao
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing 100191, China
| | - Yan Han
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266001, China
| | - Guo Nan
- School of Instrumentation Science and Opto-Electronics Engineering, Beihang University, Beijing 100191, China
| | - Man Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan 250117 China
| | - Xiaobin Zhou
- Department of Epidemiology and Health Statistics, Public Health College, Qingdao University, Qingdao 266021, China
| | - Xiaokun Hu
- Interventional Center, The Affiliated Hospital of Qingdao University, Qingdao 266001, China
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Radhakrishnan RK, Mittal BR, Gorla AKR, Basher RK, Sood A, Bal A, Kalra N, Khandelwal N, Singh N, Behera D. Real-time intraprocedural 18F-FDG PET/CT-guided biopsy using automated robopsy arm (ARA) in the diagnostic evaluation of thoracic lesions with prior inconclusive biopsy results: initial experience from a tertiary health care centre. Br J Radiol 2017; 90:20170258. [PMID: 28937268 DOI: 10.1259/bjr.20170258] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the feasibility and appraise the diagnostic utility of real time 18F-FDG PET/CT-guided biopsy under automated robopsy arm (ARA) guidance for the evaluation of thoracic lesions with prior inconclusive biopsy results. METHODS PET/CT-guided biopsy of thoracic lesions was performed in patients who had at least one previous inconclusive biopsy. A total of 25 patients (male:female-18 males, 7 females; age: range, 13-75; mean, 53.7) were included in this study. All these patients underwent percutaneous needle biopsies under real-time PET/CT guidance using ARA (ROBIO-EX, Perfint healthcare Pvt Ltd, Chennai, India) needle navigation technique. Histopathology and clinical follow-up results were reviewed for assessing the accuracy of procedures. RESULTS Adequate representative tissue sample could be retrieved in all the patients. No major procedure-related complications were encountered in any patient. Of the 25 procedures, 21 lesions were positive for malignancy and benign findings were observed in the other 4 lesions on histopathology. None of the patients required further biopsy in arriving at a final diagnosis. Overall diagnostic yield of the procedure was 100%. CONCLUSION Real time 18F-FDG PET/CT guidance for percutaneous biopsies of lung and mediastinal lesions is a feasible technique with potential utility in patients with previous inconclusive biopsy results. Advances in knowledge: 18F-FDG PET/CT guidance reduces the sampling errors by specifically targeting areas of viability and avoiding necrosis/atelectasis. A navigational tool like ARA is thought to help in accurately targeting these areas.
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Affiliation(s)
| | - Bhagwant Rai Mittal
- 1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arun Kumar Reddy Gorla
- 1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar Basher
- 1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- 1 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- 2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- 3 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Niranjan Khandelwal
- 3 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Singh
- 4 Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- 4 Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Scott SJ, Adams MS, Salgaonkar V, Sommer FG, Diederich CJ. Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas. J Ther Ultrasound 2017; 5:10. [PMID: 28469915 PMCID: PMC5414307 DOI: 10.1186/s40349-017-0090-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/07/2017] [Indexed: 02/07/2023] Open
Abstract
Background The goal of this study was to theoretically investigate the feasibility of intraductal and transgastric approaches to ultrasound-based thermal therapy of pancreatic tumors, and to evaluate possible treatment strategies. Methods This study considered ultrasound applicators with 1.2 mm outer diameter tubular transducers, which are inserted into the tissue to be treated by an endoscopic approach, either via insertion through the gastric wall (transgastric) or within the pancreatic duct lumen (intraductal). 8 patient-specific, 3D, transient, biothermal and acoustic finite element models were generated to model hyperthermia (n = 2) and ablation (n = 6), using sectored (210°–270°, n = 4) and 360° (n = 4) transducers for treatment of 3.3–17.0 cm3 tumors in the head (n = 5), body (n = 2), and tail (n = 1) of the pancreas. A parametric study was performed to determine appropriate treatment parameters as a function of tissue attenuation, blood perfusion rates, and distance to sensitive anatomy. Results Parametric studies indicated that pancreatic tumors up to 2.5 or 2.7 cm diameter can be ablated within 10 min with the transgastric and intraductal approaches, respectively. Patient-specific simulations demonstrated that 67.1–83.3% of the volumes of four sample 3.3–11.4 cm3 tumors could be ablated within 3–10 min using transgastric or intraductal approaches. 55.3–60.0% of the volume of a large 17.0 cm3 tumor could be ablated using multiple applicator positions within 20–30 min with either transgastric or intraductal approaches. 89.9–94.7% of the volume of two 4.4–11.4 cm3 tumors could be treated with intraductal hyperthermia. Sectored applicators are effective in directing acoustic output away from and preserving sensitive structures. When acoustic energy is directed towards sensitive structures, applicators should be placed at least 13.9–14.8 mm from major vessels like the aorta, 9.4–12.0 mm from other vessels, depending on the vessel size and flow rate, and 14 mm from the duodenum. Conclusions This study demonstrated the feasibility of generating shaped or conformal ablative or hyperthermic temperature distributions within pancreatic tumors using transgastric or intraductal ultrasound.
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Affiliation(s)
- Serena J Scott
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA
| | - Matthew S Adams
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA.,UC Berkeley - UC San Francisco Graduate Program in Bioengineering, California, USA
| | - Vasant Salgaonkar
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA
| | - F Graham Sommer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA USA
| | - Chris J Diederich
- Department of Radiation Oncology, Thermal Therapy Research Group, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, San Francisco, CA 94143-1708 USA.,UC Berkeley - UC San Francisco Graduate Program in Bioengineering, California, USA
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