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Dzaye O, Cornelis FH, Kunin HS, Sofocleous CT. Advancements and Future Outlook of PET/CT-Guided Interventions. Tech Vasc Interv Radiol 2023; 26:100916. [PMID: 38071029 DOI: 10.1016/j.tvir.2023.100916] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Advancements in minimally invasive technology, coupled with imaging breakthroughs, have empowered the field of interventional radiology to achieve unparalleled precision in image-guided diagnosis and treatment while simultaneously reducing periprocedural morbidity. Molecular imaging, which provides valuable physiological and metabolic information alongside anatomical localization, can expand the capabilities of image-guided interventions. Among various molecular imaging techniques, positron emission tomography (PET) stands out for its superior spatial resolution and ability to acquire quantitative data. PET has emerged as a crucial tool for oncologic imaging and plays a pivotal role in both staging and the assessment of treatment responses. Typically used in combination with computed tomography (CT) (PET/CT) and occasionally with magnetic resonance imaging MRI (PET/MRI), PET as a hybrid imaging approach offers enhanced insights into disease progression and response. In recent years, PET has also found its way into image-guided interventions, especially within the rapidly expanding field of interventional oncology. This review aims to explore the current and evolving role of metabolic imaging, specifically PET, in interventional oncology. By delving into the unique advantages and applications of PET in guiding oncological interventions and assessing response, we seek to highlight the increasing significance of this modality in the realm of interventional radiology.
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Affiliation(s)
- Omar Dzaye
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY; Molecular Imaging & Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Francois H Cornelis
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Henry S Kunin
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Constantinos T Sofocleous
- Interventional Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Zirakchian Zadeh M, Yeh R, Kirov AS, Kunin HS, Gönen M, Sotirchos VS, Soares KS, Sofocleous CT. Gradient-based Volumetric PET Parameters on Immediate Pre-ablation FDG-PET Predict Local Tumor Progression in Patients with Colorectal Liver Metastasis Treated by Microwave Ablation. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03470-6. [PMID: 37268735 DOI: 10.1007/s00270-023-03470-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 05/14/2023] [Indexed: 06/04/2023]
Abstract
PURPOSE This study aimed to evaluate the optimal method of segmentation of colorectal liver metastasis (CLM) on immediate pre-ablation PET scans and assess the prognostic value of quantitative pre-ablation PET parameters with regards to local tumor control. A secondary objective was to correlate the target tumor size estimation by PET methods with the tumor measurements on anatomical imaging. METHODOLOGY A prospectively accrued cohort of 55 CLMs (46 patients) treated with real-time 18F-FDG-PET/CT-guided percutaneous microwave ablation was followed-up for a median of 10.8 months (interquartile: 5.5-20.2). Total lesion glycolysis (TLG) and metabolic tumor volume (MTV) values of each CLM were derived from pre-ablation 18F-FDG-PET with gradient and threshold PET segmentation methodologies. The event was defined as local tumor progression (LTP). Time-dependent receiver operating characteristic (ROC) curve analyses were used to assess area under the curves (AUCs). Intraclass correlation (ICC) and 95.0% confidence interval (CI) were performed to measure the linear relationships between the continuous variables. RESULTS AUCs for prediction of LTP obtained from time-dependent ROC analysis for the gradient technique were higher in comparison to the threshold methodologies (AUCs for TLG and volume were: 0.790 and 0.807, respectively). ICC between PET gradient-based and anatomical measurements were higher in comparison to threshold methodologies (ICC for the longest diameter: 733 (95.0% CI 0.538-0.846), ICC for the shortest diameter: .747 (95.0% CI 0.546-0.859), p-values < 0.001). CONCLUSIONS The gradient-based technique had a higher AUC for prediction of LTP after microwave ablation of CLM and showed the highest correlation with anatomical imaging tumor measurements.
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Affiliation(s)
- Mahdi Zirakchian Zadeh
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, IR Suite H118, New York, NY, 10075, USA
| | - Randy Yeh
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Henry S Kunin
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, IR Suite H118, New York, NY, 10075, USA
| | - Mithat Gönen
- Biostatistics Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vlasios S Sotirchos
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, IR Suite H118, New York, NY, 10075, USA
| | - Kevin S Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Constantinos T Sofocleous
- Interventional Oncology/Radiology Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, IR Suite H118, New York, NY, 10075, USA.
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Jiang L, Jowkar N, Bhagavatula SK, Levesque VM, Walsh MF, Kapur T, Shyn PB. PET and CT Contributions to Patient Dose and Personnel Exposure from Radiation During PET/CT-Guided Tumor Ablations. J Vasc Interv Radiol 2022; 33:1234-1239. [PMID: 35817359 DOI: 10.1016/j.jvir.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 05/14/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022] Open
Abstract
This study sought to quantify positron emission tomography (PET) and computed tomography (CT) components of patient dose and personnel radiation exposure during PET/CT-guided tumor ablations, and to assess the utility of a rolling lead shield for operator protection. Two operators performed 21 PET/CT-guided ablations behind a custom 25 mm lead shield with mid-chest to mid-thigh coverage. Mean patient dose per procedure was 3.90 ± 1.13 mSv (11.3%) from PET and 30.51 ± 19.05 mSv (88.7%) from CT. Mean primary and secondary operator exposures outside neck-level thyroid shields were 0.05 mSv and 0.02 mSv per procedure, respectively. Radiation exposure behind the rolling lead shield, inside primary operator's thyroid shield, and on other personnel were below measurable threshold cumulatively over 21 procedures. Mean PET exposure at continuous close proximity to patient was 0.02 mSv per procedure. PET doses to patient and personnel were small; the rolling lead shield provided limited benefit.
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Affiliation(s)
- Liwei Jiang
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Nick Jowkar
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Sharath K Bhagavatula
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Mark F Walsh
- Department of Health Physics, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - Tina Kapur
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Deva K, Rana N, Kumar R, Mittal BR. Evaluation of Radiation Exposure to the Patients Undergoing Positron Emission Tomography/Computed Tomography-Guided Biopsies. Indian J Nucl Med 2022; 37:23-28. [PMID: 35478672 PMCID: PMC9037880 DOI: 10.4103/ijnm.ijnm_112_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose We aimed to evaluate the radiation exposure to patients undergoing positron emission tomography/computed tomography (PET/CT)-guided biopsies. Materials and Methods Patients undergoing PET/CT-guided biopsy were recruited prospectively from October 2019 to April 2020. PET/CT-guided biopsy from a tracer avid site was done using an automated-robotic-arm 1 h after intravenous injection of F-18-fluorodeoxyglucose (FDG) (2-5 mCi) or Ga-68-PSMA (1-4 mCi). Regional CT-images were acquired for biopsy planning and confirmation of needle placement. The internal radiation exposure due to the PET component was estimated using the value of activity injected and dose-coefficient for FDG and PSMA. The external radiation exposure due to the CT component was estimated using the value of dose length product and organ coefficients conversion factor. The total effective dose during the procedure was calculated by adding exposure due to both CT and PET components. Percentage contribution from CT and PET component to total effective dose was compared using a paired t-test. Results A total of 101 patients (76 males) were recruited for PET/CT-guided biopsy using FDG (n = 79) and PSMA (n = 22). The mean effective-dose due to PET and CT components and total effective-dose was 2.49 ± 1.02 mSv, 2.35 ± 1.03 mSv and 4.83 ± 1.90 mSv, respectively, for FDG-guided procedures and 1.60 ± 0.57 mSv, 3.06 ± 1.36 mSv, and 4.66 ± 1.37 mSv for Ga-68-PSMA-guided procedures. The percentage contribution of PET and CT in total effective-dose was comparable in F-18-FDG and Ga-68-PSMA PET/CT-guided biopsy procedures; however, for Ga-68-PSMA PET/CT-biopsies, CT contributed a higher radiation dose than PET component. Conclusion PET/CT-guided biopsy is a safe interventional procedure, and radiation exposure to the patients was less than routine whole-body PET/CT-imaging.
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Affiliation(s)
- Krishnapriya Deva
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nivedita Rana
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Rajender Kumar, Department is Nuclear Medicine and PET/CT, Institute is Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kairn T, Maxwell SK, Trapp JV, Crowe SB. ASSESSMENT OF INTEGRITY AND LEAD-EQUIVALENCE OF SHIELDED GARMENTS USING TWO-DIMENSIONAL X-RAY IMAGES FROM A COMPUTED TOMOGRAPHY SCANNER. RADIATION PROTECTION DOSIMETRY 2021; 193:155-164. [PMID: 33822208 DOI: 10.1093/rpd/ncab037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
Shielded garments are widely recommended for occupational radiation protection in diagnostic and interventional radiology. This study investigated a novel method for efficiently verifying shielded garment integrity while simultaneously acquiring data for lead-equivalence measurements, using two-dimensional topogram images from computed tomography (CT) scanners. This method was tested against more-conventional measurements with superficial and orthovoltage radiotherapy treatment beams, for 12 shielded garments containing 3 different lead-free shielding materials. Despite some energy-dependent results, all shielded garments approximately achieved their specified lead-equivalence for the energy range expected during clinical use for fluoroscopy procedures, except for three shielded skirts that required two layers of material to be overlapped at the front. All lead-equivalence measurements from CT topograms agreed with or conservatively underestimated the kV narrow-beam results. This method is potentially useful for independently assessing the shielding properties of new shielded garments and performing annual checks for damage or degradation of existing shielded garments.
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Affiliation(s)
- T Kairn
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston 4029, Qld, Australia
- School of Chemistry and Physics, Queensland University of Technology, 2 George St, Brisbane 4000, Qld, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Butterfield St, Herston 4029, Qld, Australia
- School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Qld 4072, Australia
| | - S K Maxwell
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston 4029, Qld, Australia
| | - J V Trapp
- School of Chemistry and Physics, Queensland University of Technology, 2 George St, Brisbane 4000, Qld, Australia
| | - S B Crowe
- Cancer Care Services, Royal Brisbane and Women's Hospital, Butterfield St, Herston 4029, Qld, Australia
- School of Chemistry and Physics, Queensland University of Technology, 2 George St, Brisbane 4000, Qld, Australia
- Herston Biofabrication Institute, Metro North Hospital and Health Service, Butterfield St, Herston 4029, Qld, Australia
- School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Qld 4072, Australia
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Kirov AS, SchÖder H, Solomon SB, Sattler B. Interventional molecular imaging. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:1-3. [PMID: 33494586 DOI: 10.23736/s1824-4785.21.03329-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Assen S Kirov
- Memorial Sloan Kettering Cancer Center, New York, NY, USA -
| | - Heiko SchÖder
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bogoni M, Cerci JJ, Cornelis FH, Nanni C, Tabacchi E, SchÖder H, Shyn PB, Sofocleous CT, Solomon SB, Kirov AS. Practice and prospects for PET/CT guided interventions. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2021; 65:20-31. [PMID: 33494585 PMCID: PMC10446123 DOI: 10.23736/s1824-4785.21.03291-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
During the past 10 years, performing real-time molecular imaging with positron emission tomography (PET) in combination with computed tomography (CT) during interventional procedures has undergone rapid development. Keeping in mind the interest of the nuclear medicine readers, an update is provided of the current workflows using real-time PET/CT in percutaneous biopsies and tumor ablations. The clinical utility of PET/CT guided biopsies in cancer patients with lung, liver, lymphoma, and bone tumors are reviewed. Several technological developments, including the introduction of new PET tracers and robotic arms as well as opportunities provided through acquiring radioactive biopsy specimens are briefly reviewed.
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Affiliation(s)
| | | | | | - Cristina Nanni
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elena Tabacchi
- Unit of Nuclear Medicine, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Heiko SchÖder
- Unit of Nuclear Medicine, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Paul B Shyn
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Constantinos T Sofocleous
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Unit of Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen S Kirov
- Unit of Molecular Imaging and Therapy Physics, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA -
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Hu EY, Levesque VM, Bay CP, Seol JG, Shyn PB. Liver Tumor Ablation Procedure Duration and Estimated Patient Radiation Dose: Comparing Positron Emission Tomography/CT and CT Guidance. J Vasc Interv Radiol 2020; 31:1052-1059. [PMID: 32534979 DOI: 10.1016/j.jvir.2019.11.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/12/2019] [Accepted: 11/28/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To compare procedure duration and patient radiation dose in positron emission tomography/computed tomography (PET/CT) and CT-guided liver tumor ablation procedures. MATERIALS AND METHODS In this retrospective, case-control study, 275 patients underwent 368 image-guided ablation procedures to treat 537 tumors. Radiologists used PET/CT guidance for 117 procedures and CT guidance for 251 procedures. PET/CT-guided procedures were performed by one radiologist (C: P.B.S.). All 3 radiologists (A: J.G.S., B: a radiologist who is not an author on this article, and C: P.B.S.) performed CT-guided procedures. Potential confounders included patient demographics, clinical and tumor characteristics, and procedural variables. RESULTS The mean duration and estimated patient radiation dose of PET/CT-guided procedures performed by radiologist C were 21.5 ± 4.9 minutes longer and 0.7 ± 2.8 mSv higher than CT-guided procedures performed by all radiologists in an unadjusted comparison. Adjusting for confounding, mean duration and estimated dose of PET/CT-guided procedures performed by radiologist C were 28.3 ± 3.8 minutes longer (P < .0001) and 6.2 ± 2.9 mSv higher (P = .03) than CT-guided procedures performed by the same radiologist. Comparing CT-guided procedures performed by all 3 radiologists, adjusted mean durations and estimated patient doses of procedures by the least experienced radiologist, radiologist A, and the second most experienced radiologist, radiologist B, were 24.2 ± 5.1 (P < .0001) and 18.1 ± 8.9 (P = .04) minutes longer and 13.1 ± 3.7 (P < .001) and 14.5 ± 6.4 (P = .02) mSv higher, respectively, than procedures performed by the most experienced radiologist, radiologist C. CONCLUSIONS PET/CT-guided liver ablations had a slightly longer duration with slightly higher estimated patient radiation dose than similar CT-guided liver ablations. Procedure duration and patient dose do not appear to be major impediments to the emerging field of PET/CT-guided tumor ablation.
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Affiliation(s)
- Emmy Y Hu
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Vincent M Levesque
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Camden P Bay
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Julia G Seol
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115
| | - Paul B Shyn
- Department of Radiology, Division of Abdominal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115.
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Mauri G, Gennaro N, De Beni S, Ierace T, Goldberg SN, Rodari M, Solbiati LA. Real-Time US- 18FDG-PET/CT Image Fusion for Guidance of Thermal Ablation of 18FDG-PET-Positive Liver Metastases: The Added Value of Contrast Enhancement. Cardiovasc Intervent Radiol 2018; 42:60-68. [PMID: 30288593 DOI: 10.1007/s00270-018-2082-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/18/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the feasibility of US-18FDG-PET/CT fusion-guided microwave ablation of liver metastases either poorly visible or totally undetectable with US, CEUS and CT, but visualized by PET imaging. MATERIALS AND METHODS Twenty-three patients with 58 liver metastases underwent microwave ablation guided by image fusion system that combines US with 18FDG-PET/CT images. In 28/58 tumors, 18FDG-PET/CT with contrast medium (PET/CECT) was used. The registration technical feasibility, registration time, rates of correct targeting, technical success at 24 h, final result at 1 year and complications were analyzed and compared between the PET/CT and PET/CECT groups. RESULTS Registration was successfully performed in all cases with a mean time of 7.8 + 1.7 min (mean + standard deviation), (4.6 + 1.5 min for PET/CECT group versus 10.9 + 1.8 min for PET/CT group, P < 0.01). In total, 46/58 (79.3%) tumors were correctly targeted, while 3/28 (10.7%) and 9/30 (30%) were incorrectly targeted in PET/CT and PET/CECT group, respectively (P < 0.05). Complete ablation was obtained at 24 h in 70.0% of cases (n = 40 tumors), 23/28 (82.1%) in the PET/CECT group and 17/30 (56.7%) in the PET/CT group (P < 0.037). Fourteen tumors underwent local retreatment (11 ablations, 2 with resection and 1 with stereotactic body radiation therapy), while 4 tumors could not be retreated because of distant disease progression and underwent systemic therapy. Finally, 54/58 (93.1%) tumors were completely treated at 1 year. One major complication occurred, a gastrointestinal hemorrhage which required surgical repair. CONCLUSIONS Percutaneous ablation of 18FDG-PET-positive liver metastases using fusion imaging of real-time US and pre-acquired 18FDG-PET/CT images is feasible, safe and effective. Contrast-enhanced PET/CT improves overall ablation accuracy and shortens procedural duration time.
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Affiliation(s)
- Giovanni Mauri
- Department of Interventional Radiology, IEO, European Institute of Oncology IRCCS, via Ripamonti 435, Milan, Italy.
| | - Nicolò Gennaro
- Training School in Radiology, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Tiziana Ierace
- Department of Radiology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Centre, Jerusalem, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marcello Rodari
- Department of Nuclear Medicine, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy
| | - Luigi Alessandro Solbiati
- Department of Radiology, IRCCS Humanitas Clinical and Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Kirov AS, Fanchon LM, Seiter D, Czmielewski C, Russell J, Dogan S, Carlin S, Pinker-Domenig K, Yorke E, Schmidtlein CR, Boyko V, Fujisawa S, Manova-Todorova K, Zanzonico P, Dauer L, Deasy JO, Humm JL, Solomon S. Technical Note: Scintillation well counters and particle counting digital autoradiography devices can be used to detect activities associated with genomic profiling adequacy of biopsy specimens obtained after a low activity 18 F-FDG injection. Med Phys 2018; 45:2179-2185. [PMID: 29480927 DOI: 10.1002/mp.12836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/14/2018] [Accepted: 02/15/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Genomic profiling of biopsied tissue is the basis for precision cancer therapy. However, biopsied materials may not contain sufficient amounts of tumor deoxyribonucleonic acid needed for the analysis. We propose a method to determine the adequacy of specimens for performing genomic profiling by quantifying their metabolic activity. METHODS We estimated the average density of tumor cells in biopsy specimens needed to successfully perform genomic analysis following the Memorial Sloan Kettering Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT) protocol from the minimum amount of deoxyribonucleonic acid needed and the volume of tissue typically used for analysis. The average 18 F-FDG uptake per cell was assessed by incubating HT-29 adenocarcinoma tumor cells in 18 F-FDG containing solution and then measuring their activity with a scintillation well counter. Consequently, we evaluated the response of two devices around the minimum expected activities which would indicate genomic profiling adequacy of biopsy specimens obtained under 18 F-FDG PET/CT guidance. Surrogate samples obtained using 18G core needle biopsies of gels containing either 18 F-FDG-loaded cells in the expected concentrations or the corresponding activity were measured using autoradiography and a scintillation well counter. Autoradiography was performed using a CCD-based device with real-time image display as well as with digital autoradiography imaging plates following a 30-min off-line protocol for specimen activity determination against previously established calibration. RESULTS Cell incubation experiments and estimates obtained from quantitative autoradiography of biopsy specimens (QABS) indicate that specimens acquired under 18 F-FDG PET/CT guidance that contained the minimum amount of cells needed for genomic profiling would have an average activity concentration in the range of about 3 to about 9 kBq/mL. When exposed to specimens with similar activity concentration, both a CCD-based autoradiography device and a scintillation well counter produced signals with sufficient signal-to-background ratio for specimen genomic adequacy identification in less than 10 min, which is short enough to allow procedure guidance. CONCLUSION Scintillation well counter measurements and CCD-based autoradiography have adequate sensitivity to detect the tumor burden needed for genomic profiling during 18 F-FDG PET/CT-guided 18G core needle biopsies of liver adenocarcinoma metastases.
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Affiliation(s)
- Assen S Kirov
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Louise M Fanchon
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Christian Czmielewski
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - James Russell
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Sean Carlin
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Katja Pinker-Domenig
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Vitaly Boyko
- Molecular Cytology Core Facility, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Sho Fujisawa
- Molecular Cytology Core Facility, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Katia Manova-Todorova
- Molecular Cytology Core Facility, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Lawrence Dauer
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - John L Humm
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Stephen Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
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Cazzato RL, Garnon J, Shaygi B, Koch G, Tsoumakidou G, Caudrelier J, Addeo P, Bachellier P, Namer IJ, Gangi A. PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art. MINIM INVASIV THER 2017; 27:27-32. [DOI: 10.1080/13645706.2017.1399280] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Roberto Luigi Cazzato
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Behnam Shaygi
- Interventional Radiology Department, Royal Devon and Exeter Hospital, NHS Trust, Exeter, UK
| | - Guillaume Koch
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Georgia Tsoumakidou
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Jean Caudrelier
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Pietro Addeo
- Department of Hepatic, Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre (Hopitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Philippe Bachellier
- Department of Hepatic, Biliary and Pancreatic Surgery and Liver Transplantation, Hôpital de Hautepierre (Hopitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Izzie Jacques Namer
- Department of Biophysics and Nuclear Medicine, Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Strasbourg, France
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Nakahara T, Iwabuchi Y, Katagiri M, Matsusaka Y, Itoh K, Ogata Y, Jinzaki M. RADIATION EXPOSURE TO OPERATORS PERFORMING PHARMACOLOGIC STRESS TESTING IN 99mTc MYOCARDIAL PERFUSION IMAGING: A PROSPECTIVE STUDY. RADIATION PROTECTION DOSIMETRY 2017; 176:235-241. [PMID: 28115658 DOI: 10.1093/rpd/ncx001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 01/05/2017] [Indexed: 06/06/2023]
Abstract
This prospective study investigated radiation exposure dose (RED) to main operator (MO) and supervisory operator (SO) performing dypiridamole stress testing in a 1-d rest/stress 99mTc tetrofosmin single-photon emission computed tomography (SPECT) of consecutive 42 patients. MO was instructed to be close to the patients during the entire procedures including the vasodilator and radiotracer injection. SO mainly recorded the data on the procedures apart from the patients. RED, procedure time (PT) and internal radioactivity (IR) of patients were measured before and after a secondary tracer injection for stress SPECT, respectively. RED was significantly greater to MO than to SO (6.2 ± 2.7 vs 2.5 ± 2.1 μSV per stress procedure, p < 0.0001). Multivariate analyses revealed that IR and PT were significantly independent factors to predict RED to both operators. Operators performing pharmacologic stress procedure should be aware that IR and PT are independent factors for RED in 99mTc myocardial perfusion imaging.
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Affiliation(s)
- Tadaki Nakahara
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yu Iwabuchi
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mari Katagiri
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yohji Matsusaka
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kazunari Itoh
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Yuji Ogata
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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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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Taylor JS, Keller L, Maybody M. PET/CT-Guided Interventions in Oncology Patients: A Nursing Perspective. JOURNAL OF RADIOLOGY NURSING 2017; 36:99-103. [PMID: 29398985 PMCID: PMC5794218 DOI: 10.1016/j.jradnu.2016.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the past five years, the utilization of PET/CT guidance is more commonly used for cancer patients undergoing biopsy and ablations at this NCI-Designated Cancer Center. The interventional use of PET/CT imaging requires nurses to have a thorough understanding of the mechanisms involved in order to provide the best care in an environment that is safe for patients and staff. Evidence suggests cohesive care and safe practice measures are achieved when patients actively participate and understand their care. This article will discuss how a collaborative, patient-centered approach in caring for oncologic patients undergoing PET/CT interventions is necessary for achieving quality patient outcomes.
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Affiliation(s)
- Julia S. Taylor
- Corresponding author: Julia S. Taylor, Department of Radiology, Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, (J.S. Taylor)
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Maybody M, Grewal RK, Healey JH, Antonescu CR, Fanchon L, Hwang S, Carrasquillo JA, Kirov A, Farooki A. Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia. Cardiovasc Intervent Radiol 2016; 39:1352-7. [PMID: 27150801 DOI: 10.1007/s00270-016-1350-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by small benign tumors of mesenchymal origin also known as phosphaturic mesenchymal tumors mixed connective tissue variant. Excellent prognosis is expected with eradication of the culprit tumor. These small tumors are notoriously difficult to localize with conventional imaging studies; this often leads to an extensive work up and prolonged morbidity. We report a patient with clinical diagnosis of TIO whose culprit tumor was localized with Ga-68 DOTATOC PET/CT and MRI. Biopsy and cryoablation were performed under Ga-68 DOTATOC PET/CT guidance. Autoradiography of the biopsy specimen was performed and showed in situ correlation between Ga-68 DOTATOC uptake and histopathology with millimeter resolution.
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Affiliation(s)
- Majid Maybody
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, M276C, New York, NY, 10065, USA.
| | - Ravinder K Grewal
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - John H Healey
- Orthopedic Surgical Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cristina R Antonescu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Louise Fanchon
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge A Carrasquillo
- Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Assen Kirov
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Azeez Farooki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
Although molecular imaging has had a dramatic impact on diagnostic imaging, it has only recently begun to be integrated into interventional procedures. Its significant impact is attributed to its ability to provide noninvasive, physiologic information that supplements conventional morphologic imaging. The four major interventional opportunities for molecular imaging are, first, to provide guidance to localize a target; second, to provide tissue analysis to confirm that the target has been reached; third, to provide in-room, posttherapy assessment; and fourth, to deliver targeted therapeutics. With improved understanding and application of(18)F-FDG, as well as the addition of new molecular probes beyond(18)F-FDG, the future holds significant promise for the expansion of molecular imaging into the realm of interventional procedures.
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Affiliation(s)
- Stephen B Solomon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Francois Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and Department of Radiology, Pellegrin Hospital, Bordeaux, France
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18
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Teixeira SC, Veen LDWVD, Sonneborn M, Koolen BB, Stokkel MPM, Olmos RAV. Dedicated breast PET (MAMMI-PET) in daily clinical practice: implications for radiation safety of nuclear medicine personnel. Biomed Phys Eng Express 2016. [DOI: 10.1088/2057-1976/2/1/015003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Chehab MA, Brinjikji W, Copelan A, Venkatesan AM. Navigational Tools for Interventional Radiology and Interventional Oncology Applications. Semin Intervent Radiol 2015; 32:416-27. [PMID: 26622105 DOI: 10.1055/s-0035-1564705] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented.
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Affiliation(s)
- Monzer A Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | - Alexander Copelan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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Vañó E, Miller DL, Dauer L. Implications in medical imaging of the new ICRP thresholds for tissue reactions. Ann ICRP 2015; 44:118-128. [PMID: 25816265 DOI: 10.1177/0146645314562322] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The International Commission on Radiological Protection (ICRP) statement on tissue reactions, issued by the Commission in April 2011, reviewed epidemiological evidence and suggested that there are some tissue reactions where threshold doses are or may be lower than those previously considered. For the lens of the eye, the threshold is now considered to be 0.5 Gy. The absorbed dose threshold for circulatory disease in the heart and brain may be as low as 0.5 Gy. These values can be reached in some patients during interventional cardiology or neuroradiology procedures. They may also be of concern for repeated computed tomography examinations of the head. The new thresholds should be considered in optimisation strategies for clinical procedures, especially in patients likely to require repeated interventions. The new dose thresholds also affect occupational protection for operators and staff. Some operators do not protect their eyes or their brain adequately. After several years of work without proper protection, the absorbed doses to the lens of the eye and the brain of staff can exceed 0.5 Gy. More research is needed to understand the biological effects of cumulative incident air kerma and the instantaneous air kerma rates currently used in medical imaging. The new thresholds, and the need for specific occupational dosimetry related to lens doses, should be considered in radiation protection programmes, and should be included in the education and training of professionals involved in fluoroscopy guided procedures and computed tomography.
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Affiliation(s)
- E Vañó
- Radiology Department, Medicine School and San Carlos Hospital, Complutense University, Madrid, 28040 Spain
| | - D L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, USA
| | - L Dauer
- Department of Medical Physics, Department of Radiology. Memorial Sloan-Kettering Cancer Center, USA
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21
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Fanchon LM, Dogan S, Moreira AL, Carlin SA, Schmidtlein CR, Yorke E, Apte AP, Burger IA, Durack JC, Erinjeri JP, Maybody M, Schöder H, Siegelbaum RH, Sofocleous CT, Deasy JO, Solomon SB, Humm JL, Kirov AS. Feasibility of in situ, high-resolution correlation of tracer uptake with histopathology by quantitative autoradiography of biopsy specimens obtained under 18F-FDG PET/CT guidance. J Nucl Med 2015; 56:538-44. [PMID: 25722446 DOI: 10.2967/jnumed.114.148668] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/26/2015] [Indexed: 01/17/2023] Open
Abstract
UNLABELLED Core biopsies obtained using PET/CT guidance contain bound radiotracer and therefore provide information about tracer uptake in situ. Our goal was to develop a method for quantitative autoradiography of biopsy specimens (QABS), to use this method to correlate (18)F-FDG tracer uptake in situ with histopathology findings, and to briefly discuss its potential application. METHODS Twenty-seven patients referred for a PET/CT-guided biopsy of (18)F-FDG-avid primary or metastatic lesions in different locations consented to participate in this institutional review board-approved study, which complied with the Health Insurance Portability and Accountability Act. Autoradiography of biopsy specimens obtained using 5 types of needles was performed immediately after extraction. The response of autoradiography imaging plates was calibrated using dummy specimens with known activity obtained using 2 core-biopsy needle sizes. The calibration curves were used to quantify the activity along biopsy specimens obtained with these 2 needles and to calculate the standardized uptake value, SUVARG. Autoradiography images were correlated with histopathologic findings and fused with PET/CT images demonstrating the position of the biopsy needle within the lesion. Logistic regression analysis was performed to search for an SUVARG threshold distinguishing benign from malignant tissue in liver biopsy specimens. Pearson correlation between SUVARG of the whole biopsy specimen and average SUVPET over the voxels intersected by the needle in the fused PET/CT image was calculated. RESULTS Activity concentrations were obtained using autoradiography for 20 specimens extracted with 18- and 20-gauge needles. The probability of finding malignancy in a specimen is greater than 50% (95% confidence) if SUVARG is greater than 7.3. For core specimens with preserved shape and orientation and in the absence of motion, one can achieve autoradiography, CT, and PET image registration with spatial accuracy better than 2 mm. The correlation coefficient between the mean specimen SUVARG and SUVPET was 0.66. CONCLUSION Performing QABS on core-biopsy specimens obtained using PET/CT guidance enables in situ correlation of (18)F-FDG tracer uptake and histopathology on a millimeter scale. QABS promises to provide useful information for guiding interventional radiology procedures and localized therapies and for in situ high-spatial-resolution validation of radiopharmaceutical uptake.
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Affiliation(s)
- Louise M Fanchon
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York INSERM, UMR1101, LaTIM, Brest, France
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andre L Moreira
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Sean A Carlin
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Aditya P Apte
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland
| | - Jeremy C Durack
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - Joseph P Erinjeri
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - Majid Maybody
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - Robert H Siegelbaum
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | | | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; and
| | - John L Humm
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Assen S Kirov
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
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Aparici CM, Aslam R, Win AZ. Initial Experience of Utilizing Real-Time Intra-Procedural PET/CT Biopsy. J Clin Imaging Sci 2014; 4:54. [PMID: 25337440 PMCID: PMC4204304 DOI: 10.4103/2156-7514.141941] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/24/2014] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Nonreal-time Positron Emission Tomography/Computed Tomography (PET/CT) biopsies that use the image co-registration of a prior PET with an intra-procedural CT have been reported. The aim of this study was to report the initial experience of performing real-time intra-procedural PET/CT-guided biopsies. MATERIALS AND METHODS All patients (n = 4) had a prior PET/CT examination of the concerning lesion and no significant CT correlate. On the day of the biopsy, 5 mCi of 18F-fluorodeoxyglucose (FDG) or NaF18 was intravenously injected. After 60 min of biodistribution of the molecular probe, PET/CT images were obtained in a limited one bed position over the region of the concerning lesion to be biopsied. RESULTS One patient had a mesenteric mass and the other three had bone lesions, one located in the rib and two in the iliac bone. The pathology report revealed that two lesions (50%) were malignant and two lesions (50%) were benign. The results of the biopsy changed management in all cases. There was 0% complication rate. CONCLUSIONS No additional software or hardware is required to perform real-time intra-procedural PET/CT-guided biopsies. It can optimize the yield, especially in cases where there are no anatomical abnormalities. Real-time intra-procedural PET/CT biopsy may have benefits over conventional biopsy techniques in terms of accuracy.
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Affiliation(s)
- Carina Mari Aparici
- Department of Radiology, University California San Francisco, California, USA
| | - Rizwan Aslam
- Department of Radiology, University California San Francisco, California, USA
| | - Aung Zaw Win
- San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Performance of intra-procedural 18-fluorodeoxyglucose PET/CT-guided biopsies for lesions suspected of malignancy but poorly visualized with other modalities. Eur J Nucl Med Mol Imaging 2014; 41:2265-72. [PMID: 25106463 DOI: 10.1007/s00259-014-2852-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/27/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE We sought to evaluate the safety and the diagnostic success rate of percutaneous biopsies performed under intra-procedural (18)F-deoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) guidance for lesions difficult to see with conventional cross-sectional imaging. METHODS From 2011 to 2013, consecutive clinically indicated percutaneous PET/CT-guided biopsies of 106 masses (mean size, 3.3 cm; range, 0.7-15.9 cm; SD, 2.9 cm) in bones (n = 33), liver (n = 26), soft tissues (n = 18), lung (n = 15) and abdomen (n = 14) were reviewed. The biopsy procedures were performed following injection of a mean of 255 MBq (SD, 74) FDG. Mean maximal standardized uptake value (SUV) of lesions was 8.8 (SD, 6.3). A systematic review of the histopathological results and outcomes was performed. RESULTS Biopsies were positive for malignancy in 76 cases (71.7%, 76/106) and for benign tissue in 30 cases (28.3%, 30/106). Immediate results were considered adequate for 100 PET/CT biopsies (94.3%, 100/106) requiring no further exploration, and for the six others (5.7%, 6/106) benign diagnoses were confirmed after surgery (n = 4) or follow-up (n = 2). The consequent overall sensitivity and the diagnostic success of biopsy were therefore 100%. No significant differences in terms of detection of malignancy were observed between the different locations. Lesions > 2 cm or with SUV > 4 were not significantly more likely to be malignant. Complications occurred after four biopsies (3.7%, 4/106). CONCLUSION Intra-procedural PET/CT guidance appears as a safe and effective method and allows high diagnostic success of percutaneous biopsies for metabolically active lesions.
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Ryan ER, Sofocleous CT, Schöder H, Carrasquillo JA, Nehmeh S, Larson SM, Thornton R, Siegelbaum RH, Erinjeri JP, Solomon SB. Split-dose technique for FDG PET/CT-guided percutaneous ablation: a method to facilitate lesion targeting and to provide immediate assessment of treatment effectiveness. Radiology 2013; 268:288-95. [PMID: 23564714 DOI: 10.1148/radiol.13121462] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To describe a split-dose technique for fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT)-guided ablation that permits both target localization and evaluation of treatment effectiveness. MATERIALS AND METHODS Institutional review board approved the study with a waiver of consent. From July to December 2011, 23 patients (13 women, 10 men; mean age, 59 years; range, 35-87 years) with 29 FDG-avid tumors (median size, 1.4 cm; range, 0.6-4.4 cm) were targeted for ablation. The location of the lesion was the liver (n = 23), lung (n = 4), adrenal gland (n = 1), and thigh (n = 1). Radiofrequency ablation was performed in 17 lesions; microwave ablation, in six; irreversible electroporation, in five; and cryoablation, in one. The pathologic condition of the tumor was metastatic colorectal adenocarcinoma in 18 lesions, primary hepatocellular carcinoma in one lesion, and a variety of metastatic tumors in the remaining 10 lesions. A total of 4 mCi (148 MBq) of FDG was administered before the procedure for localization and imaging guidance. At completion of the ablation, an additional 8 mCi (296 MBq) of FDG was administered to assess ablation adequacy. Results of subsequent imaging follow-up were used to determine if postablation imaging after the second dose of FDG reliably helped predict complete tumor ablation. Descriptive statistics were used to summarize the results. RESULTS Twenty-eight of 29 (97%) ablated lesions showed no residual FDG activity after the second intraprocedural FDG dose. One patient with residual activity underwent immediate biopsy that revealed residual viable tumor and was immediately re-treated. Follow-up imaging at a median of 155 days (range, 92-257 days) after ablation showed local recurrences in two (7%) lesions that were originally negative at postablation PET. CONCLUSION Split-dose FDG PET/CT may be a useful tool to provide both guidance and endpoint evaluation, allowing an opportunity for repeat intervention if necessary. Further work is necessary to validate these concepts.
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Affiliation(s)
- E Ronan Ryan
- Department of Radiology, Division of Interventional Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Suite H118, New York, NY 10065, USA
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