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Supanich M, Siewerdsen J, Fahrig R, Farahani K, Gang GJ, Helm P, Jans J, Jones K, Koenig T, Kuhls-Gilcrist A, Lin M, Riddell C, Ritschl L, Schafer S, Schueler B, Silver M, Timmer J, Trousset Y, Zhang J. AAPM Task Group Report 238: 3D C-arms with volumetric imaging capability. Med Phys 2023; 50:e904-e945. [PMID: 36710257 DOI: 10.1002/mp.16245] [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: 03/25/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
This report reviews the image acquisition and reconstruction characteristics of C-arm Cone Beam Computed Tomography (C-arm CBCT) systems and provides guidance on quality control of C-arm systems with this volumetric imaging capability. The concepts of 3D image reconstruction, geometric calibration, image quality, and dosimetry covered in this report are also pertinent to CBCT for Image-Guided Radiation Therapy (IGRT). However, IGRT systems introduce a number of additional considerations, such as geometric alignment of the imaging at treatment isocenter, which are beyond the scope of the charge to the task group and the report. Section 1 provides an introduction to C-arm CBCT systems and reviews a variety of clinical applications. Section 2 briefly presents nomenclature specific or unique to these systems. A short review of C-arm fluoroscopy quality control (QC) in relation to 3D C-arm imaging is given in Section 3. Section 4 discusses system calibration, including geometric calibration and uniformity calibration. A review of the unique approaches and challenges to 3D reconstruction of data sets acquired by C-arm CBCT systems is give in Section 5. Sections 6 and 7 go in greater depth to address the performance assessment of C-arm CBCT units. First, Section 6 describes testing approaches and phantoms that may be used to evaluate image quality (spatial resolution and image noise and artifacts) and identifies several factors that affect image quality. Section 7 describes both free-in-air and in-phantom approaches to evaluating radiation dose indices. The methodologies described for assessing image quality and radiation dose may be used for annual constancy assessment and comparisons among different systems to help medical physicists determine when a system is not operating as expected. Baseline measurements taken either at installation or after a full preventative maintenance service call can also provide valuable data to help determine whether the performance of the system is acceptable. Collecting image quality and radiation dose data on existing phantoms used for CT image quality and radiation dose assessment, or on newly developed phantoms, will inform the development of performance criteria and standards. Phantom images are also useful for identifying and evaluating artifacts. In particular, comparing baseline data with those from current phantom images can reveal the need for system calibration before image artifacts are detected in clinical practice. Examples of artifacts are provided in Sections 4, 5, and 6.
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Affiliation(s)
- Mark Supanich
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Pat Helm
- Medtronic Inc., Minneapolis, Minnesota, USA
| | | | - Kyle Jones
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - MingDe Lin
- Yale University, New Haven, Connecticut, USA
| | | | | | | | | | - Mike Silver
- Canon Medical Systems USA, Long Beach, California, USA
| | | | | | - Jie Zhang
- University of Kentucky, Lexington, Kentucky
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C-Arm Cone-Beam CT Virtual Navigation versus Conventional CT Guidance in the Transthoracic Lung Biopsy: A Case-Control Study. Diagnostics (Basel) 2022; 12:diagnostics12010115. [PMID: 35054282 PMCID: PMC8774822 DOI: 10.3390/diagnostics12010115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/01/2022] [Accepted: 01/02/2022] [Indexed: 11/17/2022] Open
Abstract
C-arm cone-beam computed tomography (CBCT) virtual navigation-guided lung biopsy has been developed in the last decade as an alternative to conventional CT-guided lung biopsy. This study aims to compare the biopsy accuracy and safety between these two techniques and explores the risk factors of biopsy-related complications. A total of 217 consecutive patients undergoing conventional CT- or C-arm CBCT virtual navigation-guided lung biopsy from 1 June 2018 to 31 December 2019 in this single-center were retrospectively reviewed. Multiple factors (e.g., prior emphysema, lesion size, etc.) were compared between two biopsy techniques. The risk factors of complications were explored by using logistic regression. The patients’ median age and male-to-female ratio were 63 years and 2.1:1, respectively. Eighty-two (82) patients (37.8%) underwent conventional CT-guided biopsies, and the other 135 patients (62.2%) C-arm CBCT virtual navigation-guided biopsies. Compared with patients undergoing C-arm CBCT virtual navigation-guided lung biopsies, patients undergoing conventional CT-guided lung biopsies showed higher needle repositioning rate, longer operation time, and higher effective dose of X-ray (52.4% vs. 6.7%, 25 min vs. 15 min, and 13.4 mSv vs. 7.6 mSv, respectively; p < 0.001, each). In total, the accurate biopsy was achieved in 215 of 217 patients (99.1%), without a significant difference between the two biopsy techniques (p = 1.000). The overall complication rates, including pneumothorax and pulmonary hemorrhage/hemoptysis, are 26.3% (57/217), with most minor complications (56/57, 98.2%). The needle repositioning was the only independent risk factor of complications with an odds ratio of 6.169 (p < 0.001). In conclusion, the C-arm CBCT virtual navigation is better in percutaneous lung biopsy than conventional CT guidance, facilitating needle positioning and reducing radiation exposure. Needle repositioning should be avoided because it brings about more biopsy-related complications.
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Hong W, Yoon SH, Goo JM, Park CM. Cone-Beam CT-Guided Percutaneous Transthoracic Needle Lung Biopsy of Juxtaphrenic Lesions: Diagnostic Accuracy and Complications. Korean J Radiol 2021; 22:1203-1212. [PMID: 33938644 PMCID: PMC8236357 DOI: 10.3348/kjr.2020.1229] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/10/2020] [Accepted: 12/21/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To investigate the diagnostic accuracy and complications of cone-beam CT-guided percutaneous transthoracic needle biopsy (PTNB) of juxtaphrenic lesions and identify the risk factors for diagnostic failure and complications. MATERIALS AND METHODS In total, 336 PTNB procedures for lung lesions (mean size ± standard deviation [SD], 4.3 ± 2.3 cm) abutting the diaphragm in 326 patients (189 male and 137 female; mean age ± SD, 65.2 ± 11.4 years) performed between January 2010 and December 2014 were included. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the PTNB procedures for the diagnosis of malignancy were measured based on the intention-to-diagnose principle. The risk factors for diagnostic failures and complications were evaluated using logistic regression analysis. RESULTS The accuracy, sensitivity, specificity, PPV, and NPV were 92.7% (293/316), 91.3% (219/240), 91.4% (74/81), 96.9% (219/226), and 77.9% (74/95), respectively. There were 23 diagnostic failures (7.3%), and lesion sizes ≤ 2 cm (p = 0.045) were the only significant risk factors for diagnostic failure. Complications occurred in 98 cases (29.2%), including 89 cases of pneumothorax (26.5%) and 7 cases of hemoptysis (2.1%). The multivariable analysis showed that old age (> 65 years) (p = 0.002), lesion size of ≤ 2 cm (p = 0.003), emphysema (p = 0.006), and distance from the pleura to the target lesion (> 2 cm) (p = 0.010) were significant risk factors for complications. CONCLUSION The diagnostic accuracy of cone-beam CT-guided PTNB of juxtaphrenic lesions for malignancy was fairly high, and the target lesion size was the only significant predictor of diagnostic failure. Complications of cone-beam CT-guided PTNB of juxtaphrenic lesions occurred at a reasonable rate.
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Affiliation(s)
- Wonju Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea.,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.
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Gulias-Soidan D, Crus-Sanchez NM, Fraga-Manteiga D, Cao-González JI, Balboa-Barreiro V, González-Martín C. Cone-Beam CT-Guided Lung Biopsies: Results in 94 Patients. Diagnostics (Basel) 2020; 10:diagnostics10121068. [PMID: 33321706 PMCID: PMC7764439 DOI: 10.3390/diagnostics10121068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/04/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. METHODS Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. RESULTS Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. CONCLUSION The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.
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Affiliation(s)
- Daniel Gulias-Soidan
- Department of Interventional Radiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Spain; (D.G.-S.); (N.M.C.-S.); (D.F.-M.); (J.I.C.-G.)
| | - Nilfa Milena Crus-Sanchez
- Department of Interventional Radiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Spain; (D.G.-S.); (N.M.C.-S.); (D.F.-M.); (J.I.C.-G.)
| | - Daniel Fraga-Manteiga
- Department of Interventional Radiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Spain; (D.G.-S.); (N.M.C.-S.); (D.F.-M.); (J.I.C.-G.)
| | - Juan Ignacio Cao-González
- Department of Interventional Radiology, Complejo Hospitalario Universitario de A Coruña (CHUAC), As Xubias 84, 15006 A Coruña, Spain; (D.G.-S.); (N.M.C.-S.); (D.F.-M.); (J.I.C.-G.)
| | - Vanesa Balboa-Barreiro
- Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, University of A Coruña (UDC), As Xubias 84, 15006 A Coruña, Spain;
| | - Cristina González-Martín
- Rheumatology and Public Health Research Group, Nursing Research and Health Care, Biomedical Research Institute of A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, University of Coruña (UDC), As Xubias 84, 15006 A Coruña, Spain
- Correspondence: ; Tel.: +34-981-337400 (ext. 3535); Fax: +34-981-337420
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Shivaram GM, Gill AE, Monroe EJ, Koo KSH, Hawkins CM. Cone-beam computed tomography guidance with navigational overlay for percutaneous lung nodule biopsy. Pediatr Radiol 2019; 49:327-331. [PMID: 30411171 DOI: 10.1007/s00247-018-4296-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 10/24/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Cone-beam CT is increasingly used in pediatric interventional radiology procedures. However, the feasibility or safety of using this mode of imaging guidance for percutaneous lung nodule biopsy in children has not been assessed. OBJECTIVE To retrospectively evaluate safety and diagnostic accuracy of percutaneous lung nodule biopsy in people treated at a pediatric hospital using cone-beam CT with navigational overlay. MATERIALS AND METHODS Thirty-six consecutive patients from two large tertiary-care children's hospitals with lung nodules of 48 mm or smaller underwent percutaneous lung nodule biopsy using cone-beam CT with navigational overlay. We evaluated patient demographics, pre- and post-biopsy diagnoses, number of biopsy passes, complications, radiation exposure and technical success. RESULTS Percutaneous lung nodule biopsy was performed for 37 nodules in 36 patients (23 males, 13 females, median age 15.5 years, range 8 months to 23 years). One patient underwent biopsy of two nodules at a single procedure. Median patient weight was 55 kg (range 8-97 kg). Pre-biopsy diagnoses included metastatic sarcoma or other solid tumor (n=11), leukemia/lymphoma (n=13), infection (n=10), chronic granulomatous disease (n=2) and post-transplant lymphoproliferative disorder (PTLD; n=1). Mean number of passes was 5 (range 2-15). Mean pre-procedure international normalized ratio (INR) was 1.1 and platelet count 193 × 109/L. Diagnostic specimens were obtained in 32 of 36 patients (89%). Thirteen complications were encountered in 12 patients (33% of cohort), including 9 pneumothoraces (4 requiring chest tubes); 1 hemothorax, which required a chest tube; and 3 self-limited pulmonary hemorrhages. Mean and median radiation doses were as follows: fluoroscopy time 3 min and 2.4 min, dose-area product (DAP) (recorded in 31 patients) 23,402 Gy·cm2 and 12,453 Gy·cm2, and air kerma 88 mGy and 58 mGy. CONCLUSION Percutaneous lung nodule needle biopsy can be performed accurately using cone-beam CT with navigational overlay.
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Affiliation(s)
- Giridhar M Shivaram
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA.
| | - Anne Elizabeth Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Eric J Monroe
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA
| | - Kevin S H Koo
- Department of Radiology, Section of Interventional Radiology, Seattle Children's Hospital, University of Washington School of Medicine, 4800 Sand Point Way NE, Seattle, WA, 98145, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Zhou Q, Dong J, He J, Liu D, Tian DH, Gao S, Li S, Liu L, He J, Huang Y, Xu S, Mao W, Tan Q, Chen C, Li X, Zhang Z, Jiang G, Xu L, Zhang L, Fu J, Li H, Wang Q, Tan L, Li D, Zhou Q, Fu X, Jiang Z, Chen H, Fang W, Zhang X, Li Y, Tong T, Yu Z, Liu Y, Zhi X, Yan T, Zhang X, Casal RF, Pompeo E, Carretta A, Riquet M, Rena O, Falcoz PE, Saji H, Khan AZ, Danguilan JL, Gonzalez-Rivas D, Guibert N, Zhu C, Shen J. The Society for Translational Medicine: indications and methods of percutaneous transthoracic needle biopsy for diagnosis of lung cancer. J Thorac Dis 2018; 10:5538-5544. [PMID: 30416804 DOI: 10.21037/jtd.2018.09.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jingsi Dong
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jie He
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Shugeng Gao
- Department of Thoracic Surgical Oncology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Cancer Center, Beijing 100021, China
| | - Shanqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Lunxu Liu
- Department of Cardiovascular and Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jianxing He
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou 510120, China
| | - Yunchao Huang
- Department of Thoracic and Cardiovascular Surgery, The Third Affiliated Hospital of Kunming Medical University (Yunnan Tumor Hospital), Kunming 650100, China
| | - Shidong Xu
- Department of Thoracic surgery, Harbin Medical University Cancer Hospital, Harbin 150086, China
| | - Weimin Mao
- Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Qunyou Tan
- Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
| | - Chun Chen
- Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
| | - Xiaofei Li
- Department of Thoracic Surgery, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Zhu Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai 200433, China
| | - Lin Xu
- Department of Thoracic Surgery, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Key Laboratory of Molecular and Translational Cancer Research, Cancer Institute of Jiangsu Province, Nanjing 210009, China
| | - Lanjun Zhang
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jianhua Fu
- Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chao-Yang Hospital, Beijing 100043, China
| | - Qun Wang
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Lijie Tan
- Department of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai 200032, China
| | - Danqing Li
- Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine, Beijing 100006, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiangning Fu
- Department of Thoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhongmin Jiang
- Department of Thoracic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.,Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Jiao Tong University, Shanghai 200000, China
| | - Xun Zhang
- Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, China
| | - Yin Li
- Department of Thoracic Surgery, Henan Cancer Hospital, Zhengzhou 450000, China
| | - Ti Tong
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
| | - Yongyu Liu
- Department of Thoracic Surgery, Liaoning Cancer Hospital and Institute, Shenyang 110042, China
| | - Xiuyi Zhi
- Department of Thoracic Surgery, Xuanwu Hospital of Capital Medical University, Beijing 100053, China
| | - Tiansheng Yan
- Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100083, China
| | - Xingyi Zhang
- Department of Thoracic Surgery, Second Hospital of Jilin University, Changchun 130041, China
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Eugenio Pompeo
- Department of Thoracic Surgery, Policlinico Tor Vergata, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Angelo Carretta
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Marc Riquet
- Georges Pompidou European Hospital, General Thoracic Surgery Department, Georges Pompidou European Hospital, Paris, France
| | - Ottavio Rena
- Thoracic Surgery Unit, University of Eastern Piedmont, AOU Maggiore della Carità, Vercelli, Italy
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Ali Zamir Khan
- Department of Minimally Invasive Thoracic Surgery, Medanta The Medicity, Gurgaon, India
| | - Jose Luis Danguilan
- Lung Center of the Philippines, Quezon City, Philippines, USA.,University of the Philippines College of Medicine, Manila, Philippines, USA
| | | | - Nicolas Guibert
- Pulmonology Department, Larrey University Hospital, Toulouse, France
| | - Chengchu Zhu
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
| | - Jianfei Shen
- Department of Cardiothoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Taizhou 317000, China
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Iannelli G, Caivano R, Villonio A, Semeraro V, Lucarelli NM, Ganimede MP, Gisone V, Dinardo G, Bruno S, Macarini L, Guglielmi G, Cammarota A. Percutaneous Computed Tomography-Guided Lung Biopsies using a Virtual Navigation Guidance: Our Experience. Cancer Invest 2018; 36:349-355. [PMID: 30095281 DOI: 10.1080/07357907.2018.1498877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a virtual CT-guided navigation system (Sirio-MASMEC Biomed) in performing lung biopsies, with greater attention to lesions smaller than 1 cm, compared to the traditional procedure. METHODS This study was approved by the Ethics Committee of our Institute. Two hundred patients were prospectively selected. Of these, 100 were subjected to percutaneous procedure with the use of Sirio and 100 to traditional CT-guided percutaneous procedure. The two methods were compared in terms of absorbed dose, procedure time, complications, and number of non-diagnostic specimens (diagnostic success). RESULTS Sirio has shown a significant reduction in the absorbed dose and procedure times (p < 0.05), with a lower incidence of complications compared to the traditional procedure. Sirio has also allowed to carry out biopsies of lesions' diameter ≤10 mm, obtaining fewer non diagnostic specimens thus resulting more effective in terms of diagnostic success. CONCLUSIONS The use of Sirio in sampling biopsy showed a statistically significant reduction in terms of performed scans and procedural time with lower incidence of post-procedural complications compared to the traditional percutaneous procedure, especially for lesions ≤10 mm. The best diagnostic result, the reduction of the dose absorbed and procedural complications makes the procedures more reliable, safety and less invasive. In addition, the reduction of execution time will increase the number of daily interventional procedures improving clinical management.
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Affiliation(s)
| | | | | | - Vittorio Semeraro
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Nicola Maria Lucarelli
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Maria Porzia Ganimede
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Vito Gisone
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | | | | | - Luca Macarini
- c Radiology Department , University of Foggia , Foggia , Italy
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8
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Kim H, Park CM, Yoon SH, Hwang EJ, Lee JH, Ahn SY, Goo JM. Open Bronchus Sign on CT: A Risk Factor for Hemoptysis after Percutaneous Transthoracic Biopsy. Korean J Radiol 2018; 19:880-887. [PMID: 30174477 PMCID: PMC6082752 DOI: 10.3348/kjr.2018.19.5.880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/01/2018] [Indexed: 01/29/2023] Open
Abstract
Objective We hypothesized that open bronchi within target pulmonary lesions are associated with percutaneous transthoracic needle biopsy (PTNB)-related hemoptysis. We sought to analyze and compare patient characteristics and target features as well as biopsy-related factors between patients with and without PTNB-related hemoptysis. Materials and Methods We retrospectively analyzed 1484 patients (870 males and 614 females; median age, 66 years) who had undergone 1569 cone-beam CT (CBCT)-guided PTNBs. Patient characteristics (sex, age, and pathologic diagnosis), nodule features (nodule type, size, location, and presence of an open bronchus in target nodules), and biopsy-related factors (biopsy needle size, pleura-to-target distance, blood test results, open bronchus unavoidability [OBU] index, etc.) were investigated. OBU index, which was assessed using the pre-procedural CBCT, was a subjective scoring system for the probability of needle penetration into the open bronchus. Univariate analysis and subsequent multivariate logistic regression analysis were conducted to reveal the independent risk factors for PTNB-related hemoptysis. For a subgroup of nodules with open bronchi, a trend analysis between the occurrence of hemoptysis and the OBU index was performed. Results The independent risk factors for hemoptysis were sex (female; odds ratio [OR], 1.918; p < 0.001), nodule size (OR, 0.837; p < 0.001), open bronchus (OR, 2.101; p < 0.001), and pleura-to-target distance (OR, 1.135; p = 0.003). For the target nodules with open bronchi, a significant trend between hemoptysis and OBU index (p < 0.001) was observed. Conclusion An open bronchus in a biopsy target is an independent predictor of hemoptysis, and careful imaging review may potentially reduce PTNB-related hemoptysis.
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Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea
| | - Eui Jin Hwang
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea
| | - Su Yeon Ahn
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea.,Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 03080, Korea.,Cancer Research Institute, Seoul National University, Seoul 03080, Korea
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9
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Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis. PLoS One 2018; 13:e0191590. [PMID: 29357388 PMCID: PMC5777651 DOI: 10.1371/journal.pone.0191590] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 01/08/2018] [Indexed: 12/26/2022] Open
Abstract
Background Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs. Methods A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter. Results From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69–80) using the BR approach and 93% (95% CI, 90–96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88–95) was superior to the BR approach (66%, 95% CI: 55–76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75–85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach. Conclusions CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.
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10
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Yan GW, Bhetuwal A, Yan GW, Sun QQ, Niu XK, Zhou Y, Li LF, Li BZ, Zeng H, Zhang C, Li B, Xu XX, Yang HF, Du Y. A Systematic Review and Meta-Analysis of C-Arm Cone-Beam CT-Guided Percutaneous Transthoracic Needle Biopsy of Lung Nodules. Pol J Radiol 2017; 82:152-160. [PMID: 28392852 PMCID: PMC5370428 DOI: 10.12659/pjr.899626] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/25/2016] [Indexed: 12/18/2022] Open
Abstract
Background A systematic review and meta-analysis of all available publications was performed to evaluate the diagnostic accuracy of percutaneous transthoracic needle biopsy (PTNB) using a C-Arm Cone-Beam CT (CBCT) system in patients with lung nodules. Material/Methods Thedatabases of PUBMED, OVID, EBSCO, EMBASE, and China National Knowledge Infrastructure (CNKI) were systematically searched for relevant original articles on the diagnostic accuracy of CBCT-guided PTNB for the diagnosis of nodules in the lungs. Diagnostic indices including sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and diagnostic score (DS) were calculated. Moreover,summary receiver operating characteristic curves (SROC) were constructed with Stata (version 13.0), Rev Man (version 5.3), and Meta-disc (version 1.4) software. Other clinical indices such as incidence of complications were also recorded. Results Eight studies met the inclusion and exclusion criteria for the meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, DS, and SROC with 95% confidence intervals were 0.96 (0.93–0.98), 1.00 (0.91–1.00), 711.15 (9.48–53325.89), 0.04 (0.02–0.07), 16585.29 (284.88–9.7e+05), 9.72 (5.65–13.78), and 0.99 (0.97–0.99), respectively. The incidence of pneumothorax and hemorrhage was 10–29.27% and 1.22–47.25%, respectively. Conclusions CBCT-guided PTNB has an acceptable rate of complications and is associated with a reasonable radiation exposure. Moreover, it is a highly accurate and safe technique for the diagnosis of lung nodules and can be recommended to be used in routine clinical practice.
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Affiliation(s)
- Gao-Wu Yan
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Anup Bhetuwal
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Gao-Wen Yan
- Department of Radiology, The First People's Hospital of Suining City, Suining, Sichuan, P.R. China
| | - Qin-Quan Sun
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xiang-Ke Niu
- Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, P.R. China
| | - Yu Zhou
- Department of Cardio-Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Li-Fa Li
- Department of Gastrointestinal of Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Bin-Zhong Li
- School of Basic Medical Sciences, North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Hao Zeng
- Department of Radiology, Suining Central Hospital, Suining, Sichuan, P.R. China
| | - Chuan Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Bing Li
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Xiao-Xue Xu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Han-Feng Yang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
| | - Yong Du
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, P.R. China
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Park SC, Kim CJ, Han CH, Lee SM. Factors associated with the diagnostic yield of computed tomography-guided transbronchial lung biopsy. Thorac Cancer 2017; 8:153-158. [PMID: 28177201 PMCID: PMC5415472 DOI: 10.1111/1759-7714.12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/26/2016] [Accepted: 12/27/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Computed tomography (CT) may be useful for increasing the diagnostic yield of transbronchial lung biopsy (TBLB). However, only a few studies with small sample sizes have reported the diagnostic utility of CT-guided TBLB and the factors affecting the diagnostic accuracy of CT-guided TBLB are not well known. We evaluated the diagnostic yield of CT-guided TBLB and associated factors. METHODS CT-guided TBLB was performed in 59 patients. Both conventional fluoroscopy and CT were used in all patients for TBLB. The biopsy forceps were advanced toward the lesion under conventional fluoroscopic guidance. CT was used to check whether the forceps were in the correct position. RESULTS The average diameter of the lesions was 3.1 ± 1.0 cm. The biopsy forceps correctly reached the lesion in 43 patients by real-time CT. A diagnosis was made in 42 patients, and the overall diagnostic yield was 71.2%. The sensitivity for malignancy was 85.7%. In multivariate analysis, the only factor associated with diagnostic yield was forceps position assessed by CT scan (adjusted odds ratio 53.31; 95% confidence interval 5.31, 535.27; P = 0.001). CONCLUSION CT-guided TBLB is a useful diagnostic tool for pulmonary nodules or masses. The correct positioning of biopsy forceps using CT is valuable for successful CT-guided TBLB.
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Affiliation(s)
- Seon Cheol Park
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Cheong Ju Kim
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Chang Hoon Han
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
| | - Sun Min Lee
- Division of Pulmonology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang-si, South Korea
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12
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Flat detector cone-beam CT-guided percutaneous needle biopsy of mediastinal lesions: preliminary experience. Radiol Med 2016; 121:769-79. [PMID: 27334008 DOI: 10.1007/s11547-016-0660-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 05/30/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the usefulness of flat detector cone-beam CT-guided CBCT percutaneous needle biopsy (PNB) of mediastinal lesions. METHODS A total of 100 patients with 100 solid mediastinal lesions were retrospectively enrolled to undergo percutaneous needle biopsy (PNB) procedures. The mean diameter of lesions was 4.4 ± 1.8 cm (range 1.8-9.0 cm). The needle path was carefully planned and calculated on the CBCT virtual navigation guidance system, which acquired 3D CT-like cross-sectional images. Diagnostic performance, procedure details, complication rate, and patient radiation exposure were investigated. RESULTS The technical success rate of PNB under CBCT virtual navigation system was 100 % (100/100). The sensitivity, specificity, and accuracy of PNB of small nodules under iGuide CBCT virtual navigation guidance were 95.1 % (79/83), 100 % (12/12), and 95.7 % (91/95), respectively. The number of biopsies and CBCT acquisitions were 2.6 ± 1.2 (range 1-6) and 3.0 ± 1.1 (range 2-8), respectively. Complications occurred in five (5.0 %) cases. The mean total procedure time was 11.70 ± 3.44 min (range 6-27 min), resulting in a mean exposure dose of 9.7 ± 4.3 mSv. CONCLUSION Flat detector cone-beam CT-guided PNB is an accurate and safe diagnostic method for mediastinal lesions.
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13
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Jiao DC, Li TF, Han XW, Wu G, Ma J, Fu MT, Sun Q, Beilner J. Clinical applications of the C-arm cone-beam CT-based 3D needle guidance system in performing percutaneous transthoracic needle biopsy of pulmonary lesions. Diagn Interv Radiol 2015; 20:470-4. [PMID: 25323838 DOI: 10.5152/dir.2014.13463] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE This study explored the value of flat detector C-arm CT-guidance system in performing percutaneous transthoracic needle biopsy (PTNB) for lung lesions in clinical practice. METHODS A total of 110 patients with solid lung lesions were enrolled to undergo PTNB procedures. The mean diameter of lesions was 4.63 cm (range, 0.6-15cm). The needle path was carefully planned and calculated on the C-arm CT system, which acquired three-dimensional CT-like cross-sectional images. The PTNB procedures were performed under needle guidance with fluoroscopic feedbacks. RESULTS Histopathologic tissue was successfully obtained from 108 patients with a puncture success rate of 98.2% (108/110). The diagnostic accuracy rate was found to be 96.3% (104/108). There was only one case of pneumothorax (0.9%) requiring therapy. The rates of mild pneumothorax and hemoptysis were low (12.0% and 6.5%, respectively). In addition, procedural time could be limited with this technique, which helped to reduce X-ray exposure. CONCLUSION Our study shows that C-arm CT-based needle guidance enables reliable and efficient needle positioning and progression by providing real-time intraoperative guidance.
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Affiliation(s)
- De Chao Jiao
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China; Interventional Therapy Institute of Zhengzhou University Zhengzhou, Henan, People's Republic of China.
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14
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Vestering MM, Braak SJ. Where are we on (preventing) pneumothorax after (cone-beam) computed tomography-guided lung biopsy? J Thorac Dis 2015; 7:E341-3. [PMID: 26543626 PMCID: PMC4598502 DOI: 10.3978/j.issn.2072-1439.2015.09.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Myrthe M Vestering
- Department of Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Almelo, The Netherlands
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Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance. Transl Oncol 2015; 8:258-64. [PMID: 26310371 PMCID: PMC4562972 DOI: 10.1016/j.tranon.2015.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/15/2015] [Accepted: 04/24/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND: C-arm cone-beam computed tomography (CBCT) is a comparatively novel modality for guiding percutaneous transthoracic lung biopsies (PTLBs), and despite its potential advantages over conventional computed tomography (CCT), a head-to-head comparison of the two techniques has yet to be reported in the literature. This study aims to evaluate the diagnostic value and safety of CBCT-guided PTLB compared to CCT-guided biopsy, with cases performed in a single hospital. METHODS: A total of 104 PTLB patients were retrospectively analyzed in this study. 35 PTLBs were performed under CBCT guidance, and 69 PTLBs were performed under CCT guidance. Diagnostic accuracy, sensitivity, and specificity for malignancy as well as procedure time, radiation dose of patients, and complication rate in the two groups were compared. RESULTS: Total procedure time was significantly lower in the CBCT group (32 ± 11 minutes) compared to the CCT group (38 ± 9.7 minutes; P = .009), especially among patients ≥ 70 years of age (CBCT: 33 ± 12 minutes, CCT: 42 ± 13, P = .022). For lesions in the lower lobes, the CBCT-guided group received significantly reduced effective radiation dose (2.9 ± 1.6 mSv) than CCT-guided patients (3.7 ± 0.80; P = .042). Diagnostic accuracy, sensitivity, and specificity for malignancy were comparable between the two groups, as were post-biopsy complication rates. CONCLUSION: CBCT guidance significantly reduces the procedure time and radiation exposure for PTLBs compared with CCT, and should be considered in clinical settings that may be difficult or time-consuming to perform under CCT.
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16
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Rotolo N, Floridi C, Imperatori A, Fontana F, Ierardi AM, Mangini M, Arlant V, De Marchi G, Novario R, Dominioni L, Fugazzola C, Carrafiello G. Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules. Eur Radiol 2015; 26:381-9. [PMID: 26045345 DOI: 10.1007/s00330-015-3861-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/12/2015] [Accepted: 05/21/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the diagnostic performance of cone-beam CT (CBCT)-guided and CT fluoroscopy (fluoro-CT)-guided technique for transthoracic needle biopsy (TNB) of lung nodules. METHODS The hospital records of 319 consecutive patients undergoing 324 TNBs of lung nodules in a single radiology unit in 2009-2013 were retrospectively evaluated. The newly introduced CBCT technology was used to biopsy 123 nodules; 201 nodules were biopsied by conventional fluoro-CT-guided technique. We assessed the performance of the two biopsy systems for diagnosis of malignancy and the radiation exposure. RESULTS Nodules biopsied by CBCT-guided and by fluoro-CT-guided technique had similar characteristics: size, 20 ± 6.5 mm (mean ± standard deviation) vs. 20 ± 6.8 mm (p = 0.845); depth from pleura, 15 ± 15 mm vs. 15 ± 16 mm (p = 0.595); malignant, 60% vs. 66% (p = 0.378). After a learning period, the newly introduced CBCT-guided biopsy system and the conventional fluoro-CT-guided system showed similar sensitivity (95% and 92%), specificity (100% and 100%), accuracy for diagnosis of malignancy (96% and 94%), and delivered non-significantly different median effective doses [11.1 mSv (95 % CI 8.9-16.0) vs. 14.5 mSv (95% CI 9.5-18.1); p = 0.330]. CONCLUSION The CBCT-guided and fluoro-CT-guided systems for lung nodule biopsy are similar in terms of diagnostic performance and effective dose, and may be alternatively used to optimize the available technological resources. KEY POINTS • CBCT-guided and fluoro-CT-guided lung nodule biopsy provided high and similar diagnostic accuracy. • Effective dose from CBCT-guided and fluoro-CT-guided lung nodule biopsy was similar. • To optimize resources, CBCT-guided lung nodule biopsy may be an alternative to fluoro-CT-guided.
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Affiliation(s)
- Nicola Rotolo
- Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Chiara Floridi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Federico Fontana
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Anna Maria Ierardi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Monica Mangini
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Veronica Arlant
- Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Giuseppe De Marchi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Raffaele Novario
- Medical Physics Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, Insubria University, Viale Borri 57, 21100, Varese, Italy
| | - Carlo Fugazzola
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy
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C-Arm Cone-Beam CT Virtual Navigation-Guided Percutaneous Mediastinal Mass Biopsy: Diagnostic Accuracy and Complications. Eur Radiol 2015; 25:3508-17. [PMID: 25916390 DOI: 10.1007/s00330-015-3762-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/07/2015] [Accepted: 04/01/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the usefulness of C-arm cone-beam computed tomography (CBCT) virtual navigation-guided percutaneous mediastinal mass biopsy in terms of diagnostic accuracy and complication rates. METHODS Seventy-eight CBCT virtual navigation-guided percutaneous mediastinal mass biopsies were performed in 75 patients (M:F, 38:37; mean age, 48.55 ± 18.76 years). The procedural details, diagnostic sensitivity, specificity, accuracy and complication rate were investigated. RESULTS Mean lesion size was 6.80 ± 3.08 cm, skin-to-target distance was 3.67 ± 1.80 cm, core needle biopsy rate was 96.2 % (75/78), needle indwelling time was 9.29 ± 4.34 min, total procedure time was 13.26 ± 5.29 min, number of biopsy specimens obtained was 3.13 ± 1.02, number of CBCTs performed was 3.03 ± 0.68, rate of lesion border discrimination from abutting mediastinal structures on CBCT was 26.9 % (21/78), technical success rate was 100 % (78/78), estimated effective dose was 5.33 ± 4.99 mSv, and the dose area product was 12,723.68 ± 10,665.74 mGy⋅cm(2). Among the 78 biopsies, 69 were malignant, 7 were benign and 2 were indeterminate. Diagnostic sensitivity, specificity and accuracy for the diagnosis of malignancies were 97.1 % (67/69), 100 % (7/7) and 97.4 % (74/76), respectively, with a complication rate of 3.85 % (3/78), all of which were small pneumothoraces. CONCLUSIONS CBCT virtual navigation-guided biopsy is a highly accurate and safe procedure for the evaluation of mediastinal lesions. KEY POINTS • CBCT virtual navigation-guided percutaneous mediastinal biopsy is highly accurate • CBCT virtual navigation-guided percutaneous mediastinal biopsy is a safe procedure • Mediastinal vascular injury can be avoided under CBCT virtual navigation guidance.
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Rafiei P, Kim SK, Kamran M, Saad NE. Retrospective Study in 40 Patients of Utility of C-arm FDCT as an Adjunctive Modality in Technically Challenging Image-Guided Percutaneous Drainage Procedures. Cardiovasc Intervent Radiol 2015; 38:1589-94. [PMID: 25832763 DOI: 10.1007/s00270-015-1091-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/28/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore the utility of C-arm flat detector computed tomography (FDCT) as an adjunctive modality in technically challenging image-guided percutaneous drainage procedures. METHODS Clinical and image data were reviewed on 40 consecutive patients who underwent percutaneous drainage of fluid collections in technically challenging anatomic locations that required the use of C-arm FDCT between 2009 and 2013. Percutaneous drainage was performed under ultrasound and fluoroscopic guidance with the use of C-arm FDCT as a problem-solving tool to identify appropriate needle/wire placement prior to drainage catheter placement (n = 33) or to confirm catheter positioning within the fluid collection (n = 8). Technical success and procedural complications were recorded and retrospectively analyzed. RESULTS Forty one fluid collections were identified in 40 patients. Mean number of C-arm FDCT rotational acquisitions per patient was 1.25. Mean procedure time per patient was 59.3 min. Mean fluoroscopy time was 5.5 min, and mean air kerma was 394.3 mGy. Percutaneous drainage with the use of C-arm FDCT was successful in 35 of 40 patients (87.5%). Technical failure was encountered in 5 of 40 patients due to too narrow window (n = 1), too small or no fluid collection noted on C-arm FDCT images (n = 2), and poor image quality requiring the use of a conventional CT scan (n = 2). Three procedure-related complications occurred (7.5%), which included traversed rectum, traversed spleen, and sepsis. CONCLUSION C-arm FDCT is useful as an adjunctive modality in the interventional suite for technically challenging percutaneous drainage procedures by providing sufficient anatomic detail. Complications of catheter misplacement can be avoided if C-arm FDCT is used prior to tract dilatation. If C-arm FDCT image quality of needle and/or wire placement is poor, conventional CT guidance is recommended.
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Affiliation(s)
- Poyan Rafiei
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA.
| | - Seung Kwon Kim
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA.
| | - Mudassar Kamran
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA.
| | - Nael E Saad
- Interventional Radiology, Mallinckrodt Institute of Radiology, Washington University in St Louis School of Medicine, 510 S Kingshighway Boulevard, Campus Box 8131, St Louis, MO, 63110, USA.
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Jaconi M, Pagni F, Vacirca F, Leni D, Corso R, Cortinovis D, Bidoli P, Bono F, Cuttin MS, Valente MG, Pesci A, Bedini VA, Leone BE. C-arm cone-beam CT-guided transthoracic lung core needle biopsy as a standard diagnostic tool: an observational study. Medicine (Baltimore) 2015; 94:e698. [PMID: 25816042 PMCID: PMC4554007 DOI: 10.1097/md.0000000000000698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
C-arm cone-beam computed tomography (CT)-guided transthoracic lung core needle biopsy (CNB) is a safe and accurate procedure for the evaluation of patients with pulmonary nodules. This article will focus on the clinical features related to CNB in terms of diagnostic performance and complication rate. Moreover, the concept of categorizing pathological diagnosis into 4 categories, which could be used for clinical management, follow-up, and quality assurance is also introduced. We retrospectively collected data regarding 375 C-arm cone-beam CT-guided CNBs from January 2010 and June 2014. Clinical and radiological variables were evaluated in terms of success or failure rate. Pathological reports were inserted in 4 homogenous groups (nondiagnostic--L1, benign--L2, malignant not otherwise specified--L3, and malignant with specific histotype--L4), defining for each category a hierarchy of suggested actions. The sensitivity, specificity, and positive and negative predictive value and accuracy for patients subjected to CNBs were of 96.8%, 100%, 100%, 100%, and 97.2%, respectively. Roughly 75% of our samples were diagnosed as malignant, with 60% lung adenocarcinoma diagnoses. Molecular analyses were performed on 85 malignant samples to verify applicability of targeted therapy. The rate of "nondiagnostic" samples was 12%. C-arm cone-beam CT-guided transthoracic lung CNB can represent the gold standard for the diagnostic evaluation of pulmonary nodules. A clinical and pathological multidisciplinary evaluation of CNBs was needed in terms of integration of radiological, histological, and oncological data. This approach provided exceptional performances in terms of specificity, positive and negative predictive values; sensitivity in our series was lower compared with other large studies, probably due to the application of strong criteria of adequacy for CNBs (L1 class rate). The satisfactory rate of collected material was evaluated not only in terms of merely diagnostic performances but also for predictive results by molecular analysis.
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Affiliation(s)
- Marta Jaconi
- From the Department of Pathology (MJ, FP, FB, MSC, MGV), University Milan Bicocca; Department of Radiology (FV, DL, RC); Department of Oncology (DC, PB); Department of Health Sciences (AP), Pneumology Unit, University Milan Bicocca; Department of Thoracic Surgery (VB), San Gerardo Hospital, Monza; and Department of Pathology (BEL), Desio Hospital, University Milan Bicocca, Desio, Italy
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Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients. Eur Radiol 2015; 25:1845-53. [PMID: 25636421 DOI: 10.1007/s00330-015-3601-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 01/04/2015] [Accepted: 01/15/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions. METHODS From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups. RESULTS There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8% vs. 23.1%, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6%) than conventional-group (4.2%) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002). CONCLUSIONS The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB. KEY POINTS • The rapid-rollover approach had little beneficial effect on overall pneumothorax rate. • The rapid-rollover approach significantly reduced drainage catheter placement due to pneumothorax. • The strongest risk factor was pleural punctures ≥ 2 per procedure. • Emphysema along the needle tract was a stronger risk factor than fissure-crossed.
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C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules. Radiol Med 2014; 119:820-7. [PMID: 24865938 DOI: 10.1007/s11547-014-0406-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 07/30/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of percutaneous transthoracic needle biopsy of pulmonary nodules under cone-beam computed tomography (CBCT) with "XperGuide" navigation guidance. MATERIALS AND METHODS From February 2010 to January 2012, 100 patients (63 men and 37 women; mean age 67.27 years; range 21-88 years) with 100 lung nodules (44 ≤ 3 cm, 56 > 3 cm) underwent CBCT-XperGuide guided percutaneous transthoracic needle biopsies. Technical success, diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and complications were evaluated. RESULTS Of 100 nodules (mean size 5.19 cm), 68 were diagnosed as malignant, 27 as benign, and five as indeterminate. Technical success was 95 %. Only 33 of 100 patients underwent surgery: the final pathological diagnosis was concordant with the biopsy diagnosis in 26 cases and discordant in 7 cases (false negatives). Accuracy, sensitivity, specificity, PPV and NPV were 92.6, 90.9, 100, 100 and 72 %, respectively. CONCLUSIONS CBCT-XperGuide navigation is a new, accurate and safe imaging guidance for percutaneous lung biopsies.
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Lee SM, Park CM, Lee KH, Bahn YE, Kim JI, Goo JM. C-arm cone-beam CT-guided percutaneous transthoracic needle biopsy of lung nodules: clinical experience in 1108 patients. Radiology 2013; 271:291-300. [PMID: 24475839 DOI: 10.1148/radiol.13131265] [Citation(s) in RCA: 140] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively evaluate the diagnostic performance and complications of C-arm cone-beam computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) in 1108 patients. MATERIALS AND METHODS This retrospective study was approved by the institutional review board with waiver of patient informed consent. From January 2009 to December 2011, 1108 patients (633 male, 475 female; mean age, 62.4 years ± 12.3 [standard deviation]) with 1116 pulmonary lesions (mean size, 2.7 cm ± 1.7) underwent 1153 cone-beam CT-guided PTNBs. A coaxial system with 18-gauge cutting needles was used. Diagnostic performance, complication rate, influencing factors, and patient radiation exposure were investigated. Variables influencing diagnostic performance and complications were assessed by using uni- and multivariate logistic regression analyses. RESULTS Among 1153 PTNBs, pathologic analysis showed 1148 (99.6%) were technically successful (766 malignant [66.4%], 323 benign [28.0%], and 59 [5.1%] indeterminate). Sensitivity, specificity, and accuracy for diagnosis of malignancy were 95.7% (733 of 766), 100% (323 of 323), and 97.0% (1056 of 1089), respectively. In regard to diagnostic failures (five technical failures, 33 false-negative findings), lesions 1 cm in diameter or smaller and lesions in the lower lobe were significant risk factors (P = .028 and P = .034, respectively). As for complications, pneumothorax and hemoptysis occurred in 196 (17.0%) and 80 (6.9%) procedures, respectively. Multivariate analysis revealed two or more pleural passages and emphysema along the needle pathway were the two most significant risk factors for pneumothorax, and ground-glass nodules were the most significant risk factor for hemoptysis (P < .001 for all). Virtual guidance was a significant protective factor for both pneumothorax and hemoptysis (P < .001 for both). Mean estimated effective radiation dose through cone-beam CT-guided PTNBs was 7.3 mSv ± 4.1. CONCLUSION Cone-beam CT-guided PTNB is a highly accurate and safe technique with which to diagnose pulmonary lesions with reasonable radiation exposure.
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Affiliation(s)
- Sang Min Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.), Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (S.M.L., C.M.P., K.H.L., Y.E.B., J.M.G.); Cancer Research Institute, Seoul National University, Seoul, Korea (C.M.P., J.M.G.); and Department of Radiology, Kyung Hee University Hospital, Seoul, Korea (J.I.K.)
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Busser WMH, Braak SJ, Fütterer JJ, van Strijen MJL, Hoogeveen YL, de Lange F, Schultze Kool LJ. Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance. Br J Radiol 2013; 86:20130310. [PMID: 23913308 DOI: 10.1259/bjr.20130310] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the accuracy of cone beam CT (CBCT) guidance and CT guidance in reaching small targets in relation to needle path complexity in a phantom. METHODS CBCT guidance combines three-dimensional CBCT imaging with fluoroscopy overlay and needle planning software to provide real-time needle guidance. The accuracy of needle positioning, quantified as deviation from a target, was assessed for inplane, angulated and double angulated needle paths. Four interventional radiologists reached four targets along the three paths using CBCT and CT guidance. Accuracies were compared between CBCT and CT for each needle path and between the three approaches within both modalities. The effect of user experience in CBCT guidance was also assessed. RESULTS Accuracies for CBCT were significantly better than CT for the double angulated needle path (2.2 vs 6.7 mm, p<0.001) for all radiologists. CBCT guidance showed no significant differences between the three approaches. For CT, deviations increased with increasing needle path complexity from 3.3 mm for the inplane placements to 4.4 mm (p=0.007) and 6.7 mm (p<0.001) for the angulated and double angulated CT-guided needle placements, respectively. For double angulated needle paths, experienced CBCT users showed consistently higher accuracies than trained users [1.8 mm (range 1.2-2.2) vs 3.3 mm (range 2.1-7.2) deviation from target, respectively; p=0.003]. CONCLUSION In terms of accuracy, CBCT is the preferred modality, irrespective of the level of user experience, for more difficult guidance procedures requiring double angulated needle paths as in oncological interventions. ADVANCES IN KNOWLEDGE Accuracy of CBCT guidance has not been discussed before. CBCT guidance allows accurate needle placement irrespective of needle path complexity. For angulated and double-angulated needle paths, CBCT is more accurate than CT guidance.
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Affiliation(s)
- W M H Busser
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
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