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Charalampopoulos G, Bale R, Filippiadis D, Odisio BC, Wood B, Solbiati L. Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap. Diagnostics (Basel) 2023; 14:98. [PMID: 38201407 PMCID: PMC10795729 DOI: 10.3390/diagnostics14010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.
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Affiliation(s)
- Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bradford Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Luigi Solbiati
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano (Milano), Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), 20072 Milano, Italy;
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Hagihara S, Abe Y, Godai K, Enohata K, Matsunaga A. Successful neurolytic thoracic sympathetic ganglion block using C-arm fluoroscopic cone-beam computed tomography in patients with postmastectomy pain syndrome: a report of 3 cases. JA Clin Rep 2023; 9:48. [PMID: 37530944 PMCID: PMC10397165 DOI: 10.1186/s40981-023-00639-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/16/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Postmastectomy pain syndrome involves persistent neuropathic and sympathetically maintained neuropathic pain that can be improved using a thoracic sympathetic ganglion block. However, conventional fluoroscopic procedures pose technical difficulties and are associated with potential severe complications. We report the use of C-arm fluoroscopic cone-beam computed tomography to enhance procedural success and treatment safety. CASE PRESENTATION Three women diagnosed with postmastectomy pain syndrome and experiencing persistent pain underwent C-arm fluoroscopic cone-beam computed tomography-assisted ethanol neurolytic thoracic sympathetic ganglion block. Pain severity decreased substantially after the procedure. The therapeutic effects were sustained for 12 months in cases 1 and 2 and for 5 months in case 3. All patients experienced a remarkable decrease in allodynia and hyperalgesia intensities. CONCLUSION C-arm fluoroscopic cone-beam computed tomography-assisted neurolytic thoracic sympathetic ganglion block offers a valuable alternative for managing otherwise intractable postmastectomy pain syndrome before considering more invasive techniques.
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Affiliation(s)
- Shintaro Hagihara
- Department of Anesthesiology and Pain Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
- Department of Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa, Tokyo, 141-8625, Japan.
| | - Yoichiro Abe
- Department of Pain Clinic, NTT Medical Center Tokyo, 5-9-22 Higashigotanda, Shinagawa, Tokyo, 141-8625, Japan
| | - Kohei Godai
- Department of Anesthesiology and Pain Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Kyo Enohata
- Department of Anesthesiology and Pain Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
| | - Akira Matsunaga
- Department of Anesthesiology and Pain Medicine, Kagoshima University Hospital, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Lautenschlaeger P, Rathmann N, Rothfuss A, Kuhne M, Stork S, Noll M, Hetjens S, Schoenberg SO, Stallkamp J, Diehl S. Learning Needle Placement in Soft Tissue With Robot-assisted Navigation. In Vivo 2023; 37:702-708. [PMID: 36881085 PMCID: PMC10026658 DOI: 10.21873/invivo.13131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND/AIM The aim of this phantom study was to evaluate the learning curves of novices practicing how to place a cone-beam computed tomography (CBCT)-guided needle using a novel robotic assistance system (RAS). MATERIALS AND METHODS Ten participants performed 18 punctures each with random trajectories in a phantom setting, supported by a RAS over 3 days. Precision, duration of the total intervention, duration of the needle placement, autonomy, and confidence of the participants were measured, displaying possible learning curves. RESULTS No statistically significant differences were observed in terms of needle tip deviation during the trial days (mean deviation day 1: 2.82 mm; day 3: 3.07 mm; p=0.7056). During the trial days, the duration of the total intervention (mean duration: day 1: 11:22 min; day 3: 07:39 min; p<0.0001) and the duration of the needle placement decreased (mean duration: day 1: 03:17 min; day 3: 02:11 min; p<0.0001). In addition, autonomy (mean percentage of achievable points: day 1: 94%; day 3: 99%; p<0.0001) and confidence of the participants (mean percentage of achievable points: day 1: 78%; day 3: 91%; p<0.0001) increased significantly during the trial days. CONCLUSION The participants were already able to carry out the intervention precisely using the RAS on the first day of the trial. Throughout the trial, the participants' performance improved in terms of duration and confidence.
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Affiliation(s)
- Philipp Lautenschlaeger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
| | | | - Markus Kuhne
- Fraunhofer IPA, Fraunhofer Project Group for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Matthias Noll
- Fraunhofer Institute for Computer Graphics Research, Darmstadt, Germany
| | - Svetlana Hetjens
- Department for Medical Statistics, Biomathematics and Information Processing, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Stallkamp
- Mannheim Institute for Intelligent Systems in Medicine MIISM, Department for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - Steffen Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Becker LS, Ringe KI, Dewald CLA, Canstein C, Hinrichs JB, Wacker FK, Meyer BC. Fully Integrated Laser Guidance for CT-Based Punctures: A Study in Phantoms and Patients. J Vasc Interv Radiol 2023; 34:130-138. [PMID: 36162623 DOI: 10.1016/j.jvir.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/09/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To test the hypothesis of equal or even superior applicability and accuracy of a fully integrated, laser-based computed tomography (CT) navigation system compared with conventional CT guidance for percutaneous interventions. MATERIALS AND METHODS CT-guided punctures were first performed in phantoms. Four radiologists with different experience levels (2 residents (L.B., C.D.) and 2 board-certified radiologists (B.M., K.R.) performed 48 punctures using both conventional image-guided and laser-guided approaches. Subsequently, 12 punctures were performed in patients during a clinical pilot trial. Phantom targets required an in-plane or a single-/double-angulated, out-of-plane approach. Planning and intervention time, control scan number, radiation exposure, and accuracy of needle placement (measured by deviation of the needle tip to the designated target) were assessed for each guidance technique and compared (Mann-Whitney U test and t test). Patient interventions were additionally analyzed for applicability in a clinical setting. RESULTS The application of laser guidance software in the phantom study and in 12 human patients in a clinical setting was both technically and clinically feasible in all cases. The mean planning time (P = .009), intervention time (P = .005), control scan number (P < .001), and radiation exposure (P = .013) significantly decreased for laser-navigated punctures compared with those for conventional CT guidance and especially in punctures with out-of-plane-trajectories. The accuracy significantly increased for laser-guided interventions compared with that for conventional CT (P < .001). CONCLUSIONS Interventional radiologists with differing levels of experience performed faster and more accurate punctures for out-of-plane trajectories in the phantom models, using a new, fully integrated, laser-guided CT software and demonstrated excellent clinical and technical success in initial clinical experiments.
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Affiliation(s)
- Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Cornelia L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Han YM, Kim KY. Using 3D polylines to improve cone-beam CT-guided percutaneous transthoracic needle biopsy. Br J Radiol 2022; 95:20220406. [PMID: 36169413 PMCID: PMC9733600 DOI: 10.1259/bjr.20220406] [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: 04/13/2022] [Revised: 05/20/2022] [Accepted: 09/25/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To investigate the diagnostic accuracy of using 3D polylines (3DPs) to improve cone-beam CT (CBCT) virtual navigation (VN)-guided percutaneous transthoracic needle biopsies (PTNB) of pulmonary lesions. METHODS From May 2021 to November 2021, patients (81 males and 41 females; age, 65 ± 12 years) who underwent CBCT VN with 3DPs for PTNB of pulmonary lesions were retrospectively reviewed. Fluoroscopic visibility of target lesions was evaluated using captured images from a Bull's eye view. Diagnostic accuracy was calculated, and complications were assessed. RESULTS The mean size of biopsied lesions was 23 ± 13 mm (range: 6-75 mm). Overall, 13.9% (17/122) were small pulmonary nodules (diameter ≤1 cm), and 68.0% (83/122) of biopsied lesions were fluoroscopic visible. The overall diagnostic accuracy was 94.3%. The diagnostic accuracy for visible and invisible lesions was 94.0 and 94.9%, respectively (p = 0.843), and 100% for small pulmonary nodules. Major complications occurred in 8.2% (10/122; eight pneumothorax with chest tube insertion, one hemoptysis with transfusion, and one air embolism) of patients. CONCLUSION CBCT VN with 3DP guidance provide a real-time outline of pulmonary lesions, thus enabling a reliable and accurate PTNB. ADVANCES IN KNOWLEDGE 3DP guidance could be useful technique for CBCT-guided PTNB, especially in small pulmonary nodules.
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Hatamikia S, Biguri A, Herl G, Kronreif G, Reynolds T, Kettenbach J, Russ T, Tersol A, Maier A, Figl M, Siewerdsen JH, Birkfellner W. Source-detector trajectory optimization in cone-beam computed tomography: a comprehensive review on today’s state-of-the-art. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac8590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/29/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Cone-beam computed tomography (CBCT) imaging is becoming increasingly important for a wide range of applications such as image-guided surgery, image-guided radiation therapy as well as diagnostic imaging such as breast and orthopaedic imaging. The potential benefits of non-circular source-detector trajectories was recognized in early work to improve the completeness of CBCT sampling and extend the field of view (FOV). Another important feature of interventional imaging is that prior knowledge of patient anatomy such as a preoperative CBCT or prior CT is commonly available. This provides the opportunity to integrate such prior information into the image acquisition process by customized CBCT source-detector trajectories. Such customized trajectories can be designed in order to optimize task-specific imaging performance, providing intervention or patient-specific imaging settings. The recently developed robotic CBCT C-arms as well as novel multi-source CBCT imaging systems with additional degrees of freedom provide the possibility to largely expand the scanning geometries beyond the conventional circular source-detector trajectory. This recent development has inspired the research community to innovate enhanced image quality by modifying image geometry, as opposed to hardware or algorithms. The recently proposed techniques in this field facilitate image quality improvement, FOV extension, radiation dose reduction, metal artifact reduction as well as 3D imaging under kinematic constraints. Because of the great practical value and the increasing importance of CBCT imaging in image-guided therapy for clinical and preclinical applications as well as in industry, this paper focuses on the review and discussion of the available literature in the CBCT trajectory optimization field. To the best of our knowledge, this paper is the first study that provides an exhaustive literature review regarding customized CBCT algorithms and tries to update the community with the clarification of in-depth information on the current progress and future trends.
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Hagihara S, Nakagawa M, Matsubara K, Godai K, Kamijima K, Abe Y. Successful annuloplasty using the cone-beam computed tomography-assisted radiofrequency thermocoagulation system in a patient with severe vertebral deformity: a case report. JA Clin Rep 2022; 8:63. [PMID: 35962238 PMCID: PMC9374857 DOI: 10.1186/s40981-022-00554-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Complex anatomical features are challenging for minimally invasive intradiscal therapy owing to insufficient visualization for accurate needle advancement. We report the case of a patient with dysraphic vertebral pathologies who presented with L5/S1 degeneration and was successfully treated with annuloplasty using the cone-beam computed tomography (CBCT)-assisted radiofrequency thermocoagulation system. Case presentation A 34-year-old woman presented with a lower back and left radicular pain of L5/S1 discogenic origin, accompanied by spina bifida occulta and lumbosacral transitional vertebra. Radiofrequency annuloplasty was performed to preserve disc height and spinal stability, with real-time CBCT guidance for the congenital and degenerative conditions. The procedure relieved her left lower-extremity pain and magnetic resonance imaging revealed that the L5/S1 disc bulging decreased while the disc height was preserved. Conclusion Optimal accessibility of radiofrequency thermocoagulation and effective needle guidance using CBCT significantly improve the success rate of annuloplasty at the L5/S1 degenerative disc with severe vertebral deformity.
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Sag AA, Zuchowski A, Ronald J, Goodwin CR, Enterline DS. Augmented reality overlay fluoroscopic guidance versus CT-fluoroscopic guidance for sacroplasty. Clin Imaging 2022; 85:14-21. [DOI: 10.1016/j.clinimag.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/23/2022] [Accepted: 02/12/2022] [Indexed: 12/01/2022]
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Maalouf N, Lavric D, Vasileva L, Lamadé W, Apitzsch J. Associations between Covariates and Pneumothorax Observations in CT-Guided Lung Biopsies. J Clin Med 2022; 11:jcm11071958. [PMID: 35407566 PMCID: PMC8999419 DOI: 10.3390/jcm11071958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 02/04/2023] Open
Abstract
The purpose of this study is to assess the effect of nine covariates on the occurrence or absence of stable or symptomatic pneumothorax. Forty-three patients underwent CT-guided lung biopsies from January 2020 to January 2022 (24 m, 19 f, median age 70 years). All the interventions were carried out with a semi-automatic 18G needle and a 17G trocar in a prone or supine position. Different covariates were measured and correlated to the rate and severity of the pneumothoraces observed. Nominal two-sided t-test p-values for the continuous variables and Fisher’s exact test results for the categorical variables were conducted. The data included the lesion size, distance to the pleura, needle-pleura angle, age, gender, position during the procedure, and the presence of chronic obstructive pulmonary disease. Patients with an observed pneumothorax had an average angle between the needle and the pleura of 74.00° compared to 94.68° in patients with no pneumothorax (p-value = 0.028). A smaller angle measurement correlated with a higher risk of pneumothorax development. The needle-pleural angle plays a vital role in the outcome of a CT-guided lung biopsy. Correctly adjusting the needle-pleural angle can diminish the pneumothorax risk associated with a CT-guided lung biopsy. The study results show that as the needle’s angle deviates from the perpendicular, the pleural surface area experiencing trauma increases, and pneumothorax is more likely to occur.
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Affiliation(s)
- Nour Maalouf
- Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany; (D.L.); (L.V.); (J.A.)
- Correspondence:
| | - Daniela Lavric
- Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany; (D.L.); (L.V.); (J.A.)
| | - Lora Vasileva
- Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany; (D.L.); (L.V.); (J.A.)
| | - Wolfram Lamadé
- Department of General and Visceral Surgery, Helios Hospital Pforzheim, 75175 Pforzheim, Germany;
| | - Jonas Apitzsch
- Department of Radiology and Nuclear Medicine, Helios Hospital Pforzheim, 75175 Pforzheim, Germany; (D.L.); (L.V.); (J.A.)
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Meine TC, Hinrichs JB, Werncke T, Afat S, Biggemann L, Bucher A, Büttner M, Christner S, Dethlefsen E, Engel H, Gerwing M, Getzin T, Gräger S, Gresser E, Grunz JP, Harder F, Heidenreich J, Hitpaß L, Jakobi K, Janisch M, Kocher N, Kopp M, Lennartz S, Martin O, Moher Alsady T, Pamminger M, Pedersoli F, Piechotta PL, Platz Batista da Silva N, Raudner M, Roehrich S, Schindler P, Schwarze V, Seppelt D, Sieren MM, Spurny M, Starekova J, Storz C, Wiesmüller M, Zopfs D, Ringe KI, Meyer BC, Wacker FK. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. ROFO-FORTSCHR RONTG 2021; 194:272-280. [PMID: 34794186 DOI: 10.1055/a-1586-2733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Comparison of puncture deviation and puncture duration between computed tomography (CT)- and C-arm CT (CACT)-guided puncture performed by residents in training (RiT). METHODS In a cohort of 25 RiTs enrolled in a research training program either CT- or CACT-guided puncture was performed on a phantom. Prior to the experiments, the RiT's level of training, experience playing a musical instrument, video games, and ball sports, and self-assessed manual skills and spatial skills were recorded. Each RiT performed two punctures. The first puncture was performed with a transaxial or single angulated needle path and the second with a single or double angulated needle path. Puncture deviation and puncture duration were compared between the procedures and were correlated with the self-assessments. RESULTS RiTs in both the CT guidance and CACT guidance groups did not differ with respect to radiologic experience (p = 1), angiographic experience (p = 0.415), and number of ultrasound-guided puncture procedures (p = 0.483), CT-guided puncture procedures (p = 0.934), and CACT-guided puncture procedures (p = 0.466). The puncture duration was significantly longer with CT guidance (without navigation tool) than with CACT guidance with navigation software (p < 0.001). There was no significant difference in the puncture duration between the first and second puncture using CT guidance (p = 0.719). However, in the case of CACT, the second puncture was significantly faster (p = 0.006). Puncture deviations were not different between CT-guided and CACT-guided puncture (p = 0.337) and between the first and second puncture of CT-guided and CACT-guided puncture (CT: p = 0.130; CACT: p = 0.391). The self-assessment of manual skills did not correlate with puncture deviation (p = 0.059) and puncture duration (p = 0.158). The self-assessed spatial skills correlated positively with puncture deviation (p = 0.011) but not with puncture duration (p = 0.541). CONCLUSION The RiTs achieved a puncture deviation that was clinically adequate with respect to their level of training and did not differ between CT-guided and CACT-guided puncture. The puncture duration was shorter when using CACT. CACT guidance with navigation software support has a potentially steeper learning curve. Spatial skills might accelerate the learning of image-guided puncture. KEY POINTS · The CT-guided and CACT-guided puncture experience of the RiTs selected as part of the program "Researchers for the Future" of the German Roentgen Society was adequate with respect to the level of training.. · Despite the lower collective experience of the RiTs with CACT-guided puncture with navigation software assistance, the learning curve regarding CACT-guided puncture may be faster compared to the CT-guided puncture technique.. · If the needle path is complex, CACT guidance with navigation software assistance might have an advantage over CT guidance.. CITATION FORMAT · Meine TC, Hinrichs JB, Werncke T et al. Phantom study for comparison between computed tomography- and C-Arm computed tomography-guided puncture applied by residents in radiology. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1586-2733.
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Affiliation(s)
- Timo C Meine
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Jan B Hinrichs
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Thomas Werncke
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Saif Afat
- Institute for Diagnostic and Interventional Radiology, University Hospital Tübingen, Germany
| | - Lorenz Biggemann
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Andreas Bucher
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Germany
| | - Martina Büttner
- Clinic for Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Sara Christner
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Ebba Dethlefsen
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Hannes Engel
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Mirjam Gerwing
- Clinic for Radiology, University Hospital Münster, Germany
| | - Tobias Getzin
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Stephanie Gräger
- Institute for Diagnostic and Interventional Radiology, Friedrich Schiller University Jena, Germany
| | - Eva Gresser
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Felix Harder
- Department of Diagnostic and Interventional Radiology, Technical University of Munich, München, Germany
| | - Julius Heidenreich
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Lea Hitpaß
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Kristina Jakobi
- Institute for Diagnostic and Interventional Radiology, Rostock University Medical Center, Rostock, Germany
| | | | - Nadja Kocher
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Germany
| | - Markus Kopp
- Institute of Radiology, University Hospitals Erlangen Department of Radiology, Erlangen, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Ole Martin
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Tawfik Moher Alsady
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Matthias Pamminger
- Department of Radiology, Medical University Innsbruck Department of Radiology, Innsbruck, Austria
| | - Frederico Pedersoli
- Clinic for Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Germany
| | - Paula Louise Piechotta
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Germany
| | | | - Marcus Raudner
- University Clinic of Radiology and Nuclear Medicine, General Hospital of the City of Vienna-Hospital of the Medical University of Vienna, Wien, Austria
| | - Sebastian Roehrich
- University Clinic of Radiology and Nuclear Medicine, General Hospital of the City of Vienna-Hospital of the Medical University of Vienna, Wien, Austria
| | | | - Vincent Schwarze
- Department of Radiology, Ludwig Maximilians University Munich, München, Germany
| | - Danilo Seppelt
- Department for Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus Dresden, Germany
| | - Malte M Sieren
- Clinic for Radiology und Nuclear Medicine, University Medical Center Schleswig-Holstein Lübeck Campus, Lübeck, Germany
| | - Manuela Spurny
- Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology, University Hospital Hamburg-Eppendorf Center of Diagnostic, Hamburg, Germany
| | - Corinna Storz
- Neuroradiology, University Hospital Freiburg, Germany
| | - Marco Wiesmüller
- Institute of Radiology, University Hospitals Erlangen Department of Radiology, Erlangen, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Köln, Germany
| | - Kristina Imeen Ringe
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Long DJ, Li M, De Ruiter QMB, Hecht R, Li X, Varble N, Blain M, Kassin MT, Sharma KV, Sarin S, Krishnasamy VP, Pritchard WF, Karanian JW, Wood BJ, Xu S. Comparison of Smartphone Augmented Reality, Smartglasses Augmented Reality, and 3D CBCT-guided Fluoroscopy Navigation for Percutaneous Needle Insertion: A Phantom Study. Cardiovasc Intervent Radiol 2021; 44:774-781. [PMID: 33409547 DOI: 10.1007/s00270-020-02760-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/23/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare needle placement performance using an augmented reality (AR) navigation platform implemented on smartphone or smartglasses devices to that of CBCT-guided fluoroscopy in a phantom. MATERIALS AND METHODS An AR application was developed to display a planned percutaneous needle trajectory on the smartphone (iPhone7) and smartglasses (HoloLens1) devices in real time. Two AR-guided needle placement systems and CBCT-guided fluoroscopy with navigation software (XperGuide, Philips) were compared using an anthropomorphic phantom (CIRS, Norfolk, VA). Six interventional radiologists each performed 18 independent needle placements using smartphone (n = 6), smartglasses (n = 6), and XperGuide (n = 6) guidance. Placement error was defined as the distance from the needle tip to the target center. Placement time was recorded. For XperGuide, dose-area product (DAP, mGy*cm2) and fluoroscopy time (sec) were recorded. Statistical comparisons were made using a two-way repeated measures ANOVA. RESULTS The placement error using the smartphone, smartglasses, or XperGuide was similar (3.98 ± 1.68 mm, 5.18 ± 3.84 mm, 4.13 ± 2.38 mm, respectively, p = 0.11). Compared to CBCT-guided fluoroscopy, the smartphone and smartglasses reduced placement time by 38% (p = 0.02) and 55% (p = 0.001), respectively. The DAP for insertion using XperGuide was 3086 ± 2920 mGy*cm2, and no intra-procedural radiation was required for augmented reality. CONCLUSIONS Smartphone- and smartglasses-based augmented reality reduced needle placement time and radiation exposure while maintaining placement accuracy compared to a clinically validated needle navigation platform.
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Affiliation(s)
- Dilara J Long
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ming Li
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Quirina M B De Ruiter
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Rachel Hecht
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Xiaobai Li
- Biostatistics and Clinical Epidemiology Service, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Nicole Varble
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.,Philips Research of North America, Cambridge, MA, 02141, USA
| | - Maxime Blain
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Michael T Kassin
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Karun V Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, DC, USA
| | - Shawn Sarin
- Department of Interventional Radiology, George Washington University Hospital, Washington, DC, USA
| | - Venkatesh P Krishnasamy
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
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12
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Suzuki S, Katada Y, Takayanagi T, Sugawara H, Ishikawa T, Yamamoto Y, Wada H. Evaluation of three-dimensional iterative image reconstruction in C-arm-based interventional cone-beam CT: A phantom study in comparison with customary reconstruction technique. Medicine (Baltimore) 2019; 98:e14947. [PMID: 30921193 PMCID: PMC6456140 DOI: 10.1097/md.0000000000014947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We compared images obtained using a three-dimensional iterative image reconstruction (3D-IIR) algorithm for C-arm-based interventional cone-beam computed tomography (CBCT) with that using the customary reconstruction technique to quantify the effect of reconstruction techniques on image quality.We scanned 2 phantoms using an angiography unit with digital flat-panel system-an elliptical cylinder acrylic phantom to evaluate spatial resolution and a Catphan phantom to evaluate CT number linearity, image noise, and low-contrast resolution. Three-dimensional imaging was calculated using Feldkamp algorithms, and additional image sets were reconstructed using 3D-IIR at 5 settings (Sharp, Default, Soft+, Soft++, Soft+++). We evaluated quality of images obtained using the 6 reconstruction techniques and analyzed variance to test values of the 10% value of each MTF, mean CT number, and contrast-to-noise ratio (CNR), with P < .05 considered statistically significant.Modulation transfer function curves and CT number linearity among images obtained using the customary technique and the 5 3D-IIR techniques showed excellent agreement. Noise power spectrum curves demonstrated uniform noise reduction across the spatial frequency in the iterative reconstruction, and CNR obtained using all but the Sharp 3D-IIR technique was significantly better than that using the customary reconstruction technique (Sharp, P = .1957; Default, P = .0042; others, P < .0001). Use of 3D-IIR, especially the Soft++ and Soft+++ settings, improved visualization of low-contrast targets.Use of a 3D-IIR can significantly improve image noise and low-contrast resolution while maintaining spatial resolution in C-arm-based interventional CBCT, yielding higher quality images that may increase safety and efficacy in interventional radiology.
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Affiliation(s)
- Shigeru Suzuki
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
| | - Yoshiaki Katada
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
| | - Tomoko Takayanagi
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
| | - Haruto Sugawara
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Bunkyo-ku
| | - Takuya Ishikawa
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
| | - Yuzo Yamamoto
- Department of Radiology, Tokyo Women's Medical University Medical Center East, Arakawa-ku
| | - Hiroo Wada
- Department of Public Health, Graduate School of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
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13
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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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14
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Fuhrmann I, Probst U, Wiggermann P, Beyer L. Navigation Systems for Treatment Planning and Execution of Percutaneous Irreversible Electroporation. Technol Cancer Res Treat 2018; 17:1533033818791792. [PMID: 30071779 PMCID: PMC6077881 DOI: 10.1177/1533033818791792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The application of navigational systems has the potential to improve percutaneous interventions. The accuracy of ablation probe placement can be increased and radiation doses reduced. Two different types of systems can be distinguished, tracking systems and robotic systems. This review gives an overview of navigation devices for clinical application and summarizes first findings in the implementation of navigation in percutaneous interventions using irreversible electroporation. Because of the high number of navigation systems, this review focuses on commercially available ones.
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Affiliation(s)
- Irene Fuhrmann
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Ute Probst
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Wiggermann
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Lukas Beyer
- 1 Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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15
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Pfeil A, Barbe L, Wach B, Cazzato RL, Gangi A, Renaud P. Observations And Experiments For The Definition Of A New Robotic Device Dedicated To CT, CBCT And MRI-Guided Percutaneous Procedures. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:1708-1712. [PMID: 30440724 DOI: 10.1109/embc.2018.8512682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In this paper, we present the work achieved to define the robotic functionalities of interest for percutaneous procedures as performed in interventional radiology. Our contributions are twofold. First, a detailed task analysis is performed with workflow analysis of biopsies, one of the most frequent tasks, under three imaging modalities, namely CT, CBCT and MRI. Second, the functionalities of a robotic assistant are identified, and we analyze whether a single device can bring an added value during procedures in the three modalities while keeping the robotized workflow close to manual tasks, to minimize learning time and difficulty of use. Experimental analysis on CBCT is notably used to confirm the interest of the determined robotic functionalities.
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16
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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: 14] [Impact Index Per Article: 2.3] [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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17
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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18
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Sánchez Y, Anvari A, Samir AE, Arellano RS, Prabhakar AM, Uppot RN. Navigational Guidance and Ablation Planning Tools for Interventional Radiology. Curr Probl Diagn Radiol 2017; 46:225-233. [DOI: 10.1067/j.cpradiol.2016.11.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 11/08/2016] [Indexed: 12/14/2022]
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19
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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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Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time. Cardiovasc Intervent Radiol 2016; 40:728-734. [PMID: 27942926 PMCID: PMC5371642 DOI: 10.1007/s00270-016-1533-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 12/01/2016] [Indexed: 11/08/2022]
Abstract
Purpose To assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance. Materials and Methods 32 RF ablations were retrospectively analyzed, 17 laser-guided and 15 procedures using the freehand technique. Subgroup selection of 18 ablations in the hip–pelvic region with a similar degree of difficulty was used for a direct comparison. Data are presented as median (ranges). Results Comparison of all 32 ablations resulted in fluoroscopy times of 365 s (193–878 s) for freehand and 186 s (75–587 s) for laser-guided procedures (p = 0.004). Corresponding procedure times were 56 min (35–97 min) and 52 min (30–85 min) (p = 0.355). The subgroup showed comparable target sizes, needle path lengths, and number of scans between groups. Fluoroscopy times were lower for laser-guided procedures, 215 s (75–413 s), compared to 384 s (193–878 s) for freehand (p = 0.012). Procedure times were comparable between groups, 51 min (30–72 min) for laser guidance and 58 min (35–79 min) for freehand (p = 0.172). Conclusion Adding laser guidance to CBCT-guided osteoid osteoma RF ablations significantly reduced fluoroscopy time without increasing procedure time. Level of Evidence Level 4, case series.
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Ierardi AM, Piacentino F, Giorlando F, Magenta Biasina A, Bacuzzi A, Novario R, Carrafiello G. Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level. Skeletal Radiol 2016; 45:1669-1676. [PMID: 27699478 DOI: 10.1007/s00256-016-2486-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH). MATERIALS AND METHODS We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure. RESULTS Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients. Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9-15 min), whereas mean procedural radiation dose was 46.25 Gy.cm2 (range 38.10-52.84 Gy.cm2), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s). The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively. CONCLUSIONS CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose.
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Affiliation(s)
- Anna Maria Ierardi
- Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy
| | - Filippo Piacentino
- Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy
| | - Francesca Giorlando
- Unit of Interventional Radiology, Department of Radiology, University of Insubria, Varese, 21100, Italy
| | - Alberto Magenta Biasina
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, 20142, Milan, Italy
| | - Alessandro Bacuzzi
- Anaesthesia and Palliative Care, University of Insubria, Varese, 21100, Italy
| | - Raffaele Novario
- Medical Physics Department, University of Insubria, 21100, Varese, Italy
| | - Gianpaolo Carrafiello
- Department of Diagnostic and Interventional Radiology, University of Milan, San Paolo Hospital, 20142, Milan, Italy.
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Jiao DC, Han XW, Wu G, Ren JZ. 3D CACT-assisted Radiofrequency Ablation Following Transarterial Chemoembolization for Hepatocellular Carcinoma: Early Experience. Asian Pac J Cancer Prev 2016; 16:7897-903. [PMID: 26625818 DOI: 10.7314/apjcp.2015.16.17.7897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To explored the value of 3D C-arm CT (CACT) guidance system in performing radiofrequency ablation (RFA) following transarterial chemoembolizationon (TACE) for hepatocellular carcinomas. MATERIALS AND METHODS RFA of hepatocellular carcinomas (HCC) were performed on 15 patients (21 lesions) with the assistance of CACT guidance system. Technical success, procedure time, complications and patient radiation exposure were investigated. The puncture performance level was evaluated on a five-point scale (5-1: excellent- poor). Complete ablation rate was evaluated after two months follow-up using enhanced CT scans. RESULTS The technical success rate of RFA procedure under CACT navigation system was 100%. Mean total procedure time was 24.24 ± 6.53 min, resulting in a mean effective exposure dose of 15.4 ± 5.1 mSv. The mean puncture performance level rated for CACT guided RFA procedure was 4.87 ± 0.35. Complete ablation (CA) was achieved in 20 (95.2%) of the treated 21 tumors after the first RFA session. None of patients developed intra-procedural complications. CONCLUSIONS 3D CACT guidance system enables reliable and efficient needle positioning by providing real-time intraoperative guidance for performing RFA on HCCs.
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Affiliation(s)
- De-Chao Jiao
- Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University , Zhengzhou, China E-mail :
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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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Kroes MW, van Strijen MJL, Braak SJ, Hoogeveen YL, de Lange F, Schultze Kool LJ. The Use of Laser Guidance Reduces Fluoroscopy Time for C-Arm Cone-Beam Computed Tomography-Guided Biopsies. Cardiovasc Intervent Radiol 2016; 39:1322-6. [PMID: 27094692 PMCID: PMC4963440 DOI: 10.1007/s00270-016-1345-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/30/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE When using laser guidance for cone-beam computed tomography (CBCT)-guided needle interventions, planned needle paths are visualized to the operator without the need to switch between entry- and progress-view during needle placement. The current study assesses the effect of laser guidance during CBCT-guided biopsies on fluoroscopy and procedure times. MATERIALS AND METHODS Prospective data from 15 CBCT-guided biopsies of 8-65 mm thoracic and abdominal lesions assisted by a ceiling-mounted laser guidance technique were compared to retrospective data of 36 performed CBCT-guided biopsies of lesions >20 mm using the freehand technique. Fluoroscopy time, procedure time, and number of CBCT-scans were recorded. All data are presented as median (ranges). RESULTS For biopsies using the freehand technique, more fluoroscopy time was necessary to guide the needle onto the target, 165 s (83-333 s) compared to 87 s (44-190 s) for laser guidance (p < 0.001). Procedure times were shorter for freehand-guided biopsies, 24 min versus 30 min for laser guidance (p < 0.001). CONCLUSION The use of laser guidance during CBCT-guided biopsies significantly reduces fluoroscopy time.
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Affiliation(s)
- Maarten W Kroes
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Marco J L van Strijen
- Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Sicco J Braak
- Department of Radiology, St. Antonius Hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Yvonne L Hoogeveen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Leo J Schultze Kool
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Use of cone-beam CT and live 3-D needle guidance to facilitate percutaneous nephrostomy and nephrolithotripsy access in children and adolescents. Pediatr Radiol 2016; 46:570-4. [PMID: 26637320 DOI: 10.1007/s00247-015-3499-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/05/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gaining access into non-dilated renal collecting systems for percutaneous nephrolithotripsy, particularly in patients with prohibitive body habitus and/or scoliosis, is often challenging using conventional techniques. OBJECTIVE To evaluate the feasibility of cone-beam CT for percutaneous nephrostomy placement for subsequent percutaneous nephrolithotripsy in children and adolescents. MATERIALS AND METHODS A retrospective review of percutaneous nephrostomy revealed use of cone-beam CT and 3-D guidance in 12 percutaneous nephrostomy procedures for 9 patients between 2006 and 2015. All cone-beam CT-guided percutaneous nephrostomies were for pre-lithotripsy access and all 12 were placed in non-dilated collecting systems. RESULTS Technical success was 100%. There were no complications. CONCLUSION Cone-beam CT with 3-D guidance is a technically feasible technique for percutaneous nephrostomy in children and adolescents, specifically for nephrolithotripsy access in non-dilated collecting systems.
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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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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: 31] [Impact Index Per Article: 3.4] [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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McKay T, Ingraham CR, Johnson GE, Kogut MJ, Vaidya S, Padia SA. Cone-Beam CT with Fluoroscopic Overlay Versus Conventional CT Guidance for Percutaneous Abdominopelvic Abscess Drain Placement. J Vasc Interv Radiol 2015; 27:52-7. [PMID: 26573489 DOI: 10.1016/j.jvir.2015.09.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/19/2015] [Accepted: 09/19/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To compare technical success and procedure time for percutaneous abscess drain placement with fluoroscopic cone-beam computed tomography (CT) and two-axis needle guidance versus conventional CT guidance. MATERIALS AND METHODS A total of 85 consecutive patients undergoing abdominopelvic abscess drain placement guided by fluoroscopic cone-beam CT or conventional CT were retrospectively reviewed over a 2-year period. Forty-three patients underwent drain placement with cone-beam CT using XperGuide navigation and 42 underwent placement with conventional 64-slice CT. Patient characteristics, median abscess size (6.8 cm vs 7.8 cm; P = .14), and depth to abscess (7.2 cm vs 7.7 cm; P = .88) were similar between groups. RESULTS Technical success rates were 98% (42 of 43) in the cone-beam CT group and 100% (42 of 42) in the conventional CT group (P = .32), with a 10-F pigtail drainage catheter inserted in the majority of cases. There were no complications in either group. There was no significant difference in effective dose between groups (9.6 mSv vs 10.7 mSv; P = .30). Procedure times were significantly shorter in the cone-beam CT group (43 min vs 62 min; P = .02). In addition, during the study period, there was a gradual improvement in procedure time in the cone-beam CT group (50% reduction), whereas procedure time did not change for the conventional CT group. CONCLUSIONS Cone-beam CT guidance appears to be equivalent to conventional CT guidance for drain placement into medium-sized abdominopelvic collections, yielding similar technical success rates and radiation doses, with the additional benefit of reduced procedure times.
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Affiliation(s)
- Tyler McKay
- University of Washington School of Medicine University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119
| | - Christopher R Ingraham
- Department of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119
| | - Guy E Johnson
- Department of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119
| | - Matthew J Kogut
- Department of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119
| | - Sandeep Vaidya
- Department of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119
| | - Siddharth A Padia
- Department of Interventional Radiology, University of Washington, Box 357115, 1959 NE Pacific St., Seattle, WA 98119.
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Unenhanced Cone Beam Computed Tomography and Fusion Imaging in Direct Percutaneous Sac Injection for Treatment of Type II Endoleak: Technical Note. Cardiovasc Intervent Radiol 2015; 39:447-52. [DOI: 10.1007/s00270-015-1217-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/20/2015] [Indexed: 10/22/2022]
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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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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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Floridi C, Radaelli A, Abi-Jaoudeh N, Grass M, Lin M, Chiaradia M, Geschwind JF, Kobeiter H, Squillaci E, Maleux G, Giovagnoni A, Brunese L, Wood B, Carrafiello G, Rotondo A. C-arm cone-beam computed tomography in interventional oncology: technical aspects and clinical applications. Radiol Med 2014; 119:521-32. [PMID: 25012472 DOI: 10.1007/s11547-014-0429-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 06/16/2014] [Indexed: 12/12/2022]
Abstract
C-arm cone-beam computed tomography (CBCT) is a new imaging technology integrated in modern angiographic systems. Due to its ability to obtain cross-sectional imaging and the possibility to use dedicated planning and navigation software, it provides an informed platform for interventional oncology procedures. In this paper, we highlight the technical aspects and clinical applications of CBCT imaging and navigation in the most common loco-regional oncological treatments.
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Affiliation(s)
- Chiara Floridi
- Radiology Department, Insubria University, Viale Borri 57, 21100, Varese, Italy,
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Hohenforst-Schmidt W, Banckwitz R, Zarogoulidis P, Vogl T, Darwiche K, Goldberg E, Huang H, Simoff M, Li Q, Browning R, Freitag L, Turner JF, Pivert PL, Yarmus L, Zarogoulidis K, Brachmann J. Radiation Exposure of Patients by Cone Beam CT during Endobronchial Navigation - A Phantom Study. J Cancer 2014; 5:192-202. [PMID: 24563674 PMCID: PMC3931267 DOI: 10.7150/jca.8395] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/23/2014] [Indexed: 11/18/2022] Open
Abstract
Rationale: Cone Beam Computed Tomography imaging has become increasingly important in many fields of interventional therapies. Objective: Lung navigation study which is an uncommon soft tissue approach. Methods: As no effective organ radiation dose levels were available for this kind of Cone Beam Computed Tomography application we simulated in our DynaCT (Siemens AG, Forchheim, Germany) suite 2 measurements including 3D acquisition and again for 3D acquisition and 4 endobronchial navigation maneuvers under fluoroscopy towards a nodule after the 8th segmentation in the right upper lobe over a total period of 20 minutes (min). These figures reflect the average complexity and time in our experience. We hereby describe the first time the exact protocol of lung navigation by a Cone Beam Computed Tomography approach. Measurement: The hereby first time measured body radiation doses in that approach showed very promising numbers between 0,98-1,15mSv giving specific lung radiation doses of 0,42-0,38 mSv. Main results: These figures are comparable or even better to other lung navigation systems. Cone Beam Computed Tomography offers some unique features for lung interventionists as a realtime 1-step navigation system in an open structure feasible for endobronchial and transcutaneous approach. Conclusions: Due to this low level of radiation exposure Cone Beam Computed Tomography is expected to attract interventionists interested in using and guiding endobronchial or transcutaneous ablative procedures to peripheral endobronchial and other lung lesions.
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Affiliation(s)
| | | | - Paul Zarogoulidis
- 3. Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; ; 4. Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Thomas Vogl
- 5. Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Kaid Darwiche
- 4. Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - Eugene Goldberg
- 6. Biomaterials Science and Engineering, Department of Materials Science and Engineering, University of Florida, FL, USA
| | - Haidong Huang
- 7. Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People's Republic of China; ; 8. Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA
| | - Michael Simoff
- 8. Bronchoscopy and Interventional Pulmonology, Pulmonary and Critical Care Medicine, Henry Ford Hospital, Wayne State University, School of Medicine, MI, USA
| | - Qiang Li
- 7. Department of Respiratory Diseases, Changhai Hospital/First Affiliated Hospital of the Second Military Medical University, Shanghai, People's Republic of China
| | - Robert Browning
- 9. Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - Lutz Freitag
- 4. Department of Interventional Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital, University Duisburg-Essen, Essen, Germany
| | - J Francis Turner
- 10. Pulmonary Medicine, University of Nevada School of Medicine, National Supercomputing Center for Energy and the Environment University of Nevada, Las Vegas, NV, USA
| | - Patrick Le Pivert
- 11. Interventional Drug Delivery Systems and Strategies (ID2S2), Medical Cryogenics, Jupiter, FL, USA
| | - Lonny Yarmus
- 12. Division of Pulmonary and Critical Care Medicine, Sheikh Zayed Cardiovascular & Critical Care Tower, Johns Hopkins University, Baltimore, U.S.A
| | - Konstantinos Zarogoulidis
- 3. Pulmonary Department-Oncology Unit, G Papanikolaou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Johannes Brachmann
- 1. II Medical Clinic, Coburg Hospital, University of Wuerzburg, Coburg, Germany
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