1
|
Tinguely P, Ruiter SJS, Engstrand J, de Haas RJ, Nilsson H, Candinas D, de Jong KP, Freedman J. A prospective multicentre trial on survival after Microwave Ablation VErsus Resection for Resectable Colorectal liver metastases (MAVERRIC). Eur J Cancer 2023; 187:65-76. [PMID: 37119639 DOI: 10.1016/j.ejca.2023.03.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
AIM This multi-centre prospective cohort study aimed to investigate non-inferiority in patients' overall survival when treating potentially resectable colorectal cancer liver metastasis (CRLM) with stereotactic microwave ablation (SMWA) as opposed to hepatic resection (HR). METHODS Patients with no more than 5 CRLM no larger than 30 mm, deemed eligible for both SMWA and hepatic resection at the local multidisciplinary team meetings, were deliberately treated with SMWA (study group). The contemporary control group consisted of patients with no more than 5 CRLM, none larger than 30 mm, treated with HR, extracted from a prospectively maintained nationwide Swedish database. After propensity-score matching, 3-year overall survival (OS) was compared as the primary outcome using Kaplan-Meier and Cox regression analyses. RESULTS All patients in the study group (n = 98) were matched to 158 patients from the control group (mean standardised difference in baseline covariates = 0.077). OS rates at 3 years were 78% (Confidence interval [CI] 68-85%) after SMWA versus 76% (CI 69-82%) after HR (stratified Log-rank test p = 0.861). Estimated 5-year OS rates were 56% (CI 45-66%) versus 58% (CI 50-66%). The adjusted hazard ratio for treatment type was 1.020 (CI 0.689-1.510). Overall and major complications were lower after SMWA (percentage decrease 67% and 80%, p < 0.01). Hepatic retreatments were more frequent after SMWA (percentage increase 78%, p < 0.01). CONCLUSION SMWA is a valid curative-intent treatment alternative to surgical resection for small resectable CRLM. It represents an attractive option in terms of treatment-related morbidity with potentially wider options regarding hepatic retreatments over the future course of disease.
Collapse
Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden; Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland.
| | - Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Robbert J de Haas
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Henrik Nilsson
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
2
|
Lin YM, Paolucci I, O’Connor CS, Anderson BM, Rigaud B, Fellman BM, Jones KA, Brock KK, Odisio BC. Ablative Margins of Colorectal Liver Metastases Using Deformable CT Image Registration and Autosegmentation. Radiology 2023; 307:e221373. [PMID: 36719291 PMCID: PMC10102669 DOI: 10.1148/radiol.221373] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 02/01/2023]
Abstract
Background Confirming ablation completeness with sufficient ablative margin is critical for local tumor control following colorectal liver metastasis (CLM) ablation. An image-based confirmation method considering patient- and ablation-related biomechanical deformation is an unmet need. Purpose To evaluate a biomechanical deformable image registration (DIR) method for three-dimensional (3D) minimal ablative margin (MAM) quantification and the association with local disease progression following CT-guided CLM ablation. Materials and Methods This single-institution retrospective study included patients with CLM treated with CT-guided microwave or radiofrequency ablation from October 2015 to March 2020. A biomechanical DIR method with AI-based autosegmentation of liver, tumors, and ablation zones on CT images was applied for MAM quantification retrospectively. The per-tumor incidence of local disease progression was defined as residual tumor or local tumor progression. Factors associated with local disease progression were evaluated using the multivariable Fine-Gray subdistribution hazard model. Local disease progression sites were spatially localized with the tissue at risk for tumor progression (<5 mm) using a 3D ray-tracing method. Results Overall, 213 ablated CLMs (mean diameter, 1.4 cm) in 124 consecutive patients (mean age, 57 years ± 12 [SD]; 69 women) were evaluated, with a median follow-up interval of 25.8 months. In ablated CLMs, an MAM of 0 mm was depicted in 14.6% (31 of 213), from greater than 0 to less than 5 mm in 40.4% (86 of 213), and greater than or equal to 5 mm in 45.1% (96 of 213). The 2-year cumulative incidence of local disease progression was 72% for 0 mm and 12% for greater than 0 to less than 5 mm. No local disease progression was observed for an MAM greater than or equal to 5 mm. Among 117 tumors with an MAM less than 5 mm, 36 had local disease progression and 30 were spatially localized within the tissue at risk for tumor progression. On multivariable analysis, an MAM of 0 mm (subdistribution hazard ratio, 23.3; 95% CI: 10.8, 50.5; P < .001) was independently associated with local disease progression. Conclusion Biomechanical deformable image registration and autosegmentation on CT images enabled identification and spatial localization of colorectal liver metastases at risk for local disease progression following ablation, with a minimal ablative margin greater than or equal to 5 mm as the optimal end point. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sofocleous in this issue.
Collapse
Affiliation(s)
- Yuan-Mao Lin
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Iwan Paolucci
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Caleb S. O’Connor
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Brian M. Anderson
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Bastien Rigaud
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Bryan M. Fellman
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | - Kyle A. Jones
- From the Departments of Interventional Radiology (Y.M.L., I.P.,
B.C.O.), Imaging Physics (C.S.O., B.M.A., B.R., K.A.J., K.K.B.), and
Biostatistics (B.M.F.), The University of Texas MD Anderson Cancer Center, 1515
Holcombe Blvd, Houston, TX 77030
| | | | | |
Collapse
|
3
|
Tinguely P, Laurell G, Enander A, Engstrand J, Freedman J. Ablation versus resection for resectable colorectal liver metastases - Health care related cost and survival analyses from a quasi-randomised study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:416-425. [PMID: 36123245 DOI: 10.1016/j.ejso.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this study was to compare healthcare related costs and survival in patients treated with microwave ablation (MWA) versus surgical resection for resectable colorectal liver metastases (CRLM), in patients from a quasi-randomised setting. METHODS The Swedish subset of data from a prospective multi-centre study investigating survival after percutaneous computer-assisted Microwave Ablation VErsus Resection for Resectable CRLM (MAVERRIC study) was analysed. Patients with CRLM ≤ 3 cm amenable to ablation and resection were considered for study inclusion only on even calendar weeks, while treated with gold standard resection every other week, creating a quasi-randomised setting. Survival and costs (all inpatient hospital admissions, outpatient visits, oncological treatments and radiological imaging) in the 2 years following treatment were investigated. RESULTS MWA (n = 52) and resection (n = 53) cohorts had similar baseline patient and tumour characteristics and health care consumption within 1 year prior to CRLM treatment. Treatment related morbidity and length of stay were significantly higher in the resected cohort. Overall health care related costs from decision of treatment and 2 years thereafter were lower in the MWA versus resection cohort (mean ± SD USD 80'964±59'182 versus 110'059±59'671, P < 0.01). Five-year overall survival was 50% versus 54% in MWA versus resection groups (P = 0.95). CONCLUSIONS MWA is associated with decreased morbidity, time spent in medical facilities and healthcare related costs within 2 years of initial treatment with equal overall survival, highlighting its benefits for patient and health care systems.
Collapse
Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Gustaf Laurell
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Anton Enander
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
4
|
Galmén K, Jakobsson JG, Perchiazzi G, Freedman J, Harbut P. Quantitative assessment of atelectasis formation under high frequency jet ventilation during liver tumour ablation-A computer tomography study. PLoS One 2023; 18:e0282724. [PMID: 37011083 PMCID: PMC10069764 DOI: 10.1371/journal.pone.0282724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/21/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND High frequency jet ventilation (HFJV) can be used to minimise sub-diaphragmal organ displacements. Treated patients are in a supine position, under general anaesthesia and fully muscle relaxed. These are factors that are known to contribute to the formation of atelectasis. The HFJV-catheter is inserted freely inside the endotracheal tube and the system is therefore open to atmospheric pressure. AIM The aim of this study was to assess the formation of atelectasis over time during HFJV in patients undergoing liver tumour ablation under general anaesthesia. METHOD In this observational study twenty-five patients were studied. Repeated computed tomography (CT) scans were taken at the start of HFJV and every 15 minutes thereafter up until 45 minutes. From the CT images, four lung compartments were defined: hyperinflated, normoinflated, poorly inflated and atelectatic areas. The extension of each lung compartment was expressed as a percentage of the total lung area. RESULT Atelectasis at 30 minutes, 7.9% (SD 3.5, p = 0.002) and at 45 minutes 8,1% (SD 5.2, p = 0.024), was significantly higher compared to baseline 5.6% (SD 2.5). The amount of normoinflated lung volumes were unchanged over the period studied. Only a few minor perioperative respiratory adverse events were noted. CONCLUSION Atelectasis during HFJV in stereotactic liver tumour ablation increased over the first 45 minutes but tended to stabilise with no impact on normoinflated lung volume. Using HFJV during stereotactic liver ablation is safe regarding formation of atelectasis.
Collapse
Affiliation(s)
- Karolina Galmén
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Gaetano Perchiazzi
- Department of Surgical Sciences, Hedenstierna Laboratory, Uppsala University, Uppsala, Sweden
- Department of Anaesthesia, Operation and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Jacob Freedman
- Department of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
- Division of Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Department of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|
5
|
van Kesteren Z, Veldman JK, Parkes MJ, Stevens MF, Balasupramaniam P, van den Aardweg JG, van Tienhoven G, Bel A, van Dijk IWEM. Quantifying the reduction of respiratory motion by mechanical ventilation with MRI for radiotherapy. Radiat Oncol 2022; 17:99. [PMID: 35597956 PMCID: PMC9123684 DOI: 10.1186/s13014-022-02068-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/12/2022] [Indexed: 12/13/2022] Open
Abstract
Background Due to respiratory motion, accurate radiotherapy delivery to thoracic and abdominal tumors is challenging. We aimed to quantify the ability of mechanical ventilation to reduce respiratory motion, by measuring diaphragm motion magnitudes in the same volunteers during free breathing (FB), mechanically regularized breathing (RB) at 22 breaths per minute (brpm), variation in mean diaphragm position across multiple deep inspiration breath-holds (DIBH) and diaphragm drift during single prolonged breath-holds (PBH) in two MRI sessions. Methods In two sessions, MRIs were acquired from fifteen healthy volunteers who were trained to be mechanically ventilated non-invasively We measured diaphragm motion amplitudes during FB and RB, the inter-quartile range (IQR) of the variation in average diaphragm position from one measurement over five consecutive DIBHs, and diaphragm cranial drift velocities during single PBHs from inhalation (PIBH) and exhalation (PEBH) breath-holds. Results RB significantly reduced the respiratory motion amplitude by 39%, from median (range) 20.9 (10.6–41.9) mm during FB to 12.8 (6.2–23.8) mm. The median IQR for variation in average diaphragm position over multiple DIBHs was 4.2 (1.0–23.6) mm. During single PIBHs with a median duration of 7.1 (2.0–11.1) minutes, the median diaphragm cranial drift velocity was 3.0 (0.4–6.5) mm/minute. For PEBH, the median duration was 5.8 (1.8–10.2) minutes with 4.4 (1.8–15.1) mm/minute diaphragm drift velocity. Conclusions Regularized breathing at a frequency of 22 brpm resulted in significantly smaller diaphragm motion amplitudes compared to free breathing. This would enable smaller treatment volumes in radiotherapy. Furthermore, prolonged breath-holding from inhalation and exhalation with median durations of six to seven minutes are feasible. Trial registration Medical Ethics Committee protocol NL.64693.018.18.
Collapse
Affiliation(s)
- Z van Kesteren
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
| | - J K Veldman
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M J Parkes
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M F Stevens
- Department of Anesthesiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - P Balasupramaniam
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - J G van den Aardweg
- Department of Pulmonology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - G van Tienhoven
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A Bel
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - I W E M van Dijk
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| |
Collapse
|
6
|
Tinguely P, Paolucci I, Ruiter SJS, Weber S, de Jong KP, Candinas D, Freedman J, Engstrand J. Stereotactic and Robotic Minimally Invasive Thermal Ablation of Malignant Liver Tumors: A Systematic Review and Meta-Analysis. Front Oncol 2021; 11:713685. [PMID: 34631539 PMCID: PMC8495244 DOI: 10.3389/fonc.2021.713685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/06/2021] [Indexed: 01/17/2023] Open
Abstract
Background Stereotactic navigation techniques aim to enhance treatment precision and safety in minimally invasive thermal ablation of liver tumors. We qualitatively reviewed and quantitatively summarized the available literature on procedural and clinical outcomes after stereotactic navigated ablation of malignant liver tumors. Methods A systematic literature search was performed on procedural and clinical outcomes when using stereotactic or robotic navigation for laparoscopic or percutaneous thermal ablation. The online databases Medline, Embase, and Cochrane Library were searched. Endpoints included targeting accuracy, procedural efficiency, and treatment efficacy outcomes. Meta-analysis including subgroup analyses was performed. Results Thirty-four studies (two randomized controlled trials, three prospective cohort studies, 29 case series) were qualitatively analyzed, and 22 studies were included for meta-analysis. Weighted average lateral targeting error was 3.7 mm (CI 3.2, 4.2), with all four comparative studies showing enhanced targeting accuracy compared to free-hand targeting. Weighted average overall complications, major complications, and mortality were 11.4% (6.7, 16.1), 3.4% (2.1, 5.1), and 0.8% (0.5, 1.3). Pooled estimates of primary technique efficacy were 94% (89, 97) if assessed at 1–6 weeks and 90% (87, 93) if assessed at 6–12 weeks post ablation, with remaining between-study heterogeneity. Primary technique efficacy was significantly enhanced in stereotactic vs. free-hand targeting, with odds ratio (OR) of 1.9 (1.2, 3.2) (n = 6 studies). Conclusions Advances in stereotactic navigation technologies allow highly precise and safe tumor targeting, leading to enhanced primary treatment efficacy. The use of varying definitions and terminology of safety and efficacy limits comparability among studies, highlighting the crucial need for further standardization of follow-up definitions.
Collapse
Affiliation(s)
- Pascale Tinguely
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden.,Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iwan Paolucci
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Simeon J S Ruiter
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stefan Weber
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Koert P de Jong
- Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Daniel Candinas
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jacob Freedman
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Division of Surgery, Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| |
Collapse
|
7
|
Comparison of different methods for lung immobilization in an animal model. Radiother Oncol 2020; 150:151-158. [PMID: 32580000 DOI: 10.1016/j.radonc.2020.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory-induced motion introduces uncertainties in the delivery of dose in radiotherapy treatments. Various methods are used clinically, e.g. breath-holding, while there is limited experience with other methods such as apneic oxygenation and high frequency jet ventilation (HFJV). This study aims to compare the latter approaches for lung immobilization and their clinical impact on gas exchange in an animal model. MATERIALS AND METHODS Two radiopaque tumor surrogate markers (TSM) were placed in the central (cTSM) and peripheral (dTSM) regions of the lungs in 9 anesthetized and muscle relaxed pigs undergoing 3 ventilatory interventions (1) HFJV at rates of 200 (JV200), 300 (JV300) and 400 (JV400) min-1; (2) apnea at continuous positive airway pressure (CPAP) levels of 0, 8 and 16 cmH2O; (3) conventional mechanical ventilation (CMV) as reference mode. cTSM and dTSM were visualized using fluoroscopy and their coordinates were computed. The ventilatory pattern was registered, and oxygen and carbon dioxide (pCO2) partial pressures were measured. RESULTS The highest range of TSM motion, and ventilation was found during CMV, the lowest during apnea. During HFJV the amount of motion varied inversely with increasing frequency. The reduction of TSM motion at JV300, JV400 and all CPAP levels came at the cost of increased pCO2, however the relatively low frequency of 200 min-1 for HFJV was the only ventilatory setting that enabled adequate CO2 removal. CONCLUSION In this model, HFJV at 200 min-1 was the best compromise between immobilization and gas exchange for sessions of 10-min duration.
Collapse
|
8
|
Venturi D, Glossop N, Bale R. Patient-specific templates for image-guided intervention - a phantom study. MINIM INVASIV THER 2019; 29:251-260. [PMID: 31204536 DOI: 10.1080/13645706.2019.1626251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the in vitro accuracy of a new device and method for simultaneous stereotactic CT-guided punctures.Material and methods: 240 needle paths were planned in 1 mm, 1.5 mm and 3 mm slice thickness with a custom-designed software. The data were transferred to a three-axis tabletop CNC machine that then drilled the hole pattern for the needles into square plastic plates. Kirschner wires were slid through the holes of the two parallel fixed plates to aim at the chosen targets inside the phantom. The accuracy was calculated by taking control CTs and measuring the Euclidean distance and the normal distance between the wire and the entry and target point.Results: The mean Euclidean distance of the wire tip to the target for the 1 mm, 1.5mm and 3 mm slice thickness were 2.5 mm (SD ± 0.64), 2.71mm (SD ± 0.78) and 2.8 mm (SD ± 1.0). The mean normal distance was 1.42 mm (SD ± 0.65), 1.43mm (SD ± 0.75) and 1.9 mm (SD ± 1.1), respectively.Conclusion: The system yields satisfactory accuracy comparable to other image-guided intervention systems. Involuntary movements of the patient need to be taken into account in a clinical setting.
Collapse
Affiliation(s)
- David Venturi
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Neil Glossop
- Queen's University School of Computing, Kingston, Canada.,ArciTrax Inc, Toronto, Canada
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
9
|
Abstract
Respiratory failure affects a significant percentage of critically ill children, necessitating both invasive and non-invasive respiratory support. As the outcomes of these patients have improved, children with higher acuity and more complex respiratory pathophysiology require mechanical ventilation. Despite growing understanding of lung-protective strategies and ventilation induced lung injury, certain patients still require harmful ventilatory settings with conventional mechanical ventilation (CMV). High frequency ventilation, neurally adjusted ventilatory assist, and airway pressure release ventilation offer feasible alternatives to CMV. In addition to minimizing the risk of ventilatory induced lung injury when used appropriately, they provide a unique environment to facilitate operations on certain neonates and older children. Finally, non-invasive ventilation is now commonly employed in children with surgical conditions.
Collapse
Affiliation(s)
- Ana Ruzic
- Department of Surgery, UK Healthcare Kentucky Children's Hospital, 800 Rose St, Lexington KY 40536, USA.
| |
Collapse
|
10
|
Beermann M, Lindeberg J, Engstrand J, Galmén K, Karlgren S, Stillström D, Nilsson H, Harbut P, Freedman J. 1000 consecutive ablation sessions in the era of computer assisted image guidance - Lessons learned. Eur J Radiol Open 2018; 6:1-8. [PMID: 30547062 PMCID: PMC6282637 DOI: 10.1016/j.ejro.2018.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/14/2022] Open
Abstract
Computer assisted targeting techniques are simple to use and improve results in ablative tumour treatments. The indications for ablative soft tissue tumour ablation are increasing. Treatments are superior to resective surgery in terms of complications and hospitalization, oncological non-inferiority remains to be proven. An incomplete ablation can be retreated without negative effects on survival. Jet ventilation is an effective technique to minimize organ displacement during percutaneous or laparoscopic ablation.
Background Ablation therapies for tumours are becoming more used as ablation modalities evolve and targeting solutions are getting better. There is an increasing body of long-term results challenging resection and proving lower morbidities and costs. The aim of this paper is to share the experiences from a high-volume centre in introducing computer assisted targeting solutions and efficient ablation modalities like microwave generators and irreversible electroporation. Material and methods One thousand consecutive treatments in one high-volume centre were evaluated retrospectively from prospectively collected data. Results The purpose of this paper is to present the benefits of going into computer assisted targeting techniques and microwave technology; pitfalls and overview of outcomes. The main target organ was the liver and the main indications were ablation of hepatocellular carcinomas and colorectal liver metastases. With the assistance of computer assisted targeting the local recurrence rate within 6 months has dropped from 30 to near 10%. The survival of patients with hepatocellular carcinoma and colorectal liver metastases is not worse if the tumour can be retreated after a local recurrence. Multiple colorectal liver metastases can be treated successfully. Discussion The incorporation of computer assisted targeting technologies for ultrasound-, ct guided- and laparoscopic tumour ablation has been very successful and without a noticeable learning curve. The same is true for switching from radiofrequency energies to microwave generators and irreversible electroporation. Conclusion It is well worthwhile upgrading ablation and targeting technologies to achieve excellent and reproducible results and minimizing operator dependency.
Collapse
Key Words
- Ablation
- CAS, computer assisted surgery
- Colorectal liver metastases
- Fused ultrasound
- HFJV, high frequency jet ventilation
- HIFU, high intensity focused ultrasound
- Hepatocellular carcinoma
- IRE
- IRE, irreversible electroporation
- Jet ventilation
- Kidney
- Liver
- Lung
- MWA, microwave ablation
- Microwave
- Pancreas
- RF
- RFA, radio-frequency ablation
- Renal cell carcinoma
- SBRT, stereotactic body radiation therapy
- Stereotactic navigation
- TAE, TACE, trans-arterial embolization or chemo-embolization
- TIVA, total intravenous anaesthesia
- Ultrasound
Collapse
Affiliation(s)
- Marie Beermann
- Dept of Radiology, Danderyd University Hospital, Stockholm, Sweden
| | - Johan Lindeberg
- Dept of Radiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jennie Engstrand
- Dept of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - Karolina Galmén
- Dept of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Silja Karlgren
- Dept of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - David Stillström
- Dept of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - Henrik Nilsson
- Dept of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| | - Piotr Harbut
- Dept of Anaesthesiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jacob Freedman
- Dept of Surgery and Urology, Danderyd University Hospital, Stockholm, Sweden
| |
Collapse
|