1
|
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.
Collapse
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;
| |
Collapse
|
2
|
Wu Z, Bian L, Geng H, Zheng Z, Wang H, Zhai B. Application and challenges of ChatGPT in interventional surgery. Int J Surg 2023; 109:3747-3749. [PMID: 37713498 PMCID: PMC10720859 DOI: 10.1097/js9.0000000000000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 09/17/2023]
Affiliation(s)
| | | | - Haigang Geng
- Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine
| | - Zhigang Zheng
- Department of Liver Surgery and Liver Transplantation, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | | | - Bo Zhai
- Department of Interventional Oncology
| |
Collapse
|
3
|
Gómez FM, Van der Reijd DJ, Panfilov IA, Baetens T, Wiese K, Haverkamp-Begemann N, Lam SW, Runge JH, Rice SL, Klompenhouwer EG, Maas M, Helmberger T, Beets-Tan RG. Imaging in interventional oncology, the better you see, the better you treat. J Med Imaging Radiat Oncol 2023; 67:895-902. [PMID: 38062853 DOI: 10.1111/1754-9485.13610] [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: 04/06/2023] [Accepted: 11/22/2023] [Indexed: 01/14/2024]
Abstract
Imaging and image processing is the fundamental pillar of interventional oncology in which diagnostic, procedure planning, treatment and follow-up are sustained. Knowing all the possibilities that the different image modalities can offer is capital to select the most appropriate and accurate guidance for interventional procedures. Despite there is a wide variability in physicians preferences and availability of the different image modalities to guide interventional procedures, it is important to recognize the advantages and limitations for each of them. In this review, we aim to provide an overview of the most frequently used image guidance modalities for interventional procedures and its typical and future applications including angiography, computed tomography (CT) and spectral CT, magnetic resonance imaging, Ultrasound and the use of hybrid systems. Finally, we resume the possible role of artificial intelligence related to image in patient selection, treatment and follow-up.
Collapse
Affiliation(s)
- Fernando M Gómez
- Grupo de Investigación Biomédica en Imagen, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
- Área Clínica de Imagen Médica, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Ilia A Panfilov
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Tarik Baetens
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Kevin Wiese
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Siu W Lam
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jurgen H Runge
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Samuel L Rice
- Radiology, Interventional Radiology Section, UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Monique Maas
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Helmberger
- Institut für Radiologie, Neuroradiologie und Minimal-Invasive Therapie, München Klinik Bogenhausen, Munich, Germany
| | - Regina Gh Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- GROW School for Oncology and Developmental Biology, University of Maastricht, Maastricht, The Netherlands
| |
Collapse
|
4
|
Laimer G, Bauer M, Scharll Y, Schullian P, Bale R. Multi-Probe RFA vs. Single-Probe MWA in an Ex Vivo Bovine Liver Model: Comparison of Volume and Shape of Coagulation Zones. BIOLOGY 2023; 12:1103. [PMID: 37626989 PMCID: PMC10451889 DOI: 10.3390/biology12081103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVES To compare the volumes and shapes of the coagulation zone (CZ) of a multi-probe RFA system (three RFA electrodes) and a single-probe MWA system from the same vendor in an ex vivo bovine liver model. MATERIAL & METHODS A total of 48 CZs were obtained in bovine liver specimens with three different ablation system configurations (single-probe MWA vs. multi-probe RFA with 20 mm inter-probe distance [confluent CZ] vs. multi-probe RFA with 50 mm inter-probe distance [three individual CZs]) at 4, 6, 8, and 10 min ablation time using a fixed ablation protocol. Ablation diameters were measured and ellipticity indices (EIs) and volumes calculated. Calculations for all systems/configurations were compared. RESULTS Volumes and diameters increased with ablation time for all configurations. At 4 and 6 min ablation time volumes obtained with the RFA 50 mm setup, and at 8 and 10 min with the RFA 20 mm setup were the largest at 26.5 ± 4.1 mL, 38.1 ± 5.8 mL, 46.3 ± 4.9 mL, 48.4 ± 7.3 mL, respectively. The single-probe MWA could not reach the volumes of the RFA setups for any of the ablation times evaluated. EI were very similar and almost round for RFA 20 mm and single-probe MWA, and differed significantly to the more ovoid ones for the RFA 50 mm configuration. CONCLUSIONS The multi-probe RFA system employing three electrodes achieved significantly larger ablation volumes in both configurations (confluent CZ and three individual CZs) per time as compared with a single-probe MWA system in this ex vivo bovine liver model.
Collapse
Affiliation(s)
| | | | - Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria; (G.L.)
| | | | | |
Collapse
|
5
|
Non-Surgical Locoregional Therapies Alone or in Combination with Systemic Therapy in Patients with Hepatocellular Carcinoma. Cancers (Basel) 2023; 15:cancers15061748. [PMID: 36980634 PMCID: PMC10046599 DOI: 10.3390/cancers15061748] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary liver cancer, representing the third-leading cause of cancer-related deaths worldwide. Curative intent treatment options for patients with HCC include liver transplantation, resection and ablation of small lesions. Other potentially curative therapies include cryoablation, microwave ablation and percutaneous alcohol injection. For locally advanced disease, different arterially directed therapies including transarterial chemoembolization and selective internal radiation therapy, plus external beam radiation including three-dimensional conformal radiation therapy, intensity-modulated radiation therapy, stereotactic body radiation therapy and proton beam therapy, are available or studied. Systemic therapies based on checkpoint inhibitors and tyrosine kinase inhibitors are available for the management of metastatic HCC and sometimes for locally advanced disease. Combinations of locoregional therapies with systemic drugs are currently the subject of several clinical trials.
Collapse
|
6
|
Colorectal Cancer Liver Metastases: Genomics and Biomarkers with Focus on Local Therapies. Cancers (Basel) 2023; 15:cancers15061679. [PMID: 36980565 PMCID: PMC10046329 DOI: 10.3390/cancers15061679] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/23/2023] [Accepted: 03/03/2023] [Indexed: 03/11/2023] Open
Abstract
Molecular cancer biomarkers help personalize treatment, predict oncologic outcomes, and identify patients who can benefit from specific targeted therapies. Colorectal cancer (CRC) is the third-most common cancer, with the liver being the most frequent visceral metastatic site. KRAS, NRAS, BRAF V600E Mutations, DNA Mismatch Repair Deficiency/Microsatellite Instability Status, HER2 Amplification, and NTRK Fusions are NCCN approved and actionable molecular biomarkers for colorectal cancer. Additional biomarkers are also described and can be helpful in different image-guided hepatic directed therapies specifically for CRLM. For example, tumors maintaining the Ki-67 proliferation marker after thermal ablation was shown to be particularly resilient to ablation. Ablation margin was also shown to be an important factor in predicting local recurrence, with a ≥10 mm minimal ablation margin being required to attain local tumor control, especially for patients with mutant KRAS CRLM.
Collapse
|
7
|
Spiliopoulos S, Moschovaki-Zeiger O, Sethi A, Festas G, Reppas L, Filippiadis D, Kelekis N. An update on locoregional percutaneous treatment technologies in colorectal cancer liver metastatic disease. Expert Rev Med Devices 2023; 20:293-302. [PMID: 36825337 DOI: 10.1080/17434440.2023.2185137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Liver-dominant metastatic colorectal cancer is noted in approximately 20%-35% of the patients. Systemic chemotherapy remains the first-line treatment for mCRC, but the prognosis is poor due to liver failure. Novel minimally invasive technologies have enabled the optimization of locoregional treatment options. AREAS COVERED This is a comprehensive review of novel locoregional treatment technologies, both percutaneous ablation and transcatheter arterial treatments, which can be used to decrease hepatic disease progression in patients with mCRC. Trans-arterial radioembolization is the most recently developed locoregional treatment for metastatic liver disease, and robust evidence has been accumulated over the past years. EXPERT OPINION Image-guided techniques, endovascular and ablative, have gained wide acceptance for the treatment of liver malignancies, in selected patients with non-resectable disease. The optimization of dosimetry and microsphere technological advancement will certainly upgrade the role of liver radioembolization segmentectomy or lobectomy in the upcoming years, due to its curative intent. Also, ablative interventions provide local curative intent, offering significant and sustained local tumor control. Standardization protocols in terms of predictability and reliability using immediate treatment assessment and ablation zone software could further ameliorate clinical outcomes.
Collapse
Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Ornella Moschovaki-Zeiger
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Akshay Sethi
- Department of Interventional Radiology, Aberdeen Royal Infirmary Hospital, NHS Grampian, Aberdeen, UK
| | - George Festas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Dimitris Filippiadis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Athens, Greece
| |
Collapse
|
8
|
Spenkelink IM, Heidkamp J, Avital Y, Fütterer JJ. Evaluation of the performance of robot assisted CT-guided percutaneous needle insertion: Comparison with freehand insertion in a phantom. Eur J Radiol 2023; 162:110753. [PMID: 36863276 DOI: 10.1016/j.ejrad.2023.110753] [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: 12/07/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE To evaluate the performance of a novel robot for CT-guided needle positioning procedures and compare it to the freehand technique in an abdominal phantom. METHODS One interventional radiology fellow and one experienced interventional radiologist (IR) performed twelve robot-assisted and twelve freehand needle positionings in a phantom over predetermined trajectories. The robot automatically aimed a needle-guide according to the planned trajectories, after which the clinician manually inserted the needle. Using repeated CT scans, the needle position was assessed and adjusted if the clinician deemed it necessary. Technical success, accuracy, number of position adjustments, and procedure time were measured. All outcomes were analyzed using descriptive statistics and were compared between the robot-assisted and freehand procedures using the paired t-test and Wilcoxon signed rank test. RESULTS Compared with the freehand technique, the robot system improved the number of technically successfully needle targeting (20/24 vs 14/24), with higher accuracy (mean Euclidean deviation from target center: 3.5 ± 1.8 mm vs 4.6 ± 2.1 mm, p = 0.02) and required fewer needle position adjustments (0.0 ± 0.2 steps vs 1.7 ± 0.9 steps, p < 0.001), respectively. The robot improved the needle positioning for both, the fellow and the expert IR, compared to their freehand performances, with more improvement for the fellow than for the expert IR. The procedure time was similar for the robot-assisted and freehand procedures (19.5 ± 9.2 min. vs 21.0 ± 6.9 min., p = 0.777). CONCLUSIONS CT-guided needle positioning with the robot was more successful and accurate than freehand needle positioning and required fewer needle position adjustments without prolonging the procedure.
Collapse
Affiliation(s)
- Ilse M Spenkelink
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Jan Heidkamp
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yaniv Avital
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Interventional Radiology, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
| | - Jurgen J Fütterer
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
9
|
Sebek J, Park WKC, Geimer S, Van Citters DW, Farah A, Dupuy DE, Meaney PM, Prakash P. Computational modeling of microwave ablation with thermal accelerants. Int J Hyperthermia 2023; 40:2255755. [PMID: 37710404 DOI: 10.1080/02656736.2023.2255755] [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: 03/30/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE To develop a computational model of microwave ablation (MWA) with a thermal accelerant gel and apply the model toward interpreting experimental observations in ex vivo bovine and in vivo porcine liver. METHODS A 3D coupled electromagnetic-heat transfer model was implemented to characterize thermal profiles within ex vivo bovine and in vivo porcine liver tissue during MWA with the HeatSYNC thermal accelerant. Measured temperature dependent dielectric and thermal properties of the HeatSYNC gel were applied within the model. Simulated extents of MWA zones and transient temperature profiles were compared against experimental measurements in ex vivo bovine liver. Model predictions of thermal profiles under in vivo conditions in porcine liver were used to analyze thermal ablations observed in prior experiments in porcine liver in vivo. RESULTS Measured electrical conductivity of the HeatSYNC gel was ∼83% higher compared to liver at room temperature, with positive linear temperature dependency, indicating increased microwave absorption within HeatSYNC gel compared to tissue. In ex vivo bovine liver, model predicted ablation zone extents of (31.5 × 36) mm with the HeatSYNC, compared to (32.9 ± 2.6 × 40.2 ± 2.3) mm in experiments (volume differences 4 ± 4.1 cm3). Computational models under in vivo conditions in porcine liver suggest approximating the HeatSYNC gel spreading within liver tissue during ablations as a plausible explanation for larger ablation zones observed in prior in vivo studies. CONCLUSION Computational models of MWA with thermal accelerants provide insight into the impact of accelerant on MWA, and with further development, could predict ablations with a variety of gel injection sites.
Collapse
Affiliation(s)
- Jan Sebek
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
| | | | - Shireen Geimer
- Expeditionary School at Black River, Ludlow, Vermont, USA
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | | | | | | | - Paul M Meaney
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire, USA
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, Kansas, USA
| |
Collapse
|
10
|
Huber T, Huettl F, Hanke LI, Vradelis L, Heinrich S, Hansen C, Boedecker C, Lang H. Leberchirurgie 4.0 - OP-Planung, Volumetrie, Navigation und Virtuelle
Realität. Zentralbl Chir 2022; 147:361-368. [DOI: 10.1055/a-1844-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDurch die Optimierung der konservativen Behandlung, die Verbesserung der
bildgebenden Verfahren und die Weiterentwicklung der Operationstechniken haben
sich das operative Spektrum sowie der Maßstab für die Resektabilität in Bezug
auf die Leberchirurgie in den letzten Jahrzehnten deutlich verändert.Dank zahlreicher technischer Entwicklungen, insbesondere der 3-dimensionalen
Segmentierung, kann heutzutage die präoperative Planung und die Orientierung
während der Operation selbst, vor allem bei komplexen Eingriffen, unter
Berücksichtigung der patientenspezifischen Anatomie erleichtert werden.Neue Technologien wie 3-D-Druck, virtuelle und augmentierte Realität bieten
zusätzliche Darstellungsmöglichkeiten für die individuelle Anatomie.
Verschiedene intraoperative Navigationsmöglichkeiten sollen die präoperative
Planung im Operationssaal verfügbar machen, um so die Patientensicherheit zu
erhöhen.Dieser Übersichtsartikel soll einen Überblick über den gegenwärtigen Stand der
verfügbaren Technologien sowie einen Ausblick in den Operationssaal der Zukunft
geben.
Collapse
Affiliation(s)
- Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Isabel Hanke
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Lukas Vradelis
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Stefan Heinrich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christian Hansen
- Fakultät für Informatik, Otto von Guericke Universität
Magdeburg, Magdeburg, Deutschland
| | - Christian Boedecker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| |
Collapse
|
11
|
Scharll Y, Letrari S, Laimer G, Schullian P, Bale R. Puncture accuracy of an optical tracked robotic aiming device-a phantom study. Eur Radiol 2022; 32:6769-6776. [PMID: 35678863 PMCID: PMC9474375 DOI: 10.1007/s00330-022-08915-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the targeting accuracy of stereotactic punctures based on a hybrid robotic device in combination with optical tracking-a phantom study. METHODS CT data sets of a gelatin-filled plexiglass phantom with 1-, 3-, and 5-mm slice thickness were acquired. An optical navigation device served for planning of a total of 150 needle trajectories. All punctures were carried out semi-automatically with help of the trackable iSYS-1 robotic device. Conically shaped targets inside the phantom were punctured using Kirschner wires. Up to 8 K-wires were positioned sequentially based on the same planning CT and placement accuracy was assessed by taking control CTs and measuring the Euclidean (ED) and normal distances (NDs) between the wire and the entry and target point. RESULTS Using the StealthStation S7, the accomplished mean ND at the target for the 1-mm, 3-mm, and 5-mm slice thickness was 0.89 mm (SD ± 0.42), 0.93 mm (SD ± 0.45), and 0.73 mm (SD ± 0.50), respectively. The corresponding mean ED was 1.61 mm (SD ± 0.36), 2.04 mm (SD ± 0.59), and 1.76 mm (SD ± 0.45). The mean duration of the total procedure was 27.9 min, including image acquisition, trajectory planning, registration, placement of 8 wires, and the control-CT. CONCLUSIONS The optically tracked iSYS-1 robot allows for precise punctures in a phantom. The StealthStation S7 provided acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories. In combination with our optical navigation tool, the trackable robot unit allows to cover a large treatment field and the compact design facilitates placement of needle-like instruments. KEY POINTS • The use of a robotic targeting device in combination with optical tracking (hybrid system) allows for accurate placement of needle-like instruments without repeated control imaging. • The compact robotic positioning unit in combination with a camera for optical tracking facilitates sequential placement of multiple K-wires in a large treatment volume.
Collapse
Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sofia Letrari
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| |
Collapse
|
12
|
Laimer G, Schullian P, Scharll Y, Putzer D, Eberle G, Oberhuber G, Bale R. Stereotactic radiofrequency ablation as a valid first-line treatment option for hepatocellular adenomas. Int J Hyperthermia 2022; 39:780-787. [PMID: 35654476 DOI: 10.1080/02656736.2022.2082562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES This study aimed to assess the safety and efficacy of stereotactic radiofrequency ablation (SRFA) in patients with hepatocellular adenomas (HCA). METHODS Retrospective analyses of all patients referred for SRFA treatment at our institution between January 2010 and October 2020 revealed 14 patients (10 women; mean age 34.4 [range, 17-73 years]) with 38 HCAs treated through 18 ablation sessions. Ablations were considered successful if a safety margin >5 mm was achieved. Demographic, interventional, and outcome data were collected and analyzed. Primary and secondary technical efficacy rates were assessed based on follow-up images consisting of contrast-enhanced CT or MR scans. RESULTS The mean tumor size was 22 mm (range, 7-75 mm). Overall, 37/38 (97.4%) tumors were successfully ablated at the initial SRFA (primary efficacy rate of 97.4%). The median follow-up duration was 49.6 months. No deaths or adenoma-related complications (hemorrhage or malignant transformation) were observed. Disease-free survival rates at 1, 3, and 5 years from the date of the first SRFA were 100%, 85.8%, and 85.8%, respectively. Two patients developed new distant tumors retreated with consecutive re-ablation. No major complications occurred during any of the 18 ablation sessions. CONCLUSIONS Percutaneous thermal ablation is efficient in the treatment of HCAs and may thus be considered a valid first-line treatment option. In addition, SRFA allows for an effective, minimally invasive treatment of large and multiple hepatic tumors within one session.
Collapse
Affiliation(s)
- Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniel Putzer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Oberhuber
- INNPATH, Institute of Pathology, Tirol Kliniken Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| |
Collapse
|
13
|
Schullian P, Laimer G, Johnston E, Putzer D, Eberle G, Scharll Y, Widmann G, Kolbitsch C, Bale R. Technical efficacy and local recurrence after stereotactic radiofrequency ablation of 2653 liver tumors: a 15-year single-center experience with evaluation of prognostic factors. Int J Hyperthermia 2022; 39:421-430. [PMID: 35227136 DOI: 10.1080/02656736.2022.2044522] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To assess the technical outcome and local tumor control of multi-probe stereotactic radiofrequency ablation (SRFA) in a large series of patients. Furthermore, to determine factors accounting for adverse outcomes. MATERIAL AND METHODS Between 2003 and 2018, 865 patients were treated by SRFA for 2653 primary and metastatic liver tumors with a median tumor size of 2.0 cm (0.5 - 19 cm). Primary technical efficacy (PTE) and local recurrence (LR) were evaluated, and possible predictors for adverse events analyzed using uni- and multi-variable binary logistic regression. RESULTS Overall, 2553 of 2653 tumors were successfully ablated at initial SRFA resulting in a PTE rate of 96.2%. Predictors of lower PTE rates were age > 70 years, tumor size > 5 cm, number of probes, location close to liver capsule/organs and segment II. LR occurred in 220 of 2653 tumors (8.3%) with the following predictors: age, tumor type/size, conglomerates, segments I/IVa/IVb, number of probes and location close to major vessels/bile duct. Multivariable analysis revealed tumor size > 5 cm (odds ratio [OR] 3.153), age > 70 years (OR 1.559), and location in segment II (OR 1.772) as independent prognostic factors for PTE, whereas tumor location close to major vessels (OR 1.653) and in segment IVb (OR 2.656) were identified as independent prognostic factors of LR. CONCLUSIONS Stereotactic RFA is an attractive option in the management of primary or metastatic liver tumors with good local tumor control, even in large tumors. The presented prognostic factors for adverse local oncological outcome might help to stratify unfavorable tumors for ablation.
Collapse
Affiliation(s)
- Peter Schullian
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Daniel Putzer
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Yannick Scharll
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Kolbitsch
- Department of Anesthesia, Medical University of Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Section of Interventional Oncology-Microinvasive Therapy (SIP), Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|