Accuracy of percutaneous soft-tissue interventions using a multi-axis, C-arm CT system and 3D laser guidance
Introduction
Due to an increase in applications and indications, percutaneous, minimally invasive interventions are being performed more frequently in clinical routine. In addition to interventions such as computed tomography (CT) guided placement of abscess drainages and percutaneous tissue biopsies, the increasing availability of minimally invasive treatment options such as radiofrequency or microwave ablation or new, irreversible electroporation requires systems with which a needle can be accurately placed in a target lesion or organ [1], [2], [3]. Currently, the majority of those interventions are being conducted using CT or ultrasound guidance. However, CT-guided interventions, although they are generally considered to be precise, have the disadvantage that (1.) CT is blocked for normal patient routine; (2.) gantry size limits access to the patient, and (3.) off-plane interventions are often difficult to perform. Ultrasound-guided interventions overcome these problems, but then image quality not only depends on the user but is also highly dependent on the subject being examined.
A manipulator-based, multi-axis, open C-arm interventional suite, which supports percutaneous interventions using 3D laser and fluoroscopic guidance (Artis zeego, Siemens Healthcare Sector, Germany), represents a relatively new option for needle guidance. The theoretical advantages of an open, multi-axis C-arm system are (1.) better access to the patient; (2.) a higher degree of flexibility for achieving out-of-plane puncture angles; and (3.) pre-, intra-, and post-procedural imaging using flat-panel C-arm cone-beam CT (CBCT) with acceptable quality [4]. Furthermore, examining these patients in an interventional suite frees up CT time for diagnostic examinations, which should be interesting from an economical point of view.
The aim of this phantom study was to evaluate the accuracy of needle placement and overall procedural time using an open, multi-axis, flat-panel, C-arm CT system (CBCT) in comparison to a conventional gantry-based, multi-detector CT (MDCT).
Section snippets
Phantom
In an abdominal phantom (model 057A, CIRS, Norfolk, VA, USA), eight lesions (six lesions in the liver and two in the renal pelvises) were identified in an initial CT scan. For each lesion, one in-plane and one off-plane access path was defined. Accordingly, each lesion was punctured via an identical in-plane and off-plane path under CBCT and MDCT guidance using a 20G Chiba needle (CareFusion, USA). All interventions were conducted by the same interventional radiologist who had more than 4 years
Results
Lesion diameter ranged from 8.2 to 15.3 mm (mean 10.7 mm), as measured on the CT scan conducted initially. According to the initially defined paths, lesion depth within the phantom ranged from 40.4 to 121.1 mm (mean 82.6 mm). Technically, all interventions were successful and the respective lesion was hit in all 32 interventions.
In the CBCT interventions, absolute deviation from needle tip to center of lesion ranged from 1.6 to 4.3 mm (mean 3.0 mm ± 0.9 mm). Angular deviation between planned path and
Discussion
CBCT-guided interventions are becoming more frequent as the diagnostic quality of flat-panel CT is increasing and because more interventional suites are offering some form of three-dimensional road mapping and navigational tools [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]. Schulz et al. and Tovar-Arriaga et al. both demonstrated in their work that CBCT-guided interventions conducted with the help of a robotic arm as needle holder can be conducted with high accuracy and in a timely
Conclusions
Percutaneous soft-tissue interventions under 3D laser guidance using a clinical, multi-axis, interventional C-arm CT system are feasible with an accuracy equal to that of MDCT guidance, an acceptable overall procedural time, and an acceptable number of needle corrections. In general, overall procedural times are shorter using MDCT guidance; however, the CBCT system shows advantages especially when off-plane access paths are required.
Role of the funding source
This work was in part funded by the German Federal Ministry of Research (BMBF) as part of the M2OLIE Mannheim Research Campus initiative (Forschungscampus).
This work was conducted as part of a larger research initiative comparing CBCT and MDCT.
The Institute of Clinical Radiology and Nuclear Medicine has research agreements with Siemens Healthcare Sector.
The funding sources had no direct involvement in preparation of this article.
References (19)
- et al.
Microwave ablation of osteoid osteomas using dynamic MR imaging for early treatment assessment: preliminary experience
J. Vasc. Int. Radiol.: JVIR
(2014) - et al.
Fluoroscopy-guided percutaneous biopsies: value of real-time guidance with image fusion software
J. Radiol.
(2011) - et al.
Percutaneous stereotactic radiofrequency ablation of colorectal liver metastases
Eur. Radiol.
(2012) - Gillams, A., Tumour ablation: Current role in the kidney, lung and bone. Cancer imaging: the official publication of...
- et al.
Flat-panel volume CT: fundamental principles, technology, and applications
Radiographics rev. publ. Radiol. Soc. North America, Inc
(2008) - et al.
Three-dimensional C-arm cone-beam CT: applications in the interventional suite
J. Vasc. Int. Radiol. JVIR
(2009) - et al.
Real-time 3D fluoroscopy-guided large core needle biopsy of renal masses: a critical early evaluation according to the IDEAL recommendations
Cardiovasc. Intervent. Radiol.
(2012) - et al.
3D cone-beam CT guidance, a novel technique in renal biopsy-results in 41 patients with suspected renal masses
Eur. Radiol.
(2012) - et al.
Pulmonary masses: initial results of cone-beam CT guidance with needle planning software for percutaneous lung biopsy
Cardiovasc. Intervent. Radiol.
(2012)
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