Clinical Experience with Cone-Beam CT Navigation for Tumor Ablation

Abstract

Purpose To describe clinical use and potential benefits of Cone Beam Computed Tomography (CBCT) navigation to perform image guided percutaneous tumor ablations. Materials and Methods All ablations performed between February 2011 and February 2013 using CBCT navigation, were included. Sixteen patients underwent 20 ablations for 29 lesions. CBCT ablation planning capabilities include multimodality image fusion and tumor segmentation for visualization, depiction of the predicted ablation zones for intra-procedural planning and segmentation of the ablated area for immediate post-treatment verification. Number and purpose of CBCT were examined. The initial ablation plan defined as number of probes and duration of energy delivery was recorded for 20/29 lesions. Technical success and local recurrences were recorded. Primary and secondary effectiveness rates were calculated. Results Image fusion was utilized for 16 lesions and intra-procedural ultrasound for 4. Of the 20/29 lesions, where the ablation plans were recorded, there was no deviation from the plan in 14. In the remaining 6/20, iterative planning was needed for complete tumor coverage. An average of 8.7 ± 3.2 CBCT were performed per procedure, including 1.3 ± 0.5 for tumor segmentation and planning, 1.7 ± 0.7 for probe position confirmation, 3.9 ± 2 to ensure complete coverage. Mean follow-up was 18.6 ± 6.5 months. 28/29 ablations were technically successful (96.5%). Of ablations performed with curative intent, technical effectiveness at one-month was 25/26 (96.1%) and 22/26 (84.6%) at last follow-up. Local tumor progression was observed in 11.5% (3/26). Conclusion CBCT navigation may add information to assist and improve ablation guidance and monitoring.

WITHDRAWN: Image-guided navigation systems for interstitial brachytherapy

“…Li et al [83] found out that the discrepancy between bonematch in CBCT and 3D US for prostate positioning was not significant and the discrepancy between seed-match in CBCT and 3D US was significant only in the longitudinal direction which is -1.9 +/-2.3 mm. Experiences of other CBCT-based interventional procedures such as ablation and biopsy [108,109] can be borrowed in performing navigated brachytherapy in many other sites such as the liver, lungs and metastatic lymph nodes.…”

Cone beam computed tomography-guided transpterygoidal aspiration of a carotid space abscess in Lemierre's syndrome

“…CBCT-guidance has proven effective for a wide range of pediatric and adult interventions [5] , [6] , [7] , [8] , [9] , [10] , offering several advantages over traditional CT guidance including reduced radiation dose, improved procedural ergonomics, and image-fusion capabilities. The case presented represents the first published use of a CBCT-guided transpterygoidal approach.…”

Advanced Intraprocedural Imaging Applications in Hepatobiliary Intervention

“…6). 12,23,33,36 Fig. 3 Patient with an aggressive multiple myeloma with a hepatic plasmacytoma causing biliary obstruction.…”