Image fusion and navigation platforms for percutaneous image-guided interventions

Abstract

Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.

Safety and effectiveness of percutaneous microwave ablation using combined computed tomography and ultrasound-guided imaging in patients with hepatocellular carcinoma: A prospective study

“…It is worth noting that the postprocedural complication rates of thermal ablation vary greatly, from 2.2-53.2% [14,15]; we cannot say that this is not in uenced by the method of imaging guidance. Both types of imaging guidance have their own disadvantages; to overcome these limitations, various methods have been proposed by researchers to achieve this goal, such as CT/MRI-CEUS and US-CEUS fusion imaging techniques and multimodality imaging-compatible insertion robots [16][17][18][19]. All these measures can aid operators in performing technically challenging procedures, with the potential of reducing the procedure time and radiation dose.…”

“…The median follow-up period was 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) months. During the follow-up period, 8 patients (combination group: 2 patients, CT group: 2 patients, US group: 4 patients) experienced local recurrence and received repeat MWA, and the local recurrence rates were 5.9%, 6.7%, and 16.7% in the combination group, CT group, and US group, respectively.…”

Security and Efficiency of Percutaneous Microwave Ablation using Combined Computed Tomography and Ultrasound-Guided Imaging in Patients with Hepatocellular Carcinoma: A Prospective Study

“…It is worth noting that the postprocedural complication rates of thermal ablation vary greatly, from 2.2% to 53.2% [14,15]; we cannot say that this is not in uenced by the method of imaging guidance. Both types of imaging guidance have their own disadvantages; to overcome these limitations, various methods have been proposed by researchers to achieve this goal, such as CT/MRI-CEUS and US-CEUS fusion imaging techniques and multimodality imaging-compatible insertion robots [16][17][18][19]. All these measures can aid operators in performing technically challenging procedures, with the potential of reducing the procedure time and radiation dose.…”

“…The median follow-up period was 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) months. During the follow-up period, 8 patients (combination group: 2 patients, CT group: 2 patients, US group: 4 patients) experienced local recurrence and received repeat MWA, and the local recurrence rates were 5.9%, 6.7%, and 16.7% in the combination group, CT group, and US group, respectively.…”

Theoretical investigation of transgastric and intraductal approaches for ultrasound-based thermal therapy of the pancreas

“…The pathway for additional development toward clinical implementation could include the design, fabrication, and experimental evaluations of intraluminal and transgastric devices specific for the pancreas. Specific image guidance approaches, such as MRI with non-invasive temperature monitoring [57–59], or ultrasound or CT imaging with electromagnetic tracking [60–62], could be integrated as a means to precisely position and verify therapy delivery. Incorporation of optimization-based patient specific treatment planning [39, 63, 64] could be applied for a priori or real-time determination of ideal positioning, applicator selection, and applied power trajectories.…”