Integrated cone-beam CT and fluoroscopic navigation in treatment of head and neck vascular malformations and tumors

Nesbit, Gary M.; Nesbit, Eric; Hamilton, Bronwyn E.

doi:10.1136/jnis.2010.003376

Cited by 19 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some authors have reported achieved accuracies using CBCT guidance in small patient groups to be ,5 mm in most of their cases [9][10][11]13]; however, these groups are small and there is no or little information on the used needle paths. Nonetheless, this suggests that accuracies of around 3 mm can be reached in clinical practice also, irrespective of the complexity of the needle path and the user experience level.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Busser¹,

Braak²,

Fütterer³

et al. 2013

BJR

View full text Add to dashboard Cite

Objective: To determine the accuracy of cone beam CT (CBCT) guidance and CT guidance in reaching small targets in relation to needle path complexity in a phantom. Methods: CBCT guidance combines three-dimensional CBCT imaging with fluoroscopy overlay and needle planning software to provide real-time needle guidance. The accuracy of needle positioning, quantified as deviation from a target, was assessed for inplane, angulated and double angulated needle paths. Four interventional radiologists reached four targets along the three paths using CBCT and CT guidance. Accuracies were compared between CBCT and CT for each needle path and between the three approaches within both modalities. The effect of user experience in CBCT guidance was also assessed. Results: Accuracies for CBCT were significantly better than CT for the double angulated needle path (2.2 vs 6.7 mm, p,0.001) for all radiologists. CBCT guidance showed no significant differences between the three approaches. For CT, deviations increased with increasing needle path complexity from 3.3 mm for the inplane placements to 4.4 mm (p50.007) and 6.7 mm (p,0.001) for the angulated and double angulated CT-guided needle placements, respectively. For double angulated needle paths, experienced CBCT users showed consistently higher accuracies than trained users [1.8 mm (range 1.2-2.2) vs 3.3 mm (range 2.1-7.2) deviation from target, respectively; p50.003]. Conclusion: In terms of accuracy, CBCT is the preferred modality, irrespective of the level of user experience, for more difficult guidance procedures requiring double angulated needle paths as in oncological interventions. Advances in knowledge: Accuracy of CBCT guidance has not been discussed before. CBCT guidance allows accurate needle placement irrespective of needle path complexity. For angulated and double-angulated needle paths, CBCT is more accurate than CT guidance.Needle guidance for puncture or other minimally invasive procedures is increasing in standard interventional radiology practice. In local therapy procedures, such as percutaneous ablations, accurate placement of one or more needles is important in order to provide effective treatment [1]. This is especially the case in treatment or biopsy procedures of small lesions, in which the tip of the needle needs to be placed within a range of millimetres of the target point. Therefore, image guidance plays a significant role in accurate percutaneous needle placement [2].Currently, most needle placement procedures are performed using CT guidance, fluoroscopy or ultrasound [3]. CT images provide good visualisation of the target and surrounding tissues. For needle guidance, however, CT has limitations mainly because it does not allow real-time feedback on needle progression. For semi-real-time imaging within the CT scanner, CT-fluoroscopy can be used at the expense of a higher radiation dose to the patient and operator [4]. Acquiring CT fluoroscopy images to check needle position takes approximately 1 s, time in which the needle cannot be progressed.Fluorosc...

show abstract

Section: Discussionmentioning

confidence: 99%

“…Several authors described the use of this CBCT with navigational tools in various types of procedures [6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Braak et al [8] described the effective patient dose of CBCT guidance procedures to be reduced by 13-42% compared with CT guidance for abdominal and thoracic procedures.…”

mentioning

confidence: 99%

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Busser¹,

Braak²,

Fütterer³

et al. 2013

BJR

View full text Add to dashboard Cite

show abstract

“…The concept of FDCT procedural guidance has been successfully applied with slight variations to percutaneous procedures in the brain, head and neck, and spine 1–3 7 8 10 11 14–16. There are some notable advantages to using FDCT guidance as opposed to conventional CT, including potentially lower radiation doses depending on individual procedure specifics and the fact that a traditional CT room stays functional for diagnostic studies 4 28 29.…”

Section: Discussionmentioning

confidence: 99%

“…Integrated navigational software can be used to plan a needle trajectory and provide real-time guidance for percutaneous procedures throughout the body including for intracranial, spinal, and head and neck procedures 1–3 7 8 10 11 13–15. FDCT allows the performance of complex percutaneous procedures with the safety and convenience of performing these procedures in an interventional suite or hybrid operating room as opposed to a standard CT suite 1–3 8 10 11 15. FDCT data acquired at the time of or during a procedure can additionally be fused with pre-procedure MRI data to allow navigational guidance towards FDCT occult targets 2 16…”

Section: Introductionmentioning

confidence: 99%

Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement

Mabray

Datta

Lillaney

et al. 2015

J NeuroIntervent Surg

View full text Add to dashboard Cite

Purpose Fluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom. Materials and Methods MR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR data sets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR data set. A 10cm, 19G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. 10 needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, targeting based solely off of the FDCT, with fusion steps repeated for every pass. Results Mean radial error was 2.75±1.39 mm as defined by visual assessment to the center of the DBS target and 2.80±1.43 mm as defined by FDCT to the center of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series. Conclusions Single pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5–3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimeter intracranial lesions defined on MR.

show abstract

“…In [5] the achievable accuracy when targeting head and neck vascular malformations and tumours (including VM, AVM and others in total 65 punctures in 27 patients) under the supervision of intraoperative cone beam CT (CBCT) imaging was investigated. The study demonstrated an available accuracy level of around 2 mm when utilizing CBCT guidance.…”

Section: Figure 1: Fluoroscopic Image Of a Venous Malformation Contrmentioning

confidence: 99%

Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study

et al. 2016

View full text Add to dashboard Cite

PurposeTreatment of vascular malformations requires the placement of a needle within vessels which may be as small as 1 mm, with the current state of the art relying exclusively on two dimensional fluoroscopy images for guidance. We hypothesize that the combination of stereotactic image guidance with existing targeting methods will result in faster and more reproducible needle placements, as well as reduced radiation exposure, when compared with standard methods based on fluoroscopy alone. MethodsThe proposed navigation approach was evaluated in a phantom experiment designed to allow direct comparison with the conventional method. An anatomical phantom of the left forearm was constructed, including an independent control mechanism to indicate the attainment of the target position. Three interventionalists (one inexperienced, two of them frequently practice the conventional fluoroscopic technique) performed 45 targeting attempts utilizing the combined and 45 targeting attempts utilizing the standard approaches. ResultsIn all 45 attempts the users were able to reach the target when utilizing the combined approach. In two cases targeting was stopped after 15 minutes without reaching the target when utilizing only the C-arm. The inexperienced user was faster when utilizing the combined approach and applied significantly less radiation than when utilizing the conventional approach. Conversely, both experienced users were faster when using the conventional approach, in one case significantly so, with no significant difference in radiation dose when compared to the combined approach. ConclusionsThis work presents an initial evaluation of a combined navigation fluoroscopy targeting technique in a phantom study. The results suggest that, especially for inexperienced interventionalists, navigation may help to reduce the time and the radiation dose. Future work will focus on the improvement and clinical evaluation of the proposed method.

show abstract

Integrated cone-beam CT and fluoroscopic navigation in treatment of head and neck vascular malformations and tumors

Abstract: This integrated 3D cone-beam CT and fluoroscopic guidance allowed access to deep, difficult to access, locations with ease using a single needle pass in most cases, resulting in improved treatment with decreased procedure times.

Cited by 19 publications

References 23 publications

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement

Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study

Contact Info

Product

Resources

About