Live 3D Guidance in the Interventional Radiology Suite

Racadio, John M.; Babić, Draženko; Homan, Robert; Rampton, John; Patel, Manish; Racadio, Judy M.; Johnson, Neil

doi:10.2214/ajr.07.2469

Cited by 107 publications

(63 citation statements)

References 3 publications

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Section: Resultsmentioning

confidence: 99%

“…In light of such a limitation, the FPCT guidance system has the ability to reorient the CT image onto live fluoroscopy by using the patient's osseous anatomy as reference landmarks, much in the manner that fiducials are used in other neuro-navigation systems. 10 Ultimately, if there is concern that the patient or the intracranial anatomy has moved significantly, a new FPCT and trajectory can be acquired without transferring the patient.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11] FPCT demonstrates excellent spatial resolution and, though limited in subtle contrast differentiation, is of diagnostic accuracy in the assessment of general cerebral anatomy and higher attenuation features such as hemorrhage. [5][6][7][8]10,11 Beyond the ability of FPCTbased navigation to quickly and accurately target a particular focus is the provision of real-time instrument visualization using live fluoroscopic overlay and the capability of re-imaging without moving the patient, limitations of current neuronavigational programs. 10 Ventricular drain catheter placement in the setting of subarachnoid hemorrhageϪrelated hydrocephalus is a common neurosurgical procedure.…”

mentioning

confidence: 99%

“…[5][6][7][8]10,11 Beyond the ability of FPCTbased navigation to quickly and accurately target a particular focus is the provision of real-time instrument visualization using live fluoroscopic overlay and the capability of re-imaging without moving the patient, limitations of current neuronavigational programs. 10 Ventricular drain catheter placement in the setting of subarachnoid hemorrhageϪrelated hydrocephalus is a common neurosurgical procedure. Performed at the bedside by using anatomic landmarks, ventriculostomy placement is safe and accurate with a low rate of complications.…”

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confidence: 99%

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Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Cooke¹,

Levitt²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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SUMMARY:FPCT and navigation software on contemporary fluoroscopic units perform imaging of a quality comparable with conventional CT. They can accurately guide percutaneous procedures, providing live instrument visualization and the capability to re-image without patient transfer. FPCT navigation was used in the placement of a ventricular drain in a 62-year-old woman for subarachnoidrelated hydrocephalus by using an otherwise standard bedside technique. Ventriculostomy catheter placement was technically successful without complication with a catheter at the foramen of Monro.ABBREVIATIONS: DSA ϭ digital subtraction angiography; FPCT ϭ flat panel detector CT F PCT and integrated guidance software available on contemporary fluoroscopic systems emit a lower radiation dose while producing imaging of a quality comparable with that of conventional CT.1-5 They also have the ability to perform percutaneous procedures within the body, spine, and head and neck safely and accurately.4-11 FPCT demonstrates excellent spatial resolution and, though limited in subtle contrast differentiation, is of diagnostic accuracy in the assessment of general cerebral anatomy and higher attenuation features such as hemorrhage. [5][6][7][8]10,11 Beyond the ability of FPCTbased navigation to quickly and accurately target a particular focus is the provision of real-time instrument visualization using live fluoroscopic overlay and the capability of re-imaging without moving the patient, limitations of current neuronavigational programs. 10Ventricular drain catheter placement in the setting of subarachnoid hemorrhageϪrelated hydrocephalus is a common neurosurgical procedure. Performed at the bedside by using anatomic landmarks, ventriculostomy placement is safe and accurate with a low rate of complications.12-15 Given the frequent need for ventricular drain placement and the relative technical ease of the procedure, we chose it as means to demonstrate proof of principle regarding transcranial FPCT guidance. We herein describe the use of the navigation system in the placement of a ventriculostomy catheter. Case ReportA 62-year-old woman presented with altered mental status. Physical examination revealed an intubated obtunded patient with left-sided hemiplegia and equal and reactive pupils. CT of the head showed diffuse subarachnoid hemorrhage, hydrocephalus, and significant hemorrhage in the basal cisterns. CT angiography revealed a 6 ϫ 7 mm right-sided posterior communicating artery aneurysm and a 3 ϫ 2 mm left-sided middle cerebral artery aneurysm.The patient underwent emergent FPCT-guided ventriculostomy placement in the angiography suite. To minimize movement, we carefully taped her head to the table. The left scalp was prepped, and a 1-cm incision was made at the Kocher point, approximately 11 cm posterior to the glabella and 3 cm lateral to midline in the midpupillary line. A twist-drill craniostomy was performed. The dura and pia mater were cauterized and incised.Before catheter placement, an FPCT (XperCT and XperGuide; Philips Healthcare,...

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Cooke¹,

Levitt²,

Kim³

et al. 2010

AJNR Am J Neuroradiol

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“…A radiation-free technique that also provides real-time imaging is ultrasound. However, the accuracy is operator dependent and, owing to ultrasound's low penetration depth, the area of use is restricted to superficial targets and moderate-sized patients [3].New techniques combining cone beam CT (CBCT) and fluoroscopy with dedicated needle guidance software within an angiography C-arm system aim to overcome the disadvantages of CT and allow real-time three-dimensional needle guidance in the interventional suite [5]. …”

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

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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...

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3‐D guidance of complex pulmonary artery stent placement using reconstructed rotational angiography with live overlay

Fagan

Kay

Carroll

et al. 2011

Cathet Cardio Intervent

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Technologies which allow rotational angiographic image acquisition and three dimensional (3-D) vascular reconstruction with subsequent fluoroscopic registration for live 3-D image overlay are rapidly being adopted. We present the first use of rotational angiography with integrated 3-D image overlay for guidance during complex pulmonary artery stent placement. Technical considerations, advantages, and limitations of this procedural strategy are discussed.

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Live 3D Guidance in the Interventional Radiology Suite

Abstract: This new combination further increases interventional radiologic capabilities because it provides real-time procedural evaluation and tracking.

Cited by 107 publications

References 3 publications

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

Transcranial Access Using Fluoroscopic Flat Panel Detector CT Navigation

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

3‐D guidance of complex pulmonary artery stent placement using reconstructed rotational angiography with live overlay

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