C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis

Leschka, S.; Babić, Draženko; Shikh, Samer El; Wossmann, Christine; Schumacher, Martin; Taschner, Christian

doi:10.1007/s00234-011-0866-y

Cited by 37 publications

(20 citation statements)

References 15 publications

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“…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%

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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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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

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“…Fluoroscopic navigation can display multiple X-ray images at the same time reducing radiation exposure while tracing the moving instrument in real time [12]. The success of CT-guidance for percutaneous interventions has been shown in perineural injections [7], pulsed radiofrequency stimulation [9], spinal biopsy [13], percutaneous discectomy [14], kyphoplasty [15], aspiration of spinal cysts [16], and the implantation of pedicle screws [8,11,12,[17][18][19][20]. Foley et al [18] pointed out not only advantages, but also limitations of fluoroscopic navigation and urgently invited to engage in research for other solutions.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted fluoroscopic navigation of percutaneous spinal interventions

et al. 2012

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Purpose Percutaneous spine procedures may occasionally be difficult and subject to complications. Navigation using a dynamic reference base (DRB) may ease the procedure. Yet, besides other shortcomings, its fixation demands additional incisions and thereby defies the percutaneous character of the procedure. Methods A new concept of atraumatic referencing was invented including a special epiDRB. The accuracy of navigated needle placement in soft tissue and bone was experimentally scrutinised. Axial and pin-point deviations from the planned trajectory were investigated with a CT-based 3D computer system. Clinical evaluation in a series of ten patients was also done. ResultsThe new epiDRB proved convenient and reliable. Its fixation to the skin with adhesive foil provided a stable reference for navigation that improves the workflow of percutaneous interventions, reduces radiation exposure and helps avoid complications. Conclusions Percutaneous spine interventions can be safely and accurately navigated using epiDRB with minimal trauma or radiation exposure and without additional skin incisions.

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“…In this setting, puncture was performed with a 19-gauge ELASTER needle HAKKO Co., Ltd. after using the imaging guidance to align the anterior and posterior ends of the needle. Then, a 0.038-inch Bentson wire MEDICOS Hirata Co., Ltd. was looped within the abscess cavity, and a UreSil Sheen Man Co., Ltd. catheter was placed with the help of a guidewire 14 .…”

Section: Methodsmentioning

confidence: 99%

The Usefulness of C-arm CBCT-guided Abscess Drainage with A Flat-panel Detector

Ikeda

Seino

Hashizume

et al. 2012

Showa Univ J Med Sci

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: Herein we report our experience with a C-arm cone beam computed tomography CBCT -guided abscess drainage procedure. We retrospectively examined the medical records and imaging results of patients whose abscesses were drained between 2005 and 2010 employing this system. We analyzed the technical success rate and incidence of procedure-related complications. Percutaneous abscess drainage using C-arm CBCT was performed using a atpanel detector digital subtraction angiography DSA system on 104 lesions in 97 patients 55 men, 42 women with a mean age of 64.7 30-88 years. The drainage procedure was performed twice in 6 patients and 3 times in 2 patients, and 6 patients received 2 or more punctures at the same time. The technical success rate with this procedure was 98.1 102 of 104 lesions . Placement of the drainage tube was abandoned in 2 patients due to dif culty in inserting a wire into the abscess cavity in 1 case and difficulty looping the wire in the other. The incidence of procedure-related complications was 3.85 4 of 104 lesions . Our retrospective study and review of the relevant literature revealed that the C-arm CBCT-guided abscess drainage procedure examined was generally safe for patient use, showed a high technical success rate and low incidence of procedure-related complications, and was useful for abscesses that were inaccessible using other instruments. Although C-arm CBCT has limited contrast resolution, this disadvantage is easily overcome by comparing images with those obtained using other modalities.

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C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis

Cited by 37 publications

References 15 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

Computer-assisted fluoroscopic navigation of percutaneous spinal interventions

The Usefulness of C-arm CBCT-guided Abscess Drainage with A Flat-panel Detector

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