C-arm cone-beam computed tomography needle path overlay for percutaneous biopsy of pulmonary nodules

Abstract

CBCT-XperGuide navigation is a new, accurate and safe imaging guidance for percutaneous lung biopsies.

Accuracy of percutaneous soft-tissue interventions using a multi-axis, C-arm CT system and 3D laser guidance

“…Kroeze et al suggested that core needle biopsies of renal lesions with a diameter <25mm are critical due to lack of accuracy of the CBCT system, whereas Braak et al reported an accuracy of of 95.1% in CBCT-guided interventions for renal masses with a mean diameter of 25mm 6,7 . A similarly high accuracy of 92.6% was reported by Floridi et al; however, the mean size of punctured pulmonary lesions was 52mm in their study 16 interventions are safe for bone and lung lesions larger than 15mm 18 . In a small phantom study, Ritter et al demonstrated the general feasibility of CBCT-guided interventions using a ceiling based system, however, accuracy data were not reported 19 The purpose of the present study was to evaluate the accuracy, overall procedural time, and number of needle corrections needed for needle placement under CBCT guidance in comparison to MDCT guidance in a phantom study using standardized lesions and access paths.…”

Comparison of cone-beam CT-guided and CT fluoroscopy-guided transthoracic needle biopsy of lung nodules

“…Initial experiences suggested that CBCT-guided TNB could be a useful, safe and accurate procedure for diagnosis of CBCT cone-beam computed tomography, CT computed tomography, PPV positive predictive value, NPV negative predictive value, SD standard deviation a Analysis made in the 103 biopsies for which final pathologic diagnosis was available (of 20 missing, 10 were inadequate samples and 10 were indeterminate/benign lesions currently on follow-up) b Analysis made in the 179 biopsies for which final pathologic diagnosis was available (of 22 missing, 18 were inadequate samples and four were indeterminate/benign lesions currently on follow-up) indeterminate lung nodules, with possible advantages over fluoro-CT-guided biopsy [10,[12][13][14]19]. It is well known that limited access due to a closed CT gantry increases the difficulty of TNB and increases radiation exposure for the operator, whereas the greater working space provided by the C-arm cone-beam system facilitates needle placement and speeds up the procedure [12,20].…”

“…The TNB procedures were performed by the team of three radiologists with experience in CT-guided interventional procedures (GC, FF, AMI) who introduced the new C-arm CBCT technology in our hospital in 2010 [9,10]. This study was not randomized.…”

“…Currently, TNB with CT fluoroscopy (hereafter fluoro-CT) guidance is the commonest and state-of-the-art technique, achieving greater than 90 % diagnostic accuracy for malignant lung lesions, with reasonably low morbidity and minimal mortality [3][4][5]. In recent years a new, real-time needle guidance technique using C-arm cone-beam CT (hereafter CBCT) was developed that can be used to visualize under fluoroscopic guidance the needle trajectory from skin to target pulmonary lesions during interventional radiology procedures [6][7][8][9][10]. It has been suggested that the CBCT system, compared to fluoro-CT, facilitates the needle biopsy procedure and likely reduces radiation exposure of patient and operator [11][12][13][14][15]; however a direct comparison with evaluation of the advantages of CBCT over conventional fluoro-CT biopsy is not currently available [15].…”

Usefulness of CBCT and guidance software for percutaneous embolization of a lymphatic leakage after thyroidectomy for cancer

“…Fluoroscopy documented the blush of lipophilic contrast media next to the tip of the tube of drainage. On the basis of our experience and compliance with CBCT and its applications during interventional procedures (17)(18)(19), we decided to use it as imaging guidance for the puncture of the leakage. In fact, ultrasound guidance can identify the important anatomical structures (e.g., carotid artery or laryngeal nerves) but cannot clearly identify leakage site.…”