Navigational Tools for Interventional Radiology and Interventional Oncology Applications

Abstract

The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented.

Interstitial microwave treatment for cancer: historical basis and current techniques in antenna design and performance

“…(B) Specialised antennas: designed to selectively heat focal zones presently treated with RF applicators, but in less time and with greater precision [100,101,123]. (C) Navigation with co-registration: technology exists to co-register a treatment target with a treatment device but has not been incorporated into systems that utilise ablation [124,125]. (D) New malignant organ sites: following liver ablation, new tumour sites will be targeted with MW, including more lung, breast, prostate and bone mets (see citations in Section 4.3).…”

“…Wood et al [127] discuss this setting up the treatment room of the future at NIH that includes the following: (1) pre-procedural: co-registered PET, MR and CT, tumour and vascular segmentation, vascular tree visualised in the treatment field, antenna pre-treatment planning with FEM model to predict performance; (2) intra-procedural: guidance and tracking of devices, tracked US, organ motion compensation, ablation feedback, thermography and thermal dose monitoring; and (3) post-procedural: functional MR/PET/CT, US-based elastography and match of pre-to post-ablation. Although that paper was published in 2007, more contemporary papers have begun to show the successful clinical implementation and technical hurdles overcome to implement image registration and fusion [124,128], treatment planning with on-the-fly computational modelling [129,130] and robotic assistance [125,129]. Beyond experimental work at academic medical centres, many of these features have yet to be clinically available by manufacturers, probably due to a combination of technology, safety, and regulatory hurdles.…”

A practical guide for planning pelvic bone percutaneous interventions (biopsy, tumour ablation and cementoplasty)

“…1 ). The development of flat panel detectors and cone beam CT also allows real-time imaging and capability for three-dimensional reformations with lower radiation doses than CT [ 20 – 22 ]. Although the image quality of the multiplane reformations is inferior to a conventional CT scanner, it is usually appropriate for guiding bone procedures safely [ 21 , 23 ].…”

Advanced Intraprocedural Imaging Applications in Hepatobiliary Intervention

“…Two other navigation systems, optical tracking and laser guidance, will not be discussed in this review, as these are less commonly used in percutaneous interventions. 1,32…”

“…Additionally, intraprocedural images can be registered to previously performed studies, such as CT, PET-CT, or MR scans, and integration of this information on a tracking workstation can show device positioning synchronously on pre-and intraprocedural imaging. 1,23,32 If an ultrasound probe with an EM tracking system is used, the transducer is used to select the plane of reformatting on the preprocedural dataset. In other words, the preprocedural images are registered to the real-time ultrasound images and are reconstructed to the plane of the ultrasound and displayed synchronously alongside the ultrasound images, concordant with the movement of the sonographic probe.…”