Technologies for Guidance of Radiofrequency Ablation in the Multimodality Interventional Suite of the Future

Abstract

Several new image-guidance tools and devices are being prototyped, investigated, and compared. These tools are introduced and include prototype software for image registration and fusion, thermal modeling, electromagnetic tracking, semiautomated robotic needle guidance, and multimodality imaging. The integration of treatment planning with computed tomography robot systems or electromagnetic needle-tip tracking allows for seamless, iterative, "see-and-treat," patient-specific tumor ablation. Such automation, navigation, and visualization tools could eventually optimize radiofrequency ablation and other needle-based ablation procedures and decrease variability among operators, thus facilitating the translation of novel image-guided therapies. Much of this new technology is in use or will be available to the interventional radiologist in the near future, and this brief introduction will hopefully encourage research in this emerging area.

Real-time FDG PET Guidance during Biopsies and Radiofrequency Ablation Using Multimodality Fusion with Electromagnetic Navigation

“…had control of in clusion of any data and information that might present a confl ict ical space, enabling display of location and trajectory of tracked instruments directly on the images. Many image types may be coregistered, with multiplanar multimodality images providing real-time spatial information on device location in patient anatomy during a biopsy or immediately prior to radiofrequency (RF) ablation ( 12,13 ). This is analogous to a miniaturized global positioning system for medical instruments ( 14,15 ).…”

Incorporation of Preprocedural PET into CT-Guided Radiofrequency Ablation of Hepatic Metastases: a Nonrigid Image Registration Validation Study

“…37 Unfortunately, the functional information from PET, even when available on the picture archiving and communication system, remains unavailable on image-guidance workstations in interventional pro- cedure suites, mainly because it is not spatially coupled with the ongoing guidance roadmap, the CT. We have proposed a workflow for combining PET and CT, with hardware acceleration that removes current barriers to dual-modality roadmapping. The off-line implementation of the workflow in this work that required minimal alterations to the current practice and made use of the preprocedural PET or PET/CT and intraprocedural NCCT routinely acquired for RFA of hepatic metastases proves its clinical viability.…”

“…14 Only a few preliminary attempts, however, have been made to exploit these benefits so far. 37,40 One of the first attempts to incorporate PET into hepatic RFA made use of a hybrid PET/CT scanner, which achieves image registration by sequential PET and CT scanning during a single session. In this recent case study, Prior et al performed RFA of a CT-invisible metastatic hepatic lesion of a patient.…”

Toward Simultaneous Real-Time Fluoroscopic and Nuclear Imaging in the Intervention Room

“…Tomosynthesis producing intrinsically registered hybrid images. Procedures that can potentially benefit from real-time simultaneous hybrid imaging include selective internal radiation therapy and liver radioembolization (6)(7)(8), biopsies (3,9), tumor resections (10), and radiofrequency ablations (11). Real-time functional imaging in concert with anatomic imaging would provide the physician with valuable information during the procedure, thereby improving therapeutic efficiency.…”