Limits...
Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance.

Cheng YC, Tsai SH, Cheng Y, Chen JH, Chai JW, Chen CC - Transl Oncol (2015)

Bottom Line: This study aims to evaluate the diagnostic value and safety of CBCT-guided PTLB compared to CCT-guided biopsy, with cases performed in a single hospital.Total procedure time was significantly lower in the CBCT group (32 ± 11 minutes) compared to the CCT group (38 ± 9.7 minutes; P = .009), especially among patients ≥70 years of age (CBCT: 33 ± 12 minutes, CCT: 42 ± 13, P = .022).For lesions in the lower lobes, the CBCT-guided group received significantly reduced effective radiation dose (2.9 ± 1.6 mSv) than CCT-guided patients (3.7 ± 0.80; P = .042).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.

No MeSH data available.


Related in: MedlinePlus

Cone-beam CT-guided transthoracic lung biopsy of a 1.5-cm left lower lobe nodule in an 80-year-old man. (A) Selection of skin entry site after initial planning CBCT scan, with placement of needle along an inclined axis as aided by the path-guiding software. The skin-to-pleura and skin-to-lesion distances were recorded during planning. (B) Bull’s-eye view of a pulmonary nodule, with red and green circles to help align the biopsy needle with the target lesion. Real-time graphics overlay (in blue) displays the original position of a patient’s target lesion during planning relative to its current position as it changes owing to patient motion. (C and D) Axial and sagittal views as shown during CBCT-guided needle insertion, allowing vertical angle adjustments that facilitate avoidance of intervening obstacles such as ribs and vascular structures.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4562972&req=5

f0005: Cone-beam CT-guided transthoracic lung biopsy of a 1.5-cm left lower lobe nodule in an 80-year-old man. (A) Selection of skin entry site after initial planning CBCT scan, with placement of needle along an inclined axis as aided by the path-guiding software. The skin-to-pleura and skin-to-lesion distances were recorded during planning. (B) Bull’s-eye view of a pulmonary nodule, with red and green circles to help align the biopsy needle with the target lesion. Real-time graphics overlay (in blue) displays the original position of a patient’s target lesion during planning relative to its current position as it changes owing to patient motion. (C and D) Axial and sagittal views as shown during CBCT-guided needle insertion, allowing vertical angle adjustments that facilitate avoidance of intervening obstacles such as ribs and vascular structures.

Mentions: CBCT was performed with the C-arm rotating 240° in 4 seconds, generating 242 images in a 512 × 512 matrix. The acquired CBCT images were transferred to commercially available dedicated medical imaging workstations, where the safest and most effective skin entry site and needle pathway to reach target lesion were determined (Figure 1A). Distances from needle skin entry site to lesion and skin to pleura were also measured and recorded. Virtual guidance (XperGuide; Philips Healthcare) with automatic angle alignment from the skin entry site to the target lesion (bull’s-eye view) was then used along with virtual color overlay on the fluoroscopic image (Figure 1B) to guide insertion of a 17-gauge coaxial introducer needle into the target nodule. At this point, a procedural cone-beam CT scan was performed to check the exact needle tip location (Figure 1, C and D). If the introducer needle was correctly situated with tip adjacent to the target lesion, an 18-gauge semi-automated cutting needle was inserted into the target lesion through the introducer and a tissue sample was obtained. After sufficient samples were obtained, the coaxial introducer was removed.


Percutaneous Transthoracic Lung Biopsy: Comparison Between C-Arm Cone-Beam CT and Conventional CT Guidance.

Cheng YC, Tsai SH, Cheng Y, Chen JH, Chai JW, Chen CC - Transl Oncol (2015)

Cone-beam CT-guided transthoracic lung biopsy of a 1.5-cm left lower lobe nodule in an 80-year-old man. (A) Selection of skin entry site after initial planning CBCT scan, with placement of needle along an inclined axis as aided by the path-guiding software. The skin-to-pleura and skin-to-lesion distances were recorded during planning. (B) Bull’s-eye view of a pulmonary nodule, with red and green circles to help align the biopsy needle with the target lesion. Real-time graphics overlay (in blue) displays the original position of a patient’s target lesion during planning relative to its current position as it changes owing to patient motion. (C and D) Axial and sagittal views as shown during CBCT-guided needle insertion, allowing vertical angle adjustments that facilitate avoidance of intervening obstacles such as ribs and vascular structures.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4562972&req=5

f0005: Cone-beam CT-guided transthoracic lung biopsy of a 1.5-cm left lower lobe nodule in an 80-year-old man. (A) Selection of skin entry site after initial planning CBCT scan, with placement of needle along an inclined axis as aided by the path-guiding software. The skin-to-pleura and skin-to-lesion distances were recorded during planning. (B) Bull’s-eye view of a pulmonary nodule, with red and green circles to help align the biopsy needle with the target lesion. Real-time graphics overlay (in blue) displays the original position of a patient’s target lesion during planning relative to its current position as it changes owing to patient motion. (C and D) Axial and sagittal views as shown during CBCT-guided needle insertion, allowing vertical angle adjustments that facilitate avoidance of intervening obstacles such as ribs and vascular structures.
Mentions: CBCT was performed with the C-arm rotating 240° in 4 seconds, generating 242 images in a 512 × 512 matrix. The acquired CBCT images were transferred to commercially available dedicated medical imaging workstations, where the safest and most effective skin entry site and needle pathway to reach target lesion were determined (Figure 1A). Distances from needle skin entry site to lesion and skin to pleura were also measured and recorded. Virtual guidance (XperGuide; Philips Healthcare) with automatic angle alignment from the skin entry site to the target lesion (bull’s-eye view) was then used along with virtual color overlay on the fluoroscopic image (Figure 1B) to guide insertion of a 17-gauge coaxial introducer needle into the target nodule. At this point, a procedural cone-beam CT scan was performed to check the exact needle tip location (Figure 1, C and D). If the introducer needle was correctly situated with tip adjacent to the target lesion, an 18-gauge semi-automated cutting needle was inserted into the target lesion through the introducer and a tissue sample was obtained. After sufficient samples were obtained, the coaxial introducer was removed.

Bottom Line: This study aims to evaluate the diagnostic value and safety of CBCT-guided PTLB compared to CCT-guided biopsy, with cases performed in a single hospital.Total procedure time was significantly lower in the CBCT group (32 ± 11 minutes) compared to the CCT group (38 ± 9.7 minutes; P = .009), especially among patients ≥70 years of age (CBCT: 33 ± 12 minutes, CCT: 42 ± 13, P = .022).For lesions in the lower lobes, the CBCT-guided group received significantly reduced effective radiation dose (2.9 ± 1.6 mSv) than CCT-guided patients (3.7 ± 0.80; P = .042).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.

No MeSH data available.


Related in: MedlinePlus