3:30 PM Abstract No. 223 - Use of xperguide cone beam CT in percutaneous procedures in the angiography suit

Abstract

Purpose C-arm Cone Beam CT (CBCT) is a relatively new technology installed in some angiographic suits to optimize and aid therapeutic delivery.We present our experience using the Philips Xperguide software and image fusion capability in percutaneous procedures in the angiography suite. The aim was to assess the efficacy, safety and clinical applications of CBCT guided procedures. Materials and Methods Using a single plane C-arm angiography system with a flat-panel detector (Allura Xper FD20 Philips Medical Systems, Netherlands), we performed range of procedures, including targeted biopsies, facet joint injections, drainages and radiologically inserted gastrostomy tube insertions (RIG). CBCT was performed in all patients to acquire pre-procedural imaging which was used for Xperguide planning. The CBCT was used in conjunction with live fluoroscopy to perform the procedures. Where appropriate, the contrast enhanced CT performed prior to the procedure was fused with the CBCT. These included targeted biopsies or for collections which were in proximity to fluid filled bowel loops. Technical difficulties. Ionizing radiation dose and total fluoroscopic times, technical success and complications were recorded. Results To date 30 cases have been performed at our centre: Biopsies (n=7), Facet joint/nerve root injection (n=9), Drainages (n=10) and RIGs (n=4). Image Fusion was performed in 7 cases. CBCT guided interventional procedures were efficacious with a 93.3% technical success rate. One nerve root was abandoned due to body habitus/poor visualization. A drainage was abandoned due to technical challenges. No immediate complications occurred. Average screening time was 3.6min (range 0.8 - 12.3mins). The ionising radiation dose (dose area product) mean was 22018.5 μGycm2 (range 8699 - 62890 μGycm2). Conclusion CBCT offers excellent 3D spatial and fluoroscopy guided temporal resolution with image fusion capabilities. CBCT guided procedures are efficacious and safe with the flexibility to perform procedures in the angiography suite that would otherwise benefit from CT guidance. In cases with challenging anatomy, CBCT guidance proved to be a particularly useful tool in particular in cases where live fluoroscopy is required.