Abstract No. 404 - Utilizing 3-D fluoroscopic imaging techniques in musculoskeletal oncologic intervention

Abstract

Understand concept, benefits and utility of 3-D fluoroscopic imaging in the setting of radiofrequency ablation and cement augmentation in metastatic spinal lesions. Vertebral body lesions are frequently a source of significant pain in patients with metastatic disease. Interventions such as radiofrequency ablation with cement augmentation of metastatic lesions has been increasingly shown to result in the highest degree of palliative pain control. These procedures are often under CT guidance or CT fluoroscopy. At our institution, we utilize 3-D fluoroscopic spin imaging as our technique of choice in performing these procedures. The patient is placed prone on the table, as near to the iso-center of the c-arm as possible. The c-arm is then positioned over the area of interest and preliminary rotation of the C-arm is performed to ensure there is no obstruction. A 220 degree fluoroscopic spin is performed which results in volumetric acquisition of data. In the case of spinal intervention, a bone algorithm is applied and a bony MIP of the spine is generated. This allows for three dimensional visualization of metastatic lesions in question. At our institution we utilize a unilateral transpedicular approach for ablation. Using the MIP we can generate exact coordinates for the table and c-arm in order to facilitate cannulation in orthogonal planes. These coordinates are preset into fluoroscopy console. We then proceed with ablation and augmentation. -Allows for pre- and post-procedural global evaluation of the lesion due to volumetric acquistion.-Manipulation of data into virtually any plane necessary to plan your approach.-Evaluate positioning of canulas in the middle of treatment.-Ability to obtain coordinates for specific positions of vertebral bodies of interest also facilitates in patient positioning and avoids radiation exposure from trial and error.-Personnel does not have to present during spin acquisition where much of the planning is done.-Allows for these interventions to be performed in the angiography suite as image acquisition and manipulation is entirely software based.-Allows for realtime monitoring of ablation and more importantly cement augmentation.