Abstract
Purpose: To evaluate a new miniature optical navigation system for CT-guided liver interventions. Material and Methods: A two-center, prospective study was performed with four interventional radiologists. A total of 20 patients had CT-guided liver biopsy or ablation interventions utilizing the CT-Guide? navigation system (ActiViews Inc., Wakefield, MA) between July 2011 and December 2011. The navigation system consists of a self-adhesive patientsticker printed with coincident colored and radio-opaque reference markers, a miniature disposable video camera that clips on and off an interventional instrument, and software loaded on a computer to display the navigation information. The primary end point was the frequency of a satisfactory instrument position for the intended intervention. Results: The cohort consisted of 13 males and 7 females with an average age of 63.1 years (range of 38 to 80). Most of the patients, 70%, underwent CT-guided liver biopsy while the remainder had CT-guided ablation therapy. The average lesion size was 3.1 cm (range of 1.1 - 6.9 cm). All of the interventions, regardless of lesion size, met the primary end point of satisfactory instrument positioning. There were no device-related or unexpected adverse events recorded. Only one patient had a mild adverse event and it resolved without intervention. Conclusions: This study demonstrated the safety and effectiveness of the CT-Guide? navigation system for CT-guided liver interventions, for both biopsies and ablations. The targeting success rate for a satisfactory intervention was 100% with the system.
Highlights
The use of CT-guidance for hepatic interventions has become an accepted standard of care for diagnostic biopsies and therapeutic ablations where ultrasound guidance does not adequately visualize the lesion and there is a difficult and narrow safe instrument tract to the lesion
Radiofrequency ablations (RFA) for primary or secondary malignancies can be curative for selected patients [2], but the therapeutic efficacy is dependent on accurate instrument placement
The effective use of CT-guidance is highly dependent on the skill and experience of the radiologist and may require a number of trial and error cycles in which repeated CT scans are performed, especially when the target is small or deep, or the optimal path to the target is at a difficult angle
Summary
The use of CT-guidance for hepatic interventions has become an accepted standard of care for diagnostic biopsies and therapeutic ablations where ultrasound guidance does not adequately visualize the lesion and there is a difficult and narrow safe instrument tract to the lesion. Various techniques for CT-fluoroscopic guidance are used to reduce patient and physicians radiation dose to acceptably low levels [8], this reduction can be challenging to obtain, especially in cases where there is a steep angle to the target of interest. In view of this and especially of recent increased public sensitivity to medical radiation, many physicians have lost the initial enthusiasm that had built up for this method
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