Computed Tomography Fluoroscopic Guidance Research Articles

Prospective evaluation of core number of biopsy for renal tumor: are multiple cores preferable?

PurposeThis single-center, single-arm, prospective, open-label study was conducted to evaluate the optimal number of cores (single or multiple) in renal tumor biopsy.Materials and methodsForty-four biopsies of 44 tumors (mean diameter, 2.7 ± 1.0 cm; range, 1.6–5.0 cm) were included. Biopsy was performed under ultrasound or computed tomography fluoroscopy guidance using an 18-gauge cutting needle and the co-axial method. Two or more specimens were obtained, which were divided into first and subsequent specimens. “First specimen” and “all specimens” were histologically evaluated (i.e., appropriateness of specimen, histological diagnosis, subtype, and Fuhrman grade of renal cell carcinoma [RCC]) blindly and independently by two board-certified pathologists.ResultsMultiple specimens were successfully and safely obtained in all the biopsies. All tumors were histologically diagnosed; 40 malignancies included 39 RCCs and 1 solitary fibrous tumor, and 4 benign lesions included 2 angiomyolipomas, 1 oncocytoma, and 1 capillary hemangioma. In all RCCs, the subtype could be determined (32 clear cell RCCs, 4 chromophobe RCCs, and 3 papillary RCCs), and the Furman grade was determined in 38 RCCs. When only the first specimen was evaluated, 22.7% of the specimens were inappropriate for diagnosis, and 34 (77.3%) were histologically diagnosed. The diagnostic yield was significantly lower than that of all specimens (P = 0.0044). Univariate analysis revealed that smaller lesions were a significant predictor of diagnostic failure (P = 0.020).ConclusionBiopsy with multiple cores significantly improved diagnostic yield. Thus, operators should obtain multiple cores during renal tumor biopsy.

Efficacy of Percutaneous Direct Puncture Biopsy of Malignant Lung Tumors Contacting to the Pleura.

This is a retrospective evaluation of whether percutaneous direct puncture biopsy of lung lesions contacting to the pleura is justified. Between August 2016 and July 2021, 163 consecutive patients (100 males, 63 females with a median age of 73 years) who had malignant lung tumors measuring 0.6-12.4 cm (median, 2.9 cm) that contacted to the pleura and underwent percutaneous lung biopsy under computed tomography fluoroscopic guidance using an 18-gauge end-cut needle were examined. The trajectory was direct puncture in 80 patients (49.1%, 80/163), and trans-lung in 83 patients (50.9%, 83/163). Diagnostic yield and major adverse event rates of direct and trans-lung puncture biopsies were compared. No difference was found in diagnostic yield between direct puncture and trans-lung biopsies (93.8% vs. 98.8%, p=0.11). Major adverse events were major pneumothorax (n=13/163, 8.0%), pleural dissemination (n=18/163, 11.0%), and hemothorax requiring arterial embolization (n=1/163, 1.0%). Direct puncture caused major pneumothorax significantly less than trans-lung puncture did (0%, 0/80 vs. 15.7%, 13/83, p<0.001). No significant difference was found between the two biopsy methods regarding the incidence of pleural dissemination (11.0%, 11/80 vs. 8.4%, 7/83, p=0.32). Direct puncture biopsy of malignant lung tumors contacting to the pleura is justified.

Percutaneous cryoablation combined with prior transcatheter arterial embolization for renal cell carcinomas of 3cm or larger: a prospective study.

We prospectively evaluated the safety and efficacy of percutaneous cryoablation combined with transcatheter renal arterial embolization for the treatment of tumors ≥ 3cm in diameter. We included patients aged ≥ 20years with histologically proven renal cell carcinoma with a tumor diameter ≥ 3cm who were inoperable or refused surgery. Prior to ablation, transcatheter arterial embolization was performed using a mixture of absolute ethanol and iodized oil. All cryoablation procedures were performed percutaneously under computed tomography fluoroscopy guidance. The primary endpoint was safety, which was evaluated for adverse events using CTCAE version 4.0. The secondary endpoint was survival; overall survival, progression-free survival, and cancer-specific survival were calculated. From October 2013 to March 2016, 19 patients (mean age, 75 ± 13years; 5 women, 14 men) were prospectively enrolled. The mean tumor diameter was 3.9 ± 0.7 (range 3.1-5.3) cm. Four grade 3 hematologic adverse events occurred, while no symptomatic grade ≥ 3 events occurred. The median follow-up period was 68 (range 52-84) months. During the follow-up period, two patients developedlocal tumor progression at 3 and 42months after the initial ablative procedure; no patient showed distant metastasis. Two patients died from causes other than RCC. Overall survival, progression-free survival, and cause-specific survival were 100%, 95%, and 100% at 3years, and 95%, 84%, and 100% at 5years, respectively. Percutaneous cryoablation combined with prior TAE for the treatment of tumors ≥ 3cm in diameter was safe and achieved favorable survival.

CT-Guided Femoral Approach for Psoas Muscle Abscess Drainage.

To evaluate the feasibility and safety of the computed tomography (CT)-guided femoral approach for draining a psoas muscle abscess (PMA). Between January 2014 and November 2018, the CT-guided femoral approach was employed for 9 abscesses in 8 patients who could not tolerate the prone position because of advanced age or other underlying conditions. A 17-gauge blunt metal needle was used to puncture the iliacus muscle below the groin under CT fluoroscopic guidance. A drainage catheter was then placed within the abscess cavity in the psoas major muscle. Technical success, clinical success, complications, the drainage therapy duration, susceptibility to antibiotics, survival, and recurrence were evaluated. The technical success rate was 100% among all nine lesions. The clinical success rate was 89% among all eight patients. One patient died of concomitant meningitis 15days after the procedure. No patients developed therapy-related complications. The median duration of the drainage therapy was 15days (range 6-71days). Appropriate antibiotics based on the culture susceptibility were achieved in all patients. Four patients survived, and the remaining four died at 15 to 758days (median, 36days) after the procedure; no therapy-related deaths occurred. No recurrence was seen. The CT-guided femoral approach seems feasible, effective, and safe for draining psoas muscle abscesses in ill patients who cannot tolerate the prone position.

Oncologic outcomes and safety of percutaneous cryoablation for biopsy-proven renal cell carcinoma up to 4cm in diameter: a prospective observational study.

Percutaneous cryoablation is widely used for the treatment of renal cell carcinoma. We prospectively evaluated the oncologic outcomes and safety of percutaneous cryoablation for the treatment of tumors ≤ 4cm in diameter. We included patients aged ≥ 20years, who had histologically proven renal cell carcinoma, tumor diameter ≤ 4cm, a performance status of ≤ 1, acceptable laboratory parameters, were inoperable or refused to undergo surgery, and had signed a written informed consent. The primary endpoint was the cause-specific survival rate. The secondary endpoints were overall and progression-free survival, and adverse event frequency and grade. All procedures were percutaneously performed under computed tomography fluoroscopy guidance. From October 2013 to October 2015, 33 patients (mean age: 68 ± 14years; sex: six women, 27 men) were enrolled. The mean tumor diameter was 2.1 ± 0.6 (range 1.0-3.4) cm. The median follow-up period was 60.1 (range 18.4-76.6) months. One patient died of non-renal cell carcinoma-related disease 46months after percutaneous cryoablation. The cause-specific and overall survival rates were 100% and 96.8% at 3years, and 100% and 96.8% at 5years, respectively. There was no local tumor progression or distant metastasis. The incidence of severe urological (urinary fistula and perinephric infection) and non-urological adverse events (increased creatine kinase and skin ulceration) was 6% each. Percutaneous cryoablation for renal cell carcinoma ≤ 4cm in diameter achieved good tumor control with a low complication frequency.

Computed tomography-guided biopsy for small renal masses before or immediately after tumor ablation: factors affecting diagnostic yield.

To evaluate the diagnostic yield of percutaneous renal mass biopsy (RMB) before and after ablation. In total, 333 renal masses in 332 consecutive patients underwent computed tomography (CT)-guided biopsies and were included in this study. All biopsies were performed with 18-gauge core needles with CT fluoroscopic guidance before ablation (n = 234) or immediately after radiofrequency ablation (RFA) (n = 40) or cryoablation (CA) (n = 59). The safety and diagnostic yield of RMB were evaluated. Both univariate and multivariate analyses were used to identify factors affecting diagnostic yield. No major complication occurred. The 281 specimens (84%) were diagnostic. There were 257 renal cell carcinomas (77%), 21 benign masses (6%), and 3 metastases (1%). The remaining 52 specimens (16%) were nondiagnostic. The diagnostic yields before ablation, after RFA, and CA were 91% (212/234), 80% (32/40), and 63% (37/59), respectively. Small masses (P = 0.050 and 0.006), cystic masses (P < 0.001 and < 0.001), and post-CA (P < 0.001 and < 0.001) were independent and significant factors affecting the nondiagnostic results in both univariate and multivariate analyses. CT-guided RMB can be nondiagnostic when the tumor is small, cystic, or biopsied immediately after CA.

Robot-Assisted Cortical Bone Trajectory Insertion of Pedicle Screws: 2-Dimensional Operative Video

Robot-assisted pedicle screw insertion has been slowly gaining popularity in the spine surgery community. In previous studies, robotics has been shown to increase accuracy and reduce complication rates compared to other navigation technologies, although those studies have been conducted using traditional trajectories for pedicle screw insertion. We present a surgical video in which a robotics system (Mazor X; Mazor Robotics Ltd, Caesarea, Israel) was used to create cortical bone trajectories for the insertion of the screws. The patient in this case is a 52-yr-old woman with severe L4-5 disc herniation requiring a transforaminal interbody fusion with the insertion of pedicle screws. The robotic system's scan-and-plan technique was utilized, in which an intraoperative computed tomography (CT) scan generates a real-time operative plan. Other techniques for inserting pedicle screws using cortical bone trajectories include CT navigation and fluoroscopic guidance. These techniques allow the surgeon to manually direct the screw under precise guidance in multiple planes, although the surgeon is still using all 6 degrees of freedom the human hand provides. With robotic guidance, a pilot hole is drilled, which eliminates 4 of 6 degrees of freedom, which can potentially reduce the risk of misplaced screws. To our knowledge, this is the first video demonstrating pedicle screw insertion through cortical bone trajectories using robotic guidance. Future studies are warranted to compare cortical bone trajectory insertion using different navigation techniques to determine the long-term efficacy of each technique. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary.

Radiation Exposure Reduction of CT Fluoroscopy in Targeting Celiac Plexus for Neurolysis in Chronic Pain Management

Abstract Background: Conventional CT (Computed Tomography) guided celiac block is the most accurate method for celiac block guidance the lack of real time visualization, radiation exposure & time consuming call the need for real time CT fluoroscopy guidance which provide adequate real time needle localization and radiation exposure reduction to patient and medical staff. Aim of Study: Describe technical ways that the IR (Inter-vention Radiology) team can implement ALARA (As Low As Reasonably Achievable) concept focusing on patient, operator and staff, to reduce the amount of radiation used to conduct the procedure. Patients and Methods: This study was carried out on 30 adult patients suffering from chronic abdominal pain related to infiltrative or metastatic pancreatic cancer or HCC and pain not controlled by WHO analgesic step ladder. Guided with CT fluoroscopy Celiac plexus neurolysis is performed, maximum filling of the retro-pancreatic space with ethanol is an indication of sufficient neurolysis. Applying parameters to reduce radiation exposure dose in pre-procedure helical scanning as well as get use of safety parameters of CT fluoroscopy, the total radiation dose exposure was calculated from the patient dose report. Results: The technique was successfully performed in 30 patients (100%). The mean value of total CT radiation beam intensity used to perform the procedures DLP per celiac plexus was 46.2 mGy X cm. Conclusion: CT fluoroscopy guided celiac plexus block is an easy and safe method that affords excessive success rates, applying ALARA parameters during the CTF procedure markedly decrease the affected person radiation dose in contrast with use of conventional CT guidance.

4:12 PM Abstract No. 40 Transcatheter computed tomography hepatic arteriography compared to conventional computed tomography fluoroscopy guidance in percutaneous thermal ablation to treat colorectal liver metastases: a single-center comparative analysis of two historical cohorts

4:12 PM Abstract No. 40 Transcatheter computed tomography hepatic arteriography compared to conventional computed tomography fluoroscopy guidance in percutaneous thermal ablation to treat colorectal liver metastases: a single-center comparative analysis of two historical cohorts

Fluorescent and Iodized Emulsion for Preoperative Localization of Pulmonary Nodules.

This study was conducted to develop a fluorescent iodized emulsion comprising indocyanine green (ICG) solution and lipiodol (ethiodized oil) and evaluate its feasibility for use in a clinical setting. ICG use for the preoperative localization of pulmonary nodules is limited in terms of penetration depth and diffusion. First, fluorescent microscopy was used to investigate the distribution of ICG-lipiodol emulsions prepared using different methods. The emulsions were injected in 15 lung lobes of 3 rabbits under computed tomography fluoroscopy guidance; evaluation with imaging and radiography was conducted after thoracotomy. Subsequently, the emulsions were used to preoperatively localize 29 pulmonary nodules in 24 human subjects, and wedge resections were performed using fluorescent imaging and C-arm fluoroscopy. The optimal emulsion of 10% ICG and 90% lipiodol mixed through 90 passages had even distribution and the highest signal intensity under fluorescent microscopy; it also had the best consistency in the rabbit lungs, which persisted for 24 hours at the injection site. In human subjects, the mean diameter of pulmonary nodules was 0.9 ± 0.4 cm, and depth from the pleura was 1.2 ± 0.8 cm. All emulsion types injected were well localized around the target nodules without any side effects or procedure-related complications. Wedge resection with minimally invasive approach was successful in all pulmonary nodules with a free resection margin. A fluorescent iodized emulsion prepared by mixing ICG with lipiodol enabled accurate localization and resection of pulmonary nodules.

Radiation Dose Exposure for Lumbar Transforaminal Epidural Steroid Injections and Facet Joint Blocks Under CT vs. Fluoroscopic Guidance.

Transforaminal epidural steroid injections (TFESIs) and facet joint blocks can be performed under fluoroscopy or computed tomography (CT) guidance. The purpose of this retrospective cohort study was to compare patient radiation dose for lumbar TFESIs and facet joint blocks under CT guidance vs. fluoroscopic guidance. The primary outcome of this retrospective cohort study was the difference between the estimated effective dose (ED) of CT guidance and fluoroscopic guidance for TFESIs and facet joint blocks. Patients who had undergone these procedures with both CT and fluoroscopic guidance were eligible for this study. Dose-length product for CT-guided procedures and dose-area product for fluoroscopic-guided procedures were retrospectively collected and converted to ED. Within- or between-group comparisons were performed with appropriate nonparametric tests, using a P value of < 0.05 to indicate statistical significance. The 42 patients included in this study underwent a total of 100 procedures. The median estimated ED differed significantly between CT-guided injections and fluoroscopic-guided injections (1.59 mSv (interquartile range [IQR] 0.78 to 3.09) vs. 0.19 mSv (IQR 0.11 to 0.30) (Wilcoxon signed rank test, P < 0.001). The study results suggest that TFESIs and facet joint blocks performed with CT guidance are associated with more than 8 times higher patient radiation dose exposure compared to fluoroscopic guidance. There needs to be more vigilance with regards to CT guidance in interventional pain procedures.

Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

Rationale:The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN).Patient concerns:A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever.Diagnoses:BPF with subsequent pneumonia and empyema.Interventions:Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN.Outcomes:The air leaks greatly decreased and the patient was discharged.Lessons:CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.

Real-time computed tomography fluoroscopy-guided solitary lung tumor model in a rabbit.

Preclinical studies of lung cancer require suitable large-animal models to allow evaluation and development of surgical and interventional techniques. We assessed the feasibility and safety of a novel rabbit lung cancer model of solitary tumors, in which real-time computed tomography fluoroscopy is used to guide inoculation of VX2 carcinoma single-cell suspensions. Thirty-eight rabbits were divided into four groups according to the volume of the VX2 tissue or cell suspension, the volume of lipiodol, the volume of Matrigel, and the injection needle size. The mixtures were percutaneously injected into rabbit lungs under real-time computed tomography fluoroscopy guidance. Two weeks later, VX2 lung carcinomas were confirmed via positron emission tomography/computed tomography, necropsy, and histology. Real-time computed tomography fluoroscopy allowed the precise inoculation of the tumor cell suspensions containing lipiodol, while the use of Matrigel and a small needle prevented leakage of the suspensions into the lung parenchyma. Solitary lung tumors were successfully established in rabbits (n = 22) inoculated with single-cell suspensions (150 μL), lipiodol (150 μL), and Matrigel (150 μL) using a 26-gauge needle. This combination was determined to be optimal. Pneumothorax was observed in only two of the 38 rabbits (5.3%), both of which survived to the end of the study without any intervention. Real-time computed tomography fluoroscopy-guided inoculation of VX2 single-cell suspensions with lipiodol and Matrigel using a small needle is an easy and safe method to establish solitary lung tumors in rabbits.

Robotically Driven CT-guided Needle Insertion: Preliminary Results in Phantom and Animal Experiments.

Purpose To evaluate the accuracy of the remote-controlled robotic computed tomography (CT)-guided needle insertion in phantom and animal experiments. Materials and Methods In a phantom experiment, 18 robotic and manual insertions each were performed with 19-gauge needles by using CT fluoroscopic guidance for the evaluation of the equivalence of accuracy of insertion between the two groups with a 1.0-mm margin. Needle insertion time, CT fluoroscopy time, and radiation exposure were compared by using the Student t test. The animal experiments were approved by the institutional animal care and use committee. In the animal experiment, five robotic insertions each were attempted toward targets in the liver, kidneys, lungs, and hip muscle of three swine by using 19-gauge or 17-gauge needles and by using conventional CT guidance. The feasibility, safety, and accuracy of robotic insertion were evaluated. Results The mean accuracies of robotic and manual insertion in phantoms were 1.6 and 1.4 mm, respectively. The 95% confidence interval of the mean difference was -0.3 to 0.6 mm. There were no significant differences in needle insertion time, CT fluoroscopy time, or radiation exposure to the phantom between the two methods. Effective dose to the physician during robotic insertion was always 0 μSv, while that during manual insertion was 5.7 μSv on average (P < .001). Robotic insertion was feasible in the animals, with an overall mean accuracy of 3.2 mm and three minor procedure-related complications. Conclusion Robotic insertion exhibited equivalent accuracy as manual insertion in phantoms, without radiation exposure to the physician. It was also found to be accurate in an in vivo procedure in animals. © RSNA, 2017 Online supplemental material is available for this article.

Validation of a CT-guided intervention robot for biopsy and radiofrequency ablation: experimental study with an abdominal phantom.

We aimed to evaluate the accuracy of a needle-placement robot for biopsy and radiofrequency ablation on an abdominal phantom. A master-slave robotic system has been developed that includes a needle-path planning system and a needle-inserting robot arm with computed tomography (CT) and CT fluoroscopy guidance. For evaluation of its accuracy in needle placement, a commercially available abdominal phantom (Model 057A; CIRS Inc.) was used. The liver part of the phantom contains multiple spherical simulated tumors of three different size spheres. Various needle insertion trials were performed in the transverse plane and caudocranial plane two nodule sizes (10 mm and 20 mm in diameter) to test the reliability of this robot. To assess accuracy, a CT scan was performed after each trial with the needle in situ. The overall error was 2 mm (0-2.6 mm), which was calculated as the distance from the planned trajectory before insertion to the actual needle trajectory after insertion. The standard deviations of the insertions on two nodules (10 mm and 20 mm in diameter) were 0.5 mm and 0.2 mm, respectively. The CT-compatible needle placement robot for biopsy and radiofrequency ablation shows relatively acceptable accuracy and could be used for radiofrequency ablation of nodules ≥10 mm under CT fluoroscopy guidance.

PUB024 Real-Time Computed Tomography Fluoroscopy Guidance in a Rabbit Model of Solitary Lung Cancer

We evaluate the feasibility and safety of a newly developed solitary lung cancer rabbit model that utilizes real-time computed tomography (CT) fluoroscopy-guided inoculation of VX2 single cell suspensions. Thirty-eight rabbits were divided into four groups according to number of VX2 carcinoma cells, Lipiodol amount, Matrigel amount, and injection needle size. The different VX2 tumor cell suspensions were percutaneously injected into rabbits under real-time CT fluoroscopy guidance. Two weeks later, VX2 lung cancers were confirmed by positron emission tomography/CT, necropsy, and histology. Real-time CT fluoroscopy allowed the precise inoculation of tumor cell suspensions containing Lipiodol. Use of Matrigel and a small-sized needle reduced spreading and leakage of tumor cell suspensions in the lung parenchyma. Solitary lung cancers were successfully established in all rabbits in group 4 (22/22, 100%); these rabbits were inoculated with 150 μl VX2 tumor cells filtered through a 100 μm cell strainer, 100 μl Lipiodol, and 150 μl Matrigel, using 26-gauge needles. Pneumothorax was observed in only 2 of 38 rabbits (5.3%).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Real-time CT fluoroscopy-guided inoculation of the appropriate composition of a VX2 tumor cell suspension using a small sized needle is an easy and safe method to model solitary lung cancer in rabbits.

Percutaneous drainage of psoas and iliopsoas muscle abscesses with a one-step technique under real-time computed tomography fluoroscopic guidance.

To evaluate the utility and safety of drainage catheter installation for psoas/iliopsoas muscle abscesses using a one-step technique under the guidance of real-time computed tomography (CT) fluoroscopy. Ten psoas or iliopsoas muscle abscesses in 7 patients that were treated with percutaneous drainage were included in this study. All drainage procedures were carried out using a one-step technique under real-time CT fluoroscopic guidance. The drainage catheter insertion was performed successfully with the one-step technique in all lesions. Improvements in the patients' symptoms and blood test results were seen after the drainage procedure in all cases. In addition, postoperative CT scans demonstrated that the abscesses had reduced in size or disappeared in all but one patient, who was transferred to another institution while the drainage catheter was still in place. No major complications were seen in any case. The one-step procedure is simple to perform. The percutaneous drainage of psoas or iliopsoas muscle abscesses with the one-step technique under real-time CT fluoroscopic guidance is accurate and safe. Moreover, compared with the two-step technique the one-step procedure results in a shorter drainage procedure and exposes the patient and operator to lower amounts of radiation. J. Med. Invest. 63: 323-327, August, 2016.

Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

A technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose. Our Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20-76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose. All injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58-8.00 min) and 0.11 millisievert (mSv; range 0.07-0.24 mSv); and bilateral, 6.72 min (range 4.17-21.17 min) and 0.11 mSv (range 0.09-0.51 mSv). Given the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

Adverse effects of irreversible electroporation of malignant liver tumors under CT fluoroscopic guidance: a single-center experience

We aimed to describe the frequency of adverse events after computed tomography (CT) fluoroscopy-guided irreversible electroporation (IRE) of malignant hepatic tumors and their risk factors. We retrospectively analyzed 85 IRE ablation procedures of 114 malignant liver tumors (52 primary and 62 secondary) not suitable for resection or thermal ablation in 56 patients (42 men and 14 women; median age, 61 years) with regard to mortality and treatment-related complications. Complications were evaluated according to the standardized grading system of the Society of Interventional Radiology. Factors influencing the occurrence of major and minor complications were investigated. No IRE-related death occurred. Major complications occurred in 7.1% of IRE procedures (6/85), while minor complications occurred in 18.8% (16/85). The most frequent major complication was postablative abscess (4.7%, 4/85) which affected patients with bilioenteric anastomosis significantly more often than patients without this condition (43% vs. 1.3%, P = 0.010). Bilioenteric anastomosis was additionally identified as a risk factor for major complications in general (P = 0.002). Minor complications mainly consisted of hemorrhage and portal vein branch thrombosis. The current study suggests that CT fluoroscopy-guided IRE ablation of malignant liver tumors may be a relatively low-risk procedure. However, patients with bilioenteric anastomosis seem to have an increased risk of postablative abscess formation.

Percutaneous cryoablation of renal masses under CT fluoroscopy: radiation doses to the patient and interventionalist.

Computed tomographic (CT) fluoroscopy-guided percutaneous cryoablation is an effective therapeutic method used to treat focal renal masses. The purpose of this study is to quantify the radiation dose to the patient and interventional radiologist during percutaneous cryoablation of renal masses using CT fluoroscopic guidance. Over a 1-year period, the CT fluoroscopy time during percutaneous cryoablation of renal masses was recorded in 41 patients. The level of complexity of each procedure was designated as simple, intermediate, or complex. Patient organ radiation doses were estimated using an anthropomorphic model. Dose to the interventional radiologist was estimated using ion chamber survey meters. The average CT fluoroscopy time for technically simple cases was 47s, 126s for intermediate cases, and 264s for complex cases. The relative risk of hematologic stomach and liver malignancy in patients undergoing this procedure was 1.003-1.074. The lifetime attributable risk of cancer ranged from 2 to 58, with the highest risk in younger patients for developing leukemia. The estimated radiation dose to the interventionalist without lead shielding was 390mR (3.9mGy) per year of cases. The radiation risk to the patient during CT fluoroscopy-guided percutaneous renal mass cryoablation is, as expected, related to procedure complexity. Quantification of patient organ radiation dose was estimated using an anthropomorphic model. This information, along with the associated relative risk of malignancy, may assist in evaluating risks of the procedure, particularly in younger patients. The radiation dose to the interventionist is low regardless of procedure complexity, but highlights the importance of lead shielding.