Role Of Image Guidance Research Articles

Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)\u2014part V, knee

ObjectivesInterventional procedures around the knee are widely adopted for treating different musculoskeletal conditions. A panel of experts from the Ultrasound and Interventional Subcommittees of the European Society of Musculoskeletal Radiology (ESSR) reviewed the existing literature to assess the evidence on image-guided musculoskeletal interventional procedures around the knee, with the goal of highlighting some controversies associated with these procedures, specifically the role of imaging guidance, as well as the efficacy of the medications routinely injected.MethodsWe report the results of a Delphi-based consensus of 53 experts in musculoskeletal radiology, who reviewed the published literature for evidence on image-guided interventional procedures around the knee to derive a list of pertinent clinical indications.ResultsA list of 10 statements about clinical indications of image-guided procedures around the knee was created by a Delphi-based consensus. Only two of them had the highest level of evidence; all of them received 100% consensus.ConclusionsUltrasonography guidance is strongly recommended for intra-articular and patellar tendinopathy procedures to ensure the precision and efficacy of these treatments. Prospective randomized studies remain warranted to better understand the role of imaging guidance and assess some of the medications used for interventional procedures around the knee.Key Points• A list of 10 evidence-based statements on clinical indications of image-guided interventional procedures around the knee was produced by an expert panel of the ESSR.• Strong consensus with 100% agreement was obtained for all statements.• Two statements reached the highest level of evidence, allowing us to strongly recommend the use of ultrasonography to guide intra-articular and patellar tendon procedures to ensure higher accuracy and efficacy of these treatments.

Endoscopic Third Ventriculostomy: Role of Image Guidance in Reducing the Complications.

Introduction:Endoscopic third ventriculostomy (ETV) is performed by neurosurgeons around the world for the management of hydrocephalus. ETV has been associated with multiple complications, the most significant being iatrogenic injury to the fornix. We aim to establish the fact that the use of image guidance while planning a trajectory can reduce the incidence of complications as it significantly alters the usual approach for ETV, i.e., the coronal burr hole can be useful for young neurosurgeons to overcome the learning curve associated with the procedure.Materials and Methods:This is a prospective, observational study conducted at Liaquat National Hospital. In this study, 43 patients were included who underwent ETV for hydrocephalus. Complications were divided into three major groups: arterial hemorrhage, venous hemorrhage, and injury to neural structures (fornix, hypothalamus, and oculomotor nerve). The data were compared with studies showing the complications of ETV with and without usage of image guidance.Results:Among the 43 patients who underwent ETV with image guidance, only two patients (4.65%) had iatrogenic fornix contusions. Neither of them developed memory impairment. None of the patients (0%) encountered other major iatrogenic complications, including injury to the mammillary body, basilar artery, or oculomotor nerve.Conclusion:The use of image guidance can reduce trajectory-related complications, including hemorrhage and iatrogenic injuries to the fornix. This study showed that the altered trajectory was beneficial in avoiding major neurological structures while introducing an endoscope through the cortex into the ventricular system.

What makes CT guided radiofrequency ablation for osteoid osteoma superior to open surgery in terms of pain control and patient’s quality of life?

PurposeTo demonstrate our experience in percutaneous radiofrequency ablation (RFA) as a minimally invasive therapy for patients with osteoid osteoma. Patients and methodsWe will highlight cases of osteoid osteoma treated by minimally invasive therapy (RFA) and the role of image guidance in making the procedure rapid outpatient service instead of hospitalization and morbidity of open surgery. This will include 15 patients (10 males & 5-females) aged 12–35years, (mean 20), their clinical and radiological diagnosis was osteoid osteoma. All patients were treated by CT guided percutaneous RFA under spinal and epidural anesthesia. Results14 (93.3%) of the 15-patients had prompt improvement of clinical symptoms and pain relief, one patient underwent second session of re-ablation. The mean follow-up period was 12months and no patient had pain recurrence. ConclusionPercutaneous RFA is a safe and effective minimally invasive outpatient treatment for osteoid osteoma with low cost, low morbidity, better quality of life when compared with open surgery.

Abstract

Rapid developments in imaging and radiation-delivery technology have fueled the application of small photon beams in stereotactic radiation therapy (SRT). Historically, stereotaxy referred to the use of a three-dimensional coordinate system to localize intracranial targets and has been more recently extensively developed in extracranial clinical situations. SRT involves stereotactic localization techniques combined with the delivery of multiple small photon fields in a few high-dose fractions. In SRT, the therapeutic ratio is optimized through delivery of highly conformal absorbed dose distributions with steep dose fall-off ensuring optimal absorbed dose in the target volume combined with minimal normal-tissue irradiation. Consistent with previous ICRU Reports 50 (ICRU, 1993), 62, (ICRU, 1999), and 83, (ICRU, 2010), this Report recommends a strict definition of target volumes (GTV, CTV) by reviewing imaging modalities used in clinical practice. This Report covers fundamentals of small-field dosimetry, treatment-planning algorithms, commissioning, and quality assurance for the existing delivery systems, as well as the role of image guidance during delivery. Finally, it recommends a framework for prescribing, recording, and reporting stereotactic radiotherapy, and covers most of the pathologies eligible for stereotactic delivery (malignant and non-malignant).

WE-F-BRCD-01: Transitioning from 3D IMRT to 4D IMRT and Role of Image Guidance.

Tumors often change shape and position over the course of Radiation Therapy. The adaptation of the treatment to these changes, or its initial design to be robust in light of these changes, can be referred to as 4D radiation therapy. The 4th dimension is time and includes short term (intrafraction) and longer term (inter-fraction) changes. IMRT is an important modality for designing plans that can be optimized for or can adapt to these changes. The combination of management of the tumor changes and the optimization of the radiotherapy plans to deal with these changes is 4DIMRT and will be the focus of this 2 part talk. Part 1 : Head and Neck and Prostate treatments, focusing on adaptive therapy and image guidance. Part 2: Thoracic treatments focusing on 4DCT, IGRT, IMRT in the lung and motion management strategies Learning Objectives: 1. Understand currently available IGRT and 4DCT technologies 2. Explain how these technologies can be used to improve dose delivery precision and accuracy, in particular with dynamically changing tumor volumes 3. Understand the challenges and strategies in clinical implementation of IMRT in head and neck, prostate, and thorax.

The Role of Image Guidance in Improving the Safety of Pain Treatment

The use of fluoroscopy, computed tomography, and, most recently, ultrasound in the pain clinic all have advanced rapidly, yet there is scant evidence that this improves the safety or efficacy of pain treatment. In this manuscript, the available evidence about the usefulness of diagnostic imaging and image guidance in planning and delivering pain treatment is critically reviewed. The use of image guidance has become a routine and integral component of pain treatment; however, there is insufficient scientific evidence to judge whether this has improved safety. The logical appeal is overwhelming, to the point that it is now unlikely that scientific comparisons of most techniques with and without radiographic guidance will ever be conducted. This analysis can serve to guide future investigators who set out to understand how to apply new imaging techniques, and in the process, how to rigorously evaluate their usefulness.

Re-evaluation of the role of image guidance in minimally invasive pituitary surgery: benefits and outcomes

Objective: To evaluate the utility of performing endonasal transsphenoidal pituitary surgery with computer-based neuronavigation, and to examine the efficacy of computer-based neuronavigation compared to fluoroscopy.Patients: We conducted a retrospective review of patients who underwent pituitary surgery between September 1998 and September 2008. Of 120 consecutive patients, 70 met inclusion criteria and were fully examined. The inclusion criteria were that patients had undergone endonasal transsphenoidal pituitary surgery performed by the same neurosurgeon at the same institution. Nineteen of the patients were treated using intraoperative fluoroscopy and 48 were treated using the BrainLAB VectorVision neuronavigation system. Preparation times, surgical times and associated complications were analyzed.Results: Our results indicate that image guidance reduces the overall operating room time and complication rate. Average preparation time for fluoroscopy and computer-based neuronavigation was 70.3 and 67.3 min, respectively (p = 0.3299). Average surgical time with fluoroscopy and BrainLAB was 131 and 107.9 min, respectively (p = 0.0079). The results were also analyzed with regard to other parameters such as associated complications, age and diagnoses.Conclusion: Computer guided endoscopic endonasal transsphenoidal surgery provides a three-dimensional image to the surgeon, allowing for greater visual accuracy and surgical precision and a faster procedure without radiation exposure or the need for additional personnel.

Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance

The rapid expansion of less invasive surgical and transcatheter cardiovascular procedures for a wide range of cardiovascular conditions, including coronary, valvular, structural cardiac, and aortic disease has been paralleled by novel three-dimensional (3-D) approaches to imaging. Three-dimensional imaging allows acquisition of volumetric data sets and subsequent off-line reconstructions along unlimited 2-D planes and 3-D volumes. Pre-procedural 3-D imaging provides detailed understanding of the operative field for surgical/interventional planning. Integration of imaging modalities during the procedure allows real-time guidance. Because computed tomography routinely acquires 3-D data sets, it has been one of the early imaging modalities applied in the context of surgical and interventional planning. This review describes the continuum of applications from pre-operative planning to procedural integration, based on the emerging experience with computed tomography and rotational angiography, respectively. At the same time, the potential adverse effects of imaging with X-ray-based tomographic or angiographic modalities are discussed. It is emphasized that the role of imaging guidance in this context remains unclear and will need to be evaluated in clinical trials. This is in particular true, because data showing improved outcome or even non-inferiority for most of the emerging transcatheter procedures are still lacking.

S34. The role of image guidance in surgical resection of oral cancer

S34. The role of image guidance in surgical resection of oral cancer

The role of image guidance in respiratory gated radiotherapy

Respiratory gating for radiotherapy beam delivery is a widely available technique, manufactured and sold by most of the major radiotherapy machine vendors. Respiratory gated beam delivery is intended to limit the irradiation of tumours moving with respiration to selected parts of the respiratory cycle, and thereby enable dose escalation and/or reduction of dose to organs at risk.Without adequate use of respiratory correlated image guidance on a regular basis, respiratory beam gating may however have a detrimental effect on target coverage. Image guidance of tumour respiratory motion is therefore of utmost importance for the safe introduction of respiratory gating.In this short overview, suitable image guidance strategies for respiratory gated radiotherapy are reviewed for two cancer sites; breast cancer and lung tumours.

Robotics in pediatric surgery: perspectives for imaging.

Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance.

Endoscopic repair of choanal atresia: Role of image guidance

Endoscopic repair of choanal atresia: Role of image guidance