CT fluoroscopy

Visual monitoring Endoscope Eye observation Limited (CT fluoroscopy)... 

Loser, M.H., Navab, N. A new robotic system for visually controlled percutaneous interventions under ct fluoroscopy. In Medical Image Computing and Computer-Assisted Intervention (MICCAI), Pittsburgh, USA, pp. 887-896, October 11-14 2000... 

Sheafor DH, Paulson EK, Kliewer MA et al (2000) Comparison of sonographic and CT guidance techniques. Does CT fluoroscopy decrease procedure time AJR 174 939-942... 

Robot for percutaneous vertebroplasty (Onogi et al. 2005) Graduate School of Frontier Sciences, The University of Tokyo (Tokyo, Japan) Phantom experiments CT, fluoroscopy... 

Fig. 28.6. The AcuBot robot system, used for needle placement in respiratory lung phantom during CT-fluoroscopy...

Nawfel RD, Judy PF, Silverman SG, Hooton S, Tuncali K, Adams DF (2000) Patient and personnel exposure during CT fluoroscopy-guided interventional procedures. Radiology 216 180-184... 

Satava RM (2003) Robotic surgery from past to future - a personal journey. Surg Clin North Am 83 1491-1500, xii Silverman SG, Tuncali K, Adams DF, Nawfel RD, Zou KH, Judy PE (1999) CT fluoroscopy-guided abdominal interventions techniques, results, and radiation exposure. Radiology 212 673-681... 

Froelich JJ, Wagner H-J, Ishaque N, et al. (2000) Comparison of C-arm CT fluoroscopy and conventional fluoroscopy for percutaneous biliary drainage procedures. J Vase Intervent Radiol 11 477-482... 

Fig. 37.11a,b. Patient with chronic cholecystitis who developed a hepatic abscess adjacent to the gallbladder. An 8-French drainage catheter was directly inserted from an anterior approach under CT fluoroscopy (a, b). Elective surgery of the abscess after repeated drainage procedures revealed a perforated gallbladder maintaining the inflammatory process... 

Fig. 37.13a,b. Patient (prone position) with a fever showing a presacral fluid collection 10 days after abdominoperineal rectum resection (a). An 8-French drainage catheter was inserted using the Seldinger technique, b Guide wire being introduced through an 18-G sheath under CT fluoroscopy... 

Carlson 8K etal. (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219 515-520... 

Daly B, Templeton PA (1999) Real-time CT fluoroscopy evolution of an interventional tool. Radiology 211 309-3015 Elvin A et al. (1990) Biopsy of the pancreas with a biopsy gun. Radiology 176 677 79... 

Silverman SG etal. (1999) CT fluoroscopy-guided abdominal interventions techniques, results, and radiation exposure. Radiology 212 673-681... 

Percutaneous vertebroplasty (PV) is a safe and efficient therapeutic option for patients suffering from otherwise untreatable pain and disability caused by osteoporotic fracture or tumoral involvement of a vertebra. Vertebroplasty provides nearly immediate pain relief and stabilization, leading to a high rate of successful treatments with low morbidity, no or only short hospitalization, and rare adverse events. In addition, PV contributes to spinal stabilization and can be successfully combined with chemotherapy, radiation therapy, tumor ablation, and posterior laminectomy. Therefore, the number of procedures performed has continuously increased over the last few yccus. However, indications and contraindications, technical aspects, and possible complications of PV always have to be taken into account by the interventional radiologist. The success rate strongly depends - besides on the experience of the physician performing the procedure - on the visualization equipment used, such as CT fluoroscopy. 

The PV can be performed either using biplane fluoroscopy guidance, dual guidance including CT and fluoroscopy, or CT-fluoroscopy alone. 

Fig. 38.3. A 64-year-old female patient with two painful osteolytic metastases affecting the 12th thoracic vertebra (displayed) and the 3rd lumbar vertebra. Needle placement using online CT-fluoroscopy guidance is demonstrated. The tip of the needle is positioned within the center of the osteolytic metastasis (arrow)...

The injection of cement is observed under continuous lateral fluoroscopic or online CT-fluoroscopy control to allow for instant detection of leakage (Fig. 38.4). If a leakage is detected, it is very important to stop the procedure, reverse the pressure, and wait for up to 60 s. This time allows the cement to harden and probably seal the leak. If the leak then persists, the needle either has to be repositioned or the bevel direction should be modified. In cases in which these measures are not effective, the procedure should be abandoned. To complete the filling of the affected vertebral body, the contralateral approach could be used. In order the avoid cement leakage through the puncture canal, the initial needle should remain in place. 

Fig. 38.4. Injection of cement observed by online CT-fluoroscopy, which allows instant detection of leakage. The whole vertebral body can be covered easily by stepwise movement of the table using a joystick mounted to the CT table...

First, 10 ml of 0.5% mepivacaine (Scandicain) is injected for local anesthesia. The one-step system applicator is advanced under CT fluoroscopy (Care vision, Siemens, Erlangen) directly in the planned route. CT fluoroscopy facilitates near real-time control of the applicator position and its relationship to the vital structures. After verified intratumoral positioning of the system, the inner mandrin is removed and a thermostable catheter is introduced. The flexible laser fiber (Medilas Dornier, Sunnydale, Calif., USA) is then inserted within (Vogl et al. 2004a). 

CT fluoroscopy control is regarded as ideal. With adequate technology, the radiation exposure for patients and the treating physician is unproblematic. The control by sonography and X-ray fluoroscopy would be feasible, in principle, with some lesions however, at present they are practically not used (Diederich and Hosten 2004). 

CT guidance affords the best available visualization of needle and probe placement in the lesion nidus. Helical CT with low-dose and CT fluoroscopy makes for a quicker procedure and a lower patient dose (Silverman et al. 1999 Teeuwisse et al. 2001). Lesion size and the configuration of the thermal lesion in particular can he controlled directly during the procedure. Therapy strategy can he adjusted hy the operator during the procedure and provides an effective thermal ablation and therapy result. However, the complication rate is reduced... 

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