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Sample records for tomography guided needle

  1. Computed tomography - guided cutting needle biopsy of pulmonary lesions

    International Nuclear Information System (INIS)

    Liao Shin Yu; Deheinzelin, Daniel; Younes, Riad N.; Chojniak, Rubens

    2002-01-01

    The purpose of this study was to report the experience of a radiology department in the use of computed tomography-guided cutting needle biopsy of pulmonary nodules, by evaluating diagnostic yield and incidence of complications. This is a retrospective analysis of 52 consecutive patients who underwent lung lesion biopsy guided by computed tomography, performed between May 1997 and May 2000. Thirty-five patients were male and 17 were female, with ages ranging from 5 to 85 years (median, 62 years). The size of the lesions ranged from 1.8 to 15 cm (median, 5.4 cm). In a total of 52 biopsies of lung lesions, 51 biopsies (98.1%) supplied appropriate material for histopathological diagnosis, with 9 diagnosed (17.3%) as benign and 42 (80.8%) as malignant lesions. Specific diagnosis was obtained in 44 (84.6%) biopsies: 4 benign (9.1%) and 40 (90.9%) malignant lesions. The sensitivity, specificity, and accuracy of the cutting needle biopsies for determining presence of malignancy were 96.8%, 100%, and 97.2%, respectively. Complications occurred in 9 cases (17.3%), including 6 cases (11.5%) of small pneumothorax, 1 (1.9%) of hemoptysis, 1 (1.9%) of pulmonary hematoma, and 1 (1.9%) of thoracic wall hematoma. All had spontaneous resolution. There were no complications requiring subsequent intervention. The high sensitivity and specificity of the method and the low rate of complications have established cutting needle biopsy as an efficient and safe tool for the diagnosis of lung lesions. In our hospital, cutting needle biopsy is considered a reliable procedure for the evaluation of indeterminate pulmonary nodules. (author)

  2. Computed tomography guided needle biopsy: experience from 1,300 procedures

    Energy Technology Data Exchange (ETDEWEB)

    Chojniak, Rubens; Isberner, Rony Klaus; Viana, Luciana Marinho; Yu, Liao Shin; Aita, Alessandro Amorim; Soares, Fernando Augusto [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Radiologia e Patologia

    2006-01-15

    Context and objective: computed tomography (CT) guided biopsy is widely accepted as effective and safe for diagnosis in many settings. Accuracy depends on target organ and needle type. Cutting needles present advantages over fine needles. This study presents experience from CT guided biopsies performed at an oncology center. Design and setting: retrospective study at Hospital do Cancer A. C. Camargo, Sao Paulo.Methods: 1,300 consecutive CT guided biopsies performed between July 1994 and February 2000 were analyzed. Nodules or masses were suspected as primary malignancy in 845 cases (65%) or metastatic lesion in 455 (35%). 628 lesions were thoracic, 281 abdominal, 208 retroperitoneal, 134 musculoskeletal and 49 head/neck. All biopsies were performed by one radiologist or under his supervision: 765 (59%) with 22-gauge fine-needle/aspiration technique and 535 (41%) with automated 16 or 18-gauge cutting-needle biopsy. Results: adequate samples were obtained in 70-92% of fine-needle and 93-100% of cutting-needle biopsies. The specific diagnosis rates were 54-67% for fine-needle and 82-100% for cutting-needle biopsies, according to biopsy site. For any site, sample adequacy and specific diagnosis rate were always better for cutting-needle biopsy. Among 530 lung biopsies, there were 84 pneumothorax (16%) and two hemothorax (0.3%) cases, with thoracic drainage in 24 (4.9%). Among abdominal and retroperitoneal biopsies, there were two cases of major bleeding and one of peritonitis. Conclusion: both types of needle showed satisfactory results, but cutting-needle biopsy should be used when specific diagnosis is desired without greater incidence of complications. (author)

  3. Computed tomography-guided percutaneous core needle biopsy of deep seated bone lesions in two dogs

    International Nuclear Information System (INIS)

    Mori, T.; Sakaida, M.; Yamada, M.; Akiyama, H.; Takai, Y.; Sakai, H.; Maruo, K.

    2006-01-01

    Computed Tomography (CT)-guided percutaneous core needle biopsies were undertaken for the diagnosis of osteosarcoma in the pelvis (case 1) and myeloma (case 2) in the seventh lumber vertebra which were difficult to targeted by palpation, ultrasound or fluoroscopy. In both cases, enough tissue for pathological diagnosis were obtained without any complication. CT-guided biopsy was thought to be a safe, easy and effective technique for the evaluation of the deep seated bone lesion

  4. Computed tomography-guided core-needle biopsy of lung lesions: an oncology center experience

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Marcos Duarte; Fonte, Alexandre Calabria da; Chojniak, Rubens, E-mail: marcosduarte@yahoo.com.b [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Radiology and Imaging Diagnosis; Andrade, Marcony Queiroz de [Hospital Alianca, Salvador, BA (Brazil); Gross, Jefferson Luiz [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Chest Surgery

    2011-03-15

    Objective: The present study is aimed at describing the experience of an oncology center with computed tomography guided core-needle biopsy of pulmonary lesions. Materials and Methods: Retrospective analysis of 97 computed tomography-guided core-needle biopsy of pulmonary lesions performed in the period between 1996 and 2004 in a Brazilian reference oncology center (Hospital do Cancer - A.C. Camargo). Information regarding material appropriateness and the specific diagnoses were collected and analyzed. Results: Among 97 lung biopsies, 94 (96.9%) supplied appropriate specimens for histological analyses, with 71 (73.2%) cases being diagnosed as malignant lesions and 23 (23.7%) diagnosed as benign lesions. Specimens were inappropriate for analysis in three cases. The frequency of specific diagnosis was 83 (85.6%) cases, with high rates for both malignant lesions with 63 (88.7%) cases and benign lesions with 20 (86.7%). As regards complications, a total of 12 cases were observed as follows: 7 (7.2%) cases of hematoma, 3 (3.1%) cases of pneumothorax and 2 (2.1%) cases of hemoptysis. Conclusion: Computed tomography-guided core needle biopsy of lung lesions demonstrated high rates of material appropriateness and diagnostic specificity, and low rates of complications in the present study. (author)

  5. C-arm cone beam computed tomography needle path overlay for fluoroscopic guided vertebroplasty.

    Science.gov (United States)

    Tam, Alda L; Mohamed, Ashraf; Pfister, Marcus; Chinndurai, Ponraj; Rohm, Esther; Hall, Andrew F; Wallace, Michael J

    2010-05-01

    Retrospective review. To report our early clinical experience using C-arm cone beam computed tomography (C-arm CBCT) with fluoroscopic overlay for needle guidance during vertebroplasty. C-arm CBCT is advanced three-dimensional (3-D) imaging technology that is currently available on state-of-the-art flat panel based angiography systems. The imaging information provided by C-arm CBCT allows for the acquisition and reconstruction of "CT-like" images in flat panel based angiography/interventional suites. As part of the evolution of this technology, enhancements allowing the overlay of cross-sectional imaging information can now be integrated with real time fluoroscopy. We report our early clinical experience with C-arm CBCT with fluoroscopic overlay for needle guidance during vertebroplasty. This is a retrospective review of 10 consecutive oncology patients who underwent vertebroplasty of 13 vertebral levels using C-arm CBCT with fluoroscopic overlay for needle guidance from November 2007 to December 2008. Procedural data including vertebral level, approach (transpedicular vs. extrapedicular), access (bilateral vs. unilateral) and complications were recorded. Technical success with the overlay technology was assessed based on accuracy which consisted of 4 measured parameters: distance from target to needle tip, distance from planned path to needle tip, distance from midline to needle tip, and distance from the anterior 1/3 of the vertebral body to needle tip. Success within each parameter required that the distance between the needle tip and parameter being evaluated be no more than 5 mm on multiplanar CBCT or fluoroscopy. Imaging data for 12 vertebral levels was available for review. All vertebral levels were treated using unilateral access and 9 levels were treated with an extrapedicular approach. Technical success rates were 92% for both distance from planned path and distance from midline to final needle tip, 100% when distance from needle tip to the anterior 1

  6. Computed tomography-guided needle biopsy of lung lesions in fourteen cats and dogs

    International Nuclear Information System (INIS)

    Yoshida, K.; Mori, T.; Yamada, M.; Sakaida, M.; Yonemaru, K.; Murakami, M.; Sakai, H.; Maruo, K.

    2007-01-01

    Computed tomography (CT)-guided fine-needle aspirates (FNA) or core biopsies of lung lesions were performed in nine dogs and five cats. A clinical diagnosis was obtained in twelve of fourteen animals (85%), namely 80% FNA and 100% core biopsies. Eight animals had other mass (es) apart from the lung, and five were diagnosed to metastases. In only one case, the lung mass was histopathologically diagnosed as a malignant primary tumor. Iatrogenic complications through the lung biopsies were noted in four animals, and three showed mild pneumothorax on CT images and one was bleeding from the needle. However, between fifteen and thirty minutes after the biopsy, no animal indicated signs of pneumothorax or hemorrhage

  7. Uncommon primary tumors of the orbit diagnosed by computed tomography-guided core needle biopsy: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang Jeng; Matushita Junior, Joao Paulo Kawaoka; Bitencourt, Almir Galvao Vieira; Amoedo, Mauricio Kauark; Barbosa, Paula Nicole Vieira; Chojniak, Rubens, E-mail: almirgvb@yahoo.com.br [A.C.Camargo Cancer Center, Sao Paulo, SP (Brazil). Dept. de Imagem; Neves, Flavia Branco Cerqueira Serra [Hospital do Servidor Publico Estadual, Sao Paulo, SP (Brazil). Div. de Oftalmologia

    2014-11-15

    Computed tomography-guided percutaneous biopsy is a safe and effective alternative method for evaluating selected intra-orbital lesions where the preoperative diagnosis is important for the therapeutic planning. The authors describe two cases of patients with uncommon primary orbital tumors whose diagnosis was obtained by means of computed tomography-guided core needle biopsy, with emphasis on the technical aspects of the procedure. (author)

  8. Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Staging of Patients with Non-Small Cell Lung Cancer without Mediastinal Involvement at Positron Emission Tomography-Computed Tomography

    DEFF Research Database (Denmark)

    Naur, Therese Maria Henriette; Konge, Lars; Clementsen, Paul Frost

    2017-01-01

    BACKGROUND: Staging of lung cancer is essential to the treatment, which is curative only in cases of localized disease. Previous studies have suggested that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is unnecessary when positron emission tomography-computed tomog...

  9. Fatal paradoxical pulmonary air embolism complicating percutaneous computed tomography-guided needle biopsy of the lung

    International Nuclear Information System (INIS)

    Chakravarti, Rajesh; Singh, Virendra; Isaac, Rethish; John, Joseph

    2004-01-01

    A 63-year-old man with left upper zone haziness on chest X-ray and an infiltrative lesion with a pleural mass in the left upper lobe on CT scan was scheduled for CT-guided percutaneous trans-thoracic needle biopsy. During the procedure, the patient had massive haemoptysis and cardiorespiratory arrest and could not be revived. Post-mortem CT showed air in the right atrium, right ventricle, pulmonary artery and also in the left atrium and aorta. A discussion on paradoxical air embolism following percutaneous trans-thoracic needle biopsy is presented Copyright (2004) Blackwell Publishing Asia Pty Ltd

  10. Percutaneous computed tomography-guided core needle biopsy of soft tissue tumors: results and correlation with surgical specimen analysis

    Energy Technology Data Exchange (ETDEWEB)

    Chojniak, Rubens; Grigio, Henrique Ramos; Bitencourt, Almir Galvao Vieira; Pinto, Paula Nicole Vieira; Tyng, Chiang J.; Cunha, Isabela Werneck da; Aguiar Junior, Samuel; Lopes, Ademar, E-mail: chojniak@uol.com.br [Hospital A.C. Camargo, Sao Paulo, SP (Brazil)

    2012-09-15

    Objective: To evaluate the efficacy of percutaneous computed tomography (CT)-guided core needle biopsy of soft tissue tumors in obtaining appropriate samples for histological analysis, and compare its diagnosis with the results of the surgical pathology as available. Materials and Methods: The authors reviewed medical records, imaging and histological reports of 262 patients with soft-tissue tumors submitted to CT-guided core needle biopsy in an oncologic reference center between 2003 and 2009. Results: Appropriate samples were obtained in 215 (82.1%) out of the 262 patients. The most prevalent tumors were sarcomas (38.6%), metastatic carcinomas (28.8%), benign mesenchymal tumors (20.5%) and lymphomas (9.3%). Histological grading was feasible in 92.8% of sarcoma patients, with the majority of them (77.9%) being classified as high grade tumors. Out of the total sample, 116 patients (44.3%) underwent surgical excision and diagnosis confirmation. Core biopsy demonstrated 94.6% accuracy in the identification of sarcomas, with 96.4% sensitivity and 89.5% specificity. A significant intermethod agreement about histological grading was observed between core biopsy and surgical resection (p < 0.001; kappa = 0.75). Conclusion: CT-guided core needle biopsy demonstrated a high diagnostic accuracy in the evaluation of soft tissue tumors as well as in the histological grading of sarcomas, allowing an appropriate therapeutic planning (author)

  11. Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

    Science.gov (United States)

    Noh, Tae June; Lee, Chang Hoon; Kang, Young Ae; Kwon, Sung-Youn; Yoon, Ho-Il; Kim, Tae Jung; Lee, Kyung Won; Lee, Jae Ho

    2009-01-01

    Background/Aims This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. Methods Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. Results Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. Conclusions CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax. PMID:19949733

  12. Evaluation of a novel Seldinger-needle for computed tomography guided interventions: initial experiences; Evaluierung einer neuen Seldinger-Nadel fuer computertomografisch gesteuerte Interventionen: Erste Erfahrungen

    Energy Technology Data Exchange (ETDEWEB)

    Plumhans, C.; Mahnken, A.; Iwa, R.; Behrendt, F.F.; Sebastian, K.; Guenther, R.W.; Honnef, D. [Universitaetsklinikum RWTH Aachen (Germany). Klinik fuer Radiologische Diagnostik

    2009-02-15

    To evaluate a new Seldinger puncture device for computed tomography-guided interventions under difficult conditions, to analyze applicability, and to investigate assets and drawbacks. From November 2007 to March 2008, we performed CT-guided interventions in 16 patients (7 women, 9 men; mean age 62 years old) using a new 20G-Seldinger needle (Sika-Med, Wiehl, Germany). This novel needle serves as a guide for many different interventional devices due to a guide wire welded on the proximal needle end. It allows continuous application of anesthesia via four tiny holes at the distal needle end until the region of interest is reached. Each intervention was subject to difficult interventional conditions. The indications for intervention were drainage (n = 7), Trucut biopsy of tumor (n = 8) and radiofrequency ablation (n = 1). Handling, success, advantages, drawbacks, complications and patient tolerance were noted after each procedure. A pain scale from 1 - 10 was used to grade the pain level during the intervention. All interventions were performed successfully and no severe complications were observed. Patient tolerance was very good resulting in a mean pain score of 2 {+-} 1. Regions with dangerous and difficult access were successfully reached with the new Seldinger needle in 15 of 16 cases by dilatation of the puncture tract and continuous administration of local anesthesia via the system. Furthermore, different devices such as Trucut systems and a drainage catheter were able to be inserted without complication via the needle. With a proximal removable luer-lock connection, liquid material was able to be aspirated in six cases. Under difficult interventional conditions, the use of a Seldinger needle as a reliable technique for CT-guided interventions can provide a safe and successful procedure. (orig.)

  13. Computed tomography-guided needle aspiration and biopsy of pulmonary lesions - A single-center experience in 1000 patients

    Energy Technology Data Exchange (ETDEWEB)

    Poulou, Loukia S.; Tsagouli, Paraskevi; Thanos, Loukas [Dept. of Medical Imaging and Interventional Radiology, General Hospital of Chest Diseases ' Sotiria' , Athens (Greece)], e-mail: ploukia@hotmail.com; Ziakas, Panayiotis D. [Program of Outcomes Research, Div. of Infectious Diseases, Warren Alpert Medical School, Brown Univ., RI, and Div. of Infectious Diseases, Rhode Island Hospital, Rhode Island (United States); Politi, Dimitra [Dept. of Cythopathology, General Hospital of Chest Diseases ' Sotiria' Athens (Greece); Trigidou, Rodoula [Dept. of Pathology, General Hospital of Chest Diseases ' Sotiria' Athens (Greece)

    2013-07-15

    Background: Computed tomography (CT)-guided fine needle aspiration (FNA) and biopsies are well-established, minimally invasive diagnostic tools for pulmonary lesions. Purpose: To analyze retrospectively the results of 1000 consecutive lung CT-guided FNA and/or core needle biopsies (CNB), the main outcome measures being diagnostic yield, and complication rates. Material and Methods: Patients considered eligible were those referred to our department for lung lesions. The choice of FNA, CNB, or both was based upon the radiologist's judgment. Diagnostic yield was defined as the probability of having a definite result by cytology/histology. Results: The study included 733 male patients and 267 female patients, with a mean (SD) age of 66.4 (11.4) years. The mean (SD) lesion size was 3.7 (2.4) cm in maximal diameter. Six hundred and forty-one (64%) patients underwent an FNA procedure, 245 (25%) a CNB, and 114 (11%) had been subjected to both. The diagnostic yield was 960/994 (96.6%); this decreased significantly with the use of CNB only (odds ratio [OR] 0.32; 95% CI 0.12 - 0.88; P = 0.03), while it increased with lesion size (OR 1.35; 95% CI 1.03 - 1.79; P = 0.03 per cm increase). In 506 patients (52.7%), a malignant process was diagnosed by cytopathology/histology. The complication rate reached 97/1000 (9.7%); complications included: hemorrhage, 62 (6.2%); pneumothorax, 28 (2.8%); hemorrhage and pneumothorax, 5 (0.5%); and hemoptysis, 2 (0.2%). It was not significantly affected by the type of procedure or localization of the lesion. The overall risk for complications was three times higher for lesions <4 cm (OR 3.26; 95% CI 1.96 - 5.42; P < 0.001). Conclusion: CT-guided lung biopsy has a high diagnostic yield using FNA, CNB, or both. The CNB procedure alone will not suffice. Complication rates were acceptable and correlated inversely with lesion size, not localization or type of procedure.

  14. The use of computerised tomography guided percutaneous fine needle aspiration in the evaluation of solitary pulmonary nodules.

    LENUS (Irish Health Repository)

    Khan, K A

    2012-02-01

    The evaluation of a solitary pulmonary nodule (SPN) has changed over the years with increased access to percutaneous computerised tomography (CT) guided fine needle aspiration (FNA), where bronchoscopy is unhelpful. The aim of our study was to evaluate the sample adequacy, diagnostic and complication rate of CT-FNA of a SPN at our academic teaching hospital over an 18 month period. CT-FNA was performed by a radiologist, with a cytopathologist in attendance to confirm the adequacy of the sample obtained. The size of the nodule, sample material and adequacy, diagnosis and complications were recorded. A total of 101 patients were included, 54 male and the mean age was 68 +\\/- 11 years. The mean size of the SPN was 2.3 cm (range 1-11 cm). 56 (56%) patients had a right SPN, 45 (45%) had a left SPN. CT-FNA was diagnostic in 80 (80%) patients and non-diagnostic in 21 (20%) patients. The sample was insufficient for immunocytochemistry, although the morphological appearance was diagnostic in 20 (25%) of the 80 patients. Pneumothorax occurred in 26\\/101 (26%) patients post CT-FNA, of these 7 (27%) required chest drain insertion, while 19 (73%) were managed conservatively. CT FNA is a useful tool for the diagnosis of a SPN, with our diagnostic accuracy comparable to that reported in the literature. However, CT-FNA may not provide adequate sample volume to perform ancillary testing and has a moderate complication rate.

  15. Computed Tomography-Guided Core-Needle Biopsy Specimens Demonstrate Epidermal Growth Factor Receptor Mutations in Patients with Non-Small-Cell Lung Cancer

    International Nuclear Information System (INIS)

    Chen, C.M.; Chang, J.W.C.; Cheung, Y.C.; Lin, G.; Hsieh, J.J.; Hsu, T.; Huang, S.F.

    2008-01-01

    Background: Target therapy with a new class of epidermal growth factor receptor (EGFR) inhibitors shows improved clinical response in EGFR gene-mutated lung cancers. Purpose: To evaluate the use of computed tomography (CT)-guided core-needle biopsy specimens for the assessment of EGFR gene mutation in non-small-cell lung cancer (NSCLC). Material and Methods: Seventeen (nine males, eight females) patients with advanced NSCLC were enrolled in this study. All patients underwent CT-guided core-needle biopsy of the lung tumor prior to treatment with the EGFR inhibitor gefitinib. There were no life-threatening complications of biopsy. The specimens were sent fresh-frozen for EGFR mutation analysis and histopathological study. Results: There were 12 (70.6%) EGFR gene mutants and five (29.4%) nonmutants. The objective response rate to gefitinib therapy was 73.3% (11 of 15 patients), with 91.7% (11 of 12 mutants) for the mutant group and 0% for the nonmutant group. Conclusion: CT-guided core-needle biopsy of advanced NSCLC enables the acquisition of sufficient tissue for EGFR gene mutation analysis

  16. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    )-guided percutaneous fine needle aspiration biopsy (PFNAB)/US-guided percutaneous needle core biopsy (PNCB) of abdominal lesions is efficacious in diagnosis, is helpful in treatment choice, to evaluate whether various other investigations ...

  17. Computed-Tomography-Guided Percutaneous Core Needle Biopsies of Suspected Malignant Lymphomas: Impact of Biopsy, Lesion, and Patient Parameters on Diagnostic Yield

    International Nuclear Information System (INIS)

    Hesselmann, V.; Zaehringer, M.; Krug, B.; Wesselmann, C.; Haferkamp, K.; Wickenhauser, C.; Lackner, K.

    2004-01-01

    Purpose: To investigate the diagnostic yield of core needle biopsy in patients with malignant lymphoma. Material and Methods: Computed-tomography-guided core needle biopsies in patients with malignant lymphoma performed in the period 1996 to 2001 were evaluated retrospectively. A biopsy was considered as 'fully diagnostic' if a histological diagnosis, including the histologic subtype in the event of malignant lymphoma, was achieved and the clinical course and CT follow-up of at least 6 months confirmed the biopsy results. A biopsy was regarded as 'partly diagnostic' if histological work-up defined malignant lymphoma but not the histological subtype, and if histological diagnosis bore therapeutic relevance. Diagnostic yield was correlated with features such as size of specimen, location and depth of the target lesion, and experience of the investigator. Results: 45 biopsies were performed in 40 patients. With respect to definite histopathological diagnosis, 31 biopsies (68.9%) were diagnostic and 14 (31.1%) non-diagnostic. In 4 cases (8.8%), biopsies yielded partly diagnostic results, since therapy could be scheduled after biopsy without final sub-classification. Statistical analysis of biopsy parameters revealed that sample sizes were significantly larger in the diagnostic group. Conclusion: CT-guided biopsy can be considered as an alternative for lymphoma diagnosis and should be the first interventional procedure. The most important parameter for diagnostic success is the size of the specimen

  18. Freehand biopsy guided by electromagnetic needle tracking

    DEFF Research Database (Denmark)

    Ewertsen, C; Nielsen, Marie Kristina Rue; Nielsen, M Bachmann

    2011-01-01

    To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking.......To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking....

  19. Freehand biopsy guided by electromagnetic needle tracking

    DEFF Research Database (Denmark)

    Ewertsen, C; Nielsen, Marie Kristina Rue; Nielsen, M Bachmann

    2011-01-01

    To evaluate the overall accuracy and time spent on biopsy guided by electromagnetic needle tracking in a phantom compared with the standard technique of US-guided biopsy with an attached steering device. Furthermore, to evaluate off-plane biopsy guided by needle tracking....

  20. The value of ultrasound with ultrasound-guided fine-needle aspiration biopsy compared to computed tomography in the detection of regional metastases in the clinically negative neck

    International Nuclear Information System (INIS)

    Takes, Robert P.; Righi, Paul; Meeuwis, Cees A.; Manni, Johannes J.; Knegt, Paul; Marres, Henri A.M.; Spoelstra, Hubert A.A.; Boer, Maarten F. de; Mey, Andel G.L. van der; Bruaset, I.; Ball, Valerie; Weisberger, Edward; Radpour, Shokri; Kruyt, Rene H.; Joosten, Frank B.M.; Lameris, Johan S.; Oostayen, Jacques A. van; Kopecky, Kenyon; Caldemeyer, Karen; Henzen-Logmans, Sonja C.; Wiersma-van Tilburg, J.M.; Bosman, Fred T.; Krieken, J. Han J.M. van; Hermans, Jo; Baatenburg de Jong, Robert J.

    1998-01-01

    Purpose: Head and neck oncologists have not reached consensus regarding the role of contemporary imaging techniques in the evaluation of the clinically negative neck in patients with head and neck squamous cell carcinoma (HNSCC). The purpose of the present study was to compare the accuracy of ultrasound with guided fine-needle aspiration biopsy (UGFNAB) and computed tomography (CT) in detecting lymph node metastasis in the clinically negative neck. Methods and Materials: Sixty-four neck sides of patients with HNSCC were examined preoperatively by ultrasound/UGFNAB and CT at one of five participating tertiary care medical centers. The findings were correlated with the results of histopathologic examination of the neck specimen. Results: Ultrasound with guided fine-needle aspiration biopsy was characterized by a sensitivity of 48%, specificity of 100%, and overall accuracy of 79%. Three cases had nondiagnostic aspirations using UGFNAB and were excluded. CT demonstrated a sensitivity of 54%, specificity of 92%, and overall accuracy of 77%. UGFNAB detected two additional metastases not visualized on CT, whereas CT detected no metastases not seen on UGFNAB. The results of UGFNAB were similar between the participating centers. Conclusions: Approximately one half of the clinically occult nodal metastases in our patient group were identified by both CT and UGFNAB. Overall, UGFNAB and CT demonstrated comparable accuracy. The sensitivity of CT was slightly better than UGFNAB, but the latter remained characterized by a superior specificity. The results of CT and UGFNAB did not appear to be supplementary. The choice of imaging modality for staging of the clinically negative neck depends on tumor site, T-stage, and experience and preference of the head and neck oncologist. If CT is required for staging of the primary tumor, additional staging of the neck by UGFNAB does not provide significant additional value

  1. Feasibility of computed tomography-guided core needle biopsy in producing state-of-the-art clinical management in Chinese lung cancer.

    Science.gov (United States)

    Chen, Hua-Jun; Yang, Jin-Ji; Fang, Liang-Yi; Huang, Min-Min; Yan, Hong-Hong; Zhang, Xu-Chao; Xu, Chong-Rui; Wu, Yi-Long

    2014-03-01

    A satisfactory biopsy determines the state-of-the-art management of lung cancer in this era of personalized medicine. This study aimed to investigate the suitability and efficacy of computed tomography (CT)-guided core needle biopsy in clinical management. A cohort of 353 patients with clinically suspected lung cancer was enrolled in the study. Patient factors and biopsy variables were recorded. Epidermal growth factor receptor (EGFR) gene mutations and echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK) rearrangement were detected in tumor specimens. Adequacy of biopsic obtainment for clinical trial screening and tissue bank establishment were reviewed. Overall diagnostic accuracy of malignancy achieved 98.5%. The median biopsy time of the cohort was 20 minutes. In patients with non-small cell lung cancer (NSCLC), 99.3% (287/289) were diagnosed as specific histologic subtypes, and two patients (0.7%) were determined as NSCLC not otherwise specified (NOS). EGFR mutations were analyzed in 81.7% (236/289) of patients with NSCLC, and 98.7% (233/236) showed conclusive results. EML4-ALK gene fusion was tested in 43.9% (127/289) of NSCLC patients, and 98.4% (125/127) showed conclusive results: 6.4% (8/125) of those had gene fusion. Ninety-six NSCLC patients participated in clinical trial screening and provided mandatory tumor slides for molecular profiling. Pathological evaluation was fulfilled in 90 patients (93.8%); 99.4% (320/322) of patients with malignancy provided extra tissue for the establishment of a tumor bank. CT-guided core needle biopsy provided optimal clinical management in this era of translational medicine. The biopsic modality should be prioritized in selected lung cancer patients.

  2. ULTRASONOGRAPHY AND COMPUTED TOMOGRAPHY GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN DIAGNOSING INTRA-ABDOMINAL LESIONS- A 6-YEAR RETROSPECTIVE STUDY IN A TERTIARY CARE HOSPITAL IN MANIPUR

    Directory of Open Access Journals (Sweden)

    Ratan Konjengbam

    2017-07-01

    Full Text Available BACKGROUND Fine-Needle Aspiration Cytology (FNAC is a widely used method, which is accurate and safe in a readily palpable masses. But, in those inaccessible lesions and deeper organs are safely aspirated using fine needle radiological procedure like ultrasound or computed tomography guided. The aim of the study is to assess the utility of FNAC in the diagnosis of intra-abdominal lesions and different pattern of lesions in particular to the sites. MATERIALS AND METHODS This retrospective study was done in the Department of Pathology, Regional Institute of Medical Sciences (RIMS, Imphal, between June 2010 and June 2016. The study included 128 intra-abdominal masses. Giemsa and Papanicolaou’s stains were used. The cytological diagnosis was correlated with clinical and radiological data to arrive at a final diagnosis. RESULTS Reports on FNAC smears were retrospectively analysed, which had been done in various anatomic sites- liver (70 cases, colon (19 cases, gallbladder (17 cases, mesenteric lymph nodes (12 cases, ovary (3 cases, adrenals (2 cases and 1 case each of pancreas, peritoneal wall, pelvic, suprapubic and flank masses. The mean age was 42.16 years with M:F of 1.3:1. The diagnostic yield was 85.2% in combination for Ultrasound Guided (USG and Computed Tomography (CT guided aspiration. The smears were classified as benign neoplastic, malignant neoplastic, non-neoplastic, inconclusive and unsatisfactory for interpretation. There were 79 (61.7% malignant neoplastic lesion, 5 (3.9% benign neoplastic lesion, 25 (19.5% non-neoplastic lesion, one (0.7% inconclusive lesions and 18 (14.1% unsatisfactory smears. The liver and the colon were the most common sites. Adenocarcinomas and Hepatocellular Carcinoma (HCC were the most common malignant lesions comprising of 35 (44.3% and 25 (31.6% of the total malignant lesions diagnosed. CONCLUSION Intra-abdominal FNA is a simple, economical and a safe procedure with high sensitivity, specificity and

  3. Endobronchial ultrasound-guided transbronchial needle aspiration for systematic nodal staging of lung cancer in patients with N0 disease by computed tomography and integrated positron emission tomography-computed tomography.

    Science.gov (United States)

    Ong, Philip; Grosu, Horiana; Eapen, George A; Rodriguez, Macarena; Lazarus, Donald; Ost, David; Jimenez, Carlos A; Morice, Rodolfo; Bandi, Venkata; Tamara, Luis; Cornwell, Lorraine; Green, Linda; Zhu, Angela; Casal, Roberto F

    2015-03-01

    Data regarding the sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for staging of lung cancer in patients with radiographic N0 disease is scant and inconsistent. With increasing use of nonoperative ablative therapies, studies focusing on the performance characteristics of EBUS-TBNA in this population are important. To evaluate the sensitivity and negative predictive value (NPV) of EBUS-TBNA in patients with non-small cell lung cancer and radiographic N0 disease both by computed tomography (CT) and positron emission tomography (PET)-CT. This was a retrospective review of EBUS-TBNA performed for lung cancer staging at two major academic centers from 2009 to 2014. Patients with radiographic N0 disease (lymph nodes [LN]≤1 cm in the short axis and maximum standardized uptake value≤2.5 by PET-CT) were included. Primary outcome was sensitivity and NPV of EBUS-TBNA. Two hundred twenty patients with radiographic N0 disease underwent EBUS-TBNA, and 734 LN were sampled (median 3, range 1-6). Median LN diameter was 0.72 cm. One hundred patients (45.5%) underwent surgery, and 120 patients (54.5%) had nonsurgical therapy. N status was up-staged in 49 patients (22.3%): 18 by EBUS-TBNA (N1=11, N2=6, N3=1), 27 by surgery (N1 intralobar=16, N1 extralobar=3, N2=8 [5 LN in stations 4 and 7, and 3 LN in stations 5-6), and 4 by imaging follow-up (N1=2, N2=2). Overall false-negative rate of EBUS was 14.1% (sensitivity, 36.7%; specificity, 100%; and NPV, 84.7%). False-negative rate was 27 and 3.3% in surgical and nonsurgical populations, respectively. Excluding patients with occult disease "outside" the reach of EBUS, the overall false-negative rate of EBUS-TBNA was 5.5% (sensitivity, 60%; specificity, 100%; and NPV, 93.4%). This is the largest report of EBUS-TBNA in patients with N0 disease by "integrated" PET-CT. The majority of false-negative EBUS results were in LN stations outside its reach. In our study, both sensitivity and NPV of

  4. Role of [18F]fluorodeoxyglucose positron emission tomography-computed tomography, sonography, and sonographically guided fine-needle aspiration biopsy in the diagnosis of axillary lymph nodes in patients with breast cancer: comparison of diagnostic performance.

    Science.gov (United States)

    Sohn, Yu-Mee; Hong, Il Ki; Han, Kyunghwa

    2014-06-01

    The aim of this study was to compare the diagnostic performance of [(18)F]fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) with that of sonography and sonographically guided fine-needle aspiration (FNA) for determining the preoperative axillary lymph node (ALN) status and to evaluate the factors related to false-negative PET-CT, sonographic, and FNA results in ALN staging of invasive ductal carcinoma. From March 2009 to July 2012, 226 patients had a diagnosis of primary breast cancer. Among these patients, 107 constituted the study population after exclusion of transferred patients and patients with breast cancer other than invasive ductal carcinoma. The diagnostic performance of the modalities was compared with pathologic reports. Univariate and multivariate analyses were used to evaluate the relationship between clinicopathologic factors (symptoms, T stage, hormone receptors, and histologic grade), false-negative results, and true-negative results on PET-CT, sonography, and FNA. Of the 107 patients, 45 (42.1%) had positive results on final pathologic analysis of ALNs. Sonographically guided FNA had a significantly higher specificity, positive predictive value, accuracy, and area under the receiver operating characteristic curve than sonography and PET-CT (P < .01). When sonography and PET-CT were combined, the sensitivity was significantly improved (P = .019) compared with sonography alone. When FNA and PET-CT were combined, the sensitivity and negative predictive value were significantly increased compared with each modality (P < .01). Sonographically guided FNA was found to be an excellent diagnostic tool for preoperative evaluation of the ALN status. To obviate the step of sentinel lymph node biopsy for determining the ALN status, combined evaluation of ALNs by these modalities may be more complementary than the use of a single modality. © 2014 by the American Institute of Ultrasound in Medicine.

  5. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    Energy Technology Data Exchange (ETDEWEB)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications.

  6. Ultrasound-guided percutaneous core needle biopsy of splenic lesions

    International Nuclear Information System (INIS)

    Park, SangIk; Shin, Yong Moon; Won, Hyung Jin; Kim, Pyo Nyun; Lee, Moon Gyu

    2017-01-01

    To evaluate the safety and efficacy of ultrasound-guided percutaneous core needle biopsy of splenic lesions. This retrospective study included 30 patients who underwent percutaneous core needle biopsy of their splenic lesions using 18- or 20-gauge needles between January 2001 and July 2016 in a single tertiary care center. The characteristics of the splenic lesions were determined by reviewing the ultrasound and computed tomography examinations. Acquisition rate and diagnostic accuracy were calculated, using pathologic results of the splenectomy specimen, clinical course and/or imaging follow-up as a reference standard. Post-procedure complications were identified from electronic medical records, laboratory findings and computed tomography images. Seventy-three specimens were obtained from the 30 patients and splenectomy was performed in 2 patients. Twenty-nine of the 30 patients had focal splenic lesions, while the remaining patient had homogeneous splenomegaly. Acquisition rate and diagnostic accuracy were 80.0% (24/30) and 76.7% (23/30), respectively. Perisplenic hemorrhage without hemodynamic instability developed in one patient. Ultrasound-guided percutaneous core needle biopsy of splenic lesions is a safe method for achieving a histopathologic diagnosis and can be considered as an alternative to splenectomy in patients with a high risk of splenectomy-related complications

  7. Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid

    Science.gov (United States)

    ... Physician Resources Professions Site Index A-Z Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid An ... Aspiration Biopsy of the Thyroid? What is Ultrasound-Guided Fine Needle Aspiration Biopsy of the Thyroid? During ...

  8. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms

    International Nuclear Information System (INIS)

    Ben-Shlomo, A.; Cohen, D.; Bruckheimer, E.; Bachar, G. N.; Konstantinovsky, R.; Birk, E.; Atar, E.

    2016-01-01

    PurposeTo compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT.MethodEffective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms.ResultsThe effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590 % for upper lung, 639 and 525 % for mid-lung, and 461 and 251 % for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762 % for liver and 513 and 608 % for kidney biopsies.ConclusionsBased on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  9. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms

    Energy Technology Data Exchange (ETDEWEB)

    Ben-Shlomo, A. [Soreq NRC, Radiation Protection Domain (Israel); Cohen, D.; Bruckheimer, E. [Schneider Children’s Medical Center, Section of Pediatric Cardiology (Israel); Bachar, G. N.; Konstantinovsky, R. [Rabin Medical Center, Department of Diagnostic Radiology (Israel); Birk, E. [Schneider Children’s Medical Center, Section of Pediatric Cardiology (Israel); Atar, E., E-mail: elia@clalit.org.il [Rabin Medical Center, Department of Diagnostic Radiology (Israel)

    2016-05-15

    PurposeTo compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT.MethodEffective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms.ResultsThe effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590 % for upper lung, 639 and 525 % for mid-lung, and 461 and 251 % for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762 % for liver and 513 and 608 % for kidney biopsies.ConclusionsBased on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  10. Comparing Effective Doses During Image-Guided Core Needle Biopsies with Computed Tomography Versus C-Arm Cone Beam CT Using Adult and Pediatric Phantoms.

    Science.gov (United States)

    Ben-Shlomo, A; Cohen, D; Bruckheimer, E; Bachar, G N; Konstantinovsky, R; Birk, E; Atar, E

    2016-05-01

    To compare the effective doses of needle biopsies based on dose measurements and simulations using adult and pediatric phantoms, between cone beam c-arm CT (CBCT) and CT. Effective doses were calculated and compared based on measurements and Monte Carlo simulations of CT- and CBCT-guided biopsy procedures of the lungs, liver, and kidney using pediatric and adult phantoms. The effective doses for pediatric and adult phantoms, using our standard protocols for upper, middle and lower lungs, liver, and kidney biopsies, were significantly lower under CBCT guidance than CT. The average effective dose for a 5-year old for these five biopsies was 0.36 ± 0.05 mSv with the standard CBCT exposure protocols and 2.13 ± 0.26 mSv with CT. The adult average effective dose for the five biopsies was 1.63 ± 0.22 mSv with the standard CBCT protocols and 8.22 ± 1.02 mSv using CT. The CT effective dose was higher than CBCT protocols for child and adult phantoms by 803 and 590% for upper lung, 639 and 525% for mid-lung, and 461 and 251% for lower lung, respectively. Similarly, the effective dose was higher by 691 and 762% for liver and 513 and 608% for kidney biopsies. Based on measurements and simulations with pediatric and adult phantoms, radiation effective doses during image-guided needle biopsies of the lung, liver, and kidney are significantly lower with CBCT than with CT.

  11. Acupuncture sensation during ultrasound guided acupuncture needling

    Science.gov (United States)

    Park, Jongbae J.; Akazawa, Margeaux; Ahn, Jaeki; Beckman-Harned, Selena; Lin, Feng-Chang; Lee, Kwangjae; Fine, Jason; Davis, Robert T; Langevin, Helene

    2014-01-01

    Background Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis. Purpose To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging. Methods Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation + rotation. Results In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation + rotation and oscillation alone did not significantly differ between acupuncture and control points. Conclusion The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted. PMID:21642648

  12. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    Energy Technology Data Exchange (ETDEWEB)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel (Dept. of Radiology, Medical Faculty, Univ. Duesseldorf, Duesseldorf (Germany)), email: Patric.Kroepil@med.uni-duesseldorf.de

    2011-10-15

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 +- 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 +- 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 +- 33 vs. n = 126 +- 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  13. CT-guided biopsy of thoracic lesions with a novel wire-based needle guide device - initial experiences

    International Nuclear Information System (INIS)

    Kroepil, Patric; Bilk, Philip; Quentin, Michael; Miese, Falk R; Lanzman, Rotem S; Scherer, Axel

    2011-01-01

    Background Biopsies guided by computed tomography (CT) play an important role in clinical practice. A short duration, minimal radiation dose and complication rate are of particular interest. Purpose To evaluate the potential of a novel self-manufactured wire-based needle guide device for CT-guided thoracic biopsies with respect to radiation dose, intervention time and complication rate. Material and Methods Forty patients that underwent CT-guided biopsies of thoracic lesions were included in this study and assigned to two groups. Patients in group A (n = 20, mean age 69 ± 8.4 years) underwent biopsies with a novel wire-based needle guide device, while patients in group B (n = 20, mean age 68.4 ± 10.1 years) were biopsied without a needle guide device. The novel self-manufactured needle guide device consists of an iron/zinc wire modelled to a ring with a flexible arm and an eye at the end of the arm to stabilize the biopsy needle in the optimal position during intervention. Predefined parameters (radiation dose, number of acquired CT-slices, duration of intervention, complications) were compared between both groups. Results Mean radiation dose (CTDIvol 192 mGy versus 541 mGy; P = 0.001) and the number of acquired slices during intervention (n = 49 ± 33 vs. n = 126 ± 78; P = 0.001) were significantly lower in group A compared with group B. Intervention time in group A (13.1 min) was significantly lower than in group B (18.5 min, P < 0.01). A pneumothorax as peri-interventional complication was observed less frequent after device assisted biopsies (n = 4 vs. n = 8, n.s.). Conclusion The novel wire-based needle guide device is a promising tool to facilitate CT-guided thoracic biopsies reducing radiation dose, intervention time, and related complications. Further studies are mandatory to confirm these initial results

  14. Enabling image fusion for a CT guided needle placement robot

    Science.gov (United States)

    Seifabadi, Reza; Xu, Sheng; Aalamifar, Fereshteh; Velusamy, Gnanasekar; Puhazhendi, Kaliyappan; Wood, Bradford J.

    2017-03-01

    Purpose: This study presents development and integration of hardware and software that enables ultrasound (US) and computer tomography (CT) fusion for a FDA-approved CT-guided needle placement robot. Having real-time US image registered to a priori-taken intraoperative CT image provides more anatomic information during needle insertion, in order to target hard-to-see lesions or avoid critical structures invisible to CT, track target motion, and to better monitor ablation treatment zone in relation to the tumor location. Method: A passive encoded mechanical arm is developed for the robot in order to hold and track an abdominal US transducer. This 4 degrees of freedom (DOF) arm is designed to attach to the robot end-effector. The arm is locked by default and is released by a press of button. The arm is designed such that the needle is always in plane with US image. The articulated arm is calibrated to improve its accuracy. Custom designed software (OncoNav, NIH) was developed to fuse real-time US image to a priori-taken CT. Results: The accuracy of the end effector before and after passive arm calibration was 7.07mm +/- 4.14mm and 1.74mm +/-1.60mm, respectively. The accuracy of the US image to the arm calibration was 5mm. The feasibility of US-CT fusion using the proposed hardware and software was demonstrated in an abdominal commercial phantom. Conclusions: Calibration significantly improved the accuracy of the arm in US image tracking. Fusion of US to CT using the proposed hardware and software was feasible.

  15. An ultrasound needle insertion guide in a porcine phantom model.

    Science.gov (United States)

    Whittaker, S; Lethbridge, G; Kim, C; Keon Cohen, Z; Ng, I

    2013-08-01

    We compared nerve blockade with and without the Infiniti(TM) needle guide in an ultrasound in-plane porcine simulation. We recruited 30 anaesthetists with varying blockade experience. Using the guide, the needle tip was more visible (for a median (IQR [range]) of 67 (56-100]) % of the time; and invisible for 2 (1-4 [0-19]) s) than when the guide was not used (respectively 23 (13-43 [0-80]) % and 25 (9-52 [1-198]) s; both p < 0.001). The corresponding block times were 8 (6-10 [3-28]) s and 32 (15-67 [5-225]) s, respectively; p < 0.001. The needle guide reduced the block time and the time that the needle was invisible, irrespective of anaesthetist experience. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  16. Ultrasound probe and needle-guide calibration for robotic ultrasound scanning and needle targeting.

    Science.gov (United States)

    Kim, Chunwoo; Chang, Doyoung; Petrisor, Doru; Chirikjian, Gregory; Han, Misop; Stoianovici, Dan

    2013-06-01

    Image-to-robot registration is a typical step for robotic image-guided interventions. If the imaging device uses a portable imaging probe that is held by a robot, this registration is constant and has been commonly named probe calibration. The same applies to probes tracked by a position measurement device. We report a calibration method for 2-D ultrasound probes using robotic manipulation and a planar calibration rig. Moreover, a needle guide that is attached to the probe is also calibrated for ultrasound-guided needle targeting. The method is applied to a transrectal ultrasound (TRUS) probe for robot-assisted prostate biopsy. Validation experiments include TRUS-guided needle targeting accuracy tests. This paper outlines the entire process from the calibration to image-guided targeting. Freehand TRUS-guided prostate biopsy is the primary method of diagnosing prostate cancer, with over 1.2 million procedures performed annually in the U.S. alone. However, freehand biopsy is a highly challenging procedure with subjective quality control. As such, biopsy devices are emerging to assist the physician. Here, we present a method that uses robotic TRUS manipulation. A 2-D TRUS probe is supported by a 4-degree-of-freedom robot. The robot performs ultrasound scanning, enabling 3-D reconstructions. Based on the images, the robot orients a needle guide on target for biopsy. The biopsy is acquired manually through the guide. In vitro tests showed that the 3-D images were geometrically accurate, and an image-based needle targeting accuracy was 1.55 mm. These validate the probe calibration presented and the overall robotic system for needle targeting. Targeting accuracy is sufficient for targeting small, clinically significant prostatic cancer lesions, but actual in vivo targeting will include additional error components that will have to be determined.

  17. CT guided percutaneous needle biopsy of the chest: initial experience

    African Journals Online (AJOL)

    The objective of this article is to report our first experience of CT guided percutaneous thoracic biopsy and to demonstrate the accuracy and safety of this procedure. This was a retrospective study of 28 CT-Guided Percutaneous Needle Biopsies of the Chest performed on 24 patients between November 2014 and April 2015.

  18. Effect of Needle Size in Ultrasound-guided Core Needle Breast Biopsy: Comparison of 14-, 16-, and 18-Gauge Needles.

    Science.gov (United States)

    Giuliani, Michela; Rinaldi, Pierluigi; Rella, Rossella; Fabrizi, Gina; Petta, Federica; Carlino, Giorgio; Di Leone, Alba; Mulè, Antonino; Bufi, Enida; Romani, Maurizio; Belli, Paolo; Bonomo, Lorenzo

    2017-11-01

    The aim of the present study was to assess the diagnostic accuracy of ultrasound-guided core needle biopsy (US-CNB) of breast lesions, comparing smaller needles (16- and 18-gauge) with the 14-gauge needle, and to analyze the lesion characteristics influencing US-CNB diagnostic performance. All the patients provided informed consent before the biopsy procedure. The data from breast lesions that had undergone US-CNB in our institution from January 2011 to January 2015 were retrospectively reviewed. The inclusion criterion was the surgical histopathologic examination findings of the entire lesion or radiologic follow-up data for ≥ 24 months. The exclusion criterion was the use of preoperative neoadjuvant therapy. The US-CNB results were compared with the surgical pathologic results or with the follow-up findings in the 3 needle size groups (14-, 16-, and 18-gauge). The needle size- and lesion characteristic-specific diagnostic accuracy parameters were evaluated. Statistical analysis was performed using a dedicated software program, and P ≤ .01 was considered significant. A total of 1118 US-CNB cases (1042 patients) were included. Of the 1118 cases, 630 (56.3%) were in the 14-gauge group, 136 (12.2%) in the 16-gauge, and 352 (31.5%) in the 18-gauge needle group. Surgery was performed on 800 lesions (71.6%). Of these, 619 were malignant, 77 were high risk, and 104 were benign. The remaining 318 lesions (28.4%) underwent follow-up imaging studies. All the lesions were stable and, therefore, were considered benign. No differences were observed in the diagnostic accuracy parameters among the 3 needle size groups (P > .01). The false-negative rate was greater for lesions  .01). US-CNB performed with small needles (16 and 18 gauge) had the same diagnostic accuracy as that performed with 14-gauge needles, regardless of the lesion characteristics. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Ultrasound-guided fine needle aspiration versus core needle biopsy: comparison of post-biopsy hematoma rates and risk factors.

    Science.gov (United States)

    Chae, In Hye; Kim, Eun-Kyung; Moon, Hee Jung; Yoon, Jung Hyun; Park, Vivian Y; Kwak, Jin Young

    2017-07-01

    To compare post-biopsy hematoma rates between ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy, and to investigate risk factors for post-biopsy hematoma. A total of 5304 thyroid nodules which underwent ultrasound guided biopsy were included in this retrospective study. We compared clinical and US features between patients with and without post-biopsy hematoma. Associations between these features and post-biopsy hematoma were analyzed. Post-biopsy hematoma rate was 0.8% (43/5121) for ultrasound guided-fine needle aspiration and 4.9% (9/183) for ultrasound guided-core needle biopsy (P core needle biopsy (9/179, 5.0%) than with ultrasound guided-fine needle aspiration (9/1138, 0.8%) (P core needle biopsy was the only significant risk factor for post-biopsy hematoma (adjusted Odds Ratio, 6.458, P core needle biopsy than in ultrasound guided-fine needle aspiration and ultrasound guided-core needle biopsy was the only independent factor of post-biopsy hematoma in thyroid nodules.

  20. Ultrasound guided percutaneous fine needle aspiration biopsy ...

    African Journals Online (AJOL)

    2011-06-15

    Jun 15, 2011 ... guided PFNAB/US-guided PNCB was the diagnostic test in 23.33% cases. It confirmed a highly ..... provides guidance in multiple axial, longitudinal and .... Source of Support: Nil, Con.ict of Interest: None declared. Gani, et al.

  1. A retrospective analysis of ultrasound-guided large core needle ...

    African Journals Online (AJOL)

    A retrospective analysis of ultrasound-guided large core needle biopsies of breast lesions at a regional public hospital in Durban, KwaZulu-Natal, South Africa. ... Objective: To assess the influence of technical variables on the diagnostic yield of breast specimens obtained by using US-LCNB, and the sensitivity of detecting ...

  2. Ultrasound-guided needle aspiration of parotid abscess

    Directory of Open Access Journals (Sweden)

    André Takahashi

    2012-01-01

    Full Text Available Ultrasound (US has been used as a tool for parotid abscess diagnosis and treatment. The present article aimed to report a case of 72-year-old woman with parotid abscess treated by US-guided needle aspiration and conventional surgical drainage. Along with the clinical report, indications, advantages, and limitations of the method are discussed.

  3. Ultrasound-guided core needle biopsy for breast cancer

    International Nuclear Information System (INIS)

    Naqvi, S.Q.H.; Solangi, R.A.; Memon, M.; Solangi, R.A.

    2008-01-01

    To evaluate the efficacy of ultrasound-guided core needle biopsy (US-CNB) as a preoperative diagnostic modality for breast cancer. Females with solid and/or intermediate breast lesions visualized on ultrasonography. Apart from clinical work-up, all the above mentioned patients underwent ultrasound-guided core needle biopsy and excisional biopsy of their breast lesions. The histopathological diagnosis on ultrasound-guided core needle biopsy was then compared with the findings of the excisional biopsy. Out of the total 93 cases, 47(50.5%) had benign lesions on ultrasound; US-CNB showed 24 as fibroadenomata, four with chronic non-specific mastitis, five chronic suppurative mastitis, one tuberculosis, four fat necrosis, two lactational adenoma and seven cases with benign ductal hyperplasia without atypia. Nine (9.7%) cases showed suspicious abnormality on ultrasound; US-CNB revealed five cases with atypical ductal hyperplasia, one ductal carcinoma in situ and three invasive ductal carcinoma. Thirty seven (39.8%) cases were highly suggestive of malignancy on ultrasound; US-CNB showed 34 as invasive ductal carcinoma, two invasive lobular and one medullary carcinoma. Excisional biopsy confirmed the diagnosis of ultrasound-guided core needle biopsy in all cases except four; one case of chronic suppurative mastitis was diagnosed as that of tuberculosis and three cases of atypial ductal hyperplasia as invasive ductal carcinoma. Hence there was no false positive case, but four (4.3%) false negative cases. The sensitivity of the US-CNB was thus 100% and specificity 91.1%. Ultrasound guided core needle biopsy is a satisfactory procedure for the histopathological diagnosis of breast lesions. Any unsatisfactory, suspicious or atypical change on US-CNB should be followed by an open biopsy. (author)

  4. Investigation of tissue cellularity at the tip of the core biopsy needle with optical coherence tomography.

    Science.gov (United States)

    Iftimia, Nicusor; Park, Jesung; Maguluri, Gopi; Krishnamurthy, Savitri; McWatters, Amanda; Sabir, Sharjeel H

    2018-02-01

    We report the development and the pre-clinical testing of a new technology based on optical coherence tomography (OCT) for investigating tissue composition at the tip of the core biopsy needle. While ultrasound, computed tomography, and magnetic resonance imaging are routinely used to guide needle placement within a tumor, they still do not provide the resolution needed to investigate tissue cellularity (ratio between viable tumor and benign stroma) at the needle tip prior to taking a biopsy core. High resolution OCT imaging, however, can be used to investigate tissue morphology at the micron scale, and thus to determine if the biopsy core would likely have the expected composition. Therefore, we implemented this capability within a custom-made biopsy gun and evaluated its capability for a correct estimation of tumor tissue cellularity. A pilot study on a rabbit model of soft tissue cancer has shown the capability of this technique to provide correct evaluation of tumor tissue cellularity in over 85% of the cases. These initial results indicate the potential benefit of the OCT-based approach for improving the success of the core biopsy procedures.

  5. Ultrasound guided needle biopsy of skeletal muscle in neuromuscular disease

    DEFF Research Database (Denmark)

    Lindequist, S; Schrøder, H D; Larsen, C

    1990-01-01

    Guided by ultrasonography percutaneous needle biopsy of skeletal muscle was performed in 24 patients, using the one hand held Biopty system and a 2 mm Tru-Cut needle. The specimens were graded with regard to diagnostic quality and utility and almost all specimens (96%) were of highest quality. Th....... The use of ultrasonography was helpful in selecting a suitable area for the biopsy and vascular structures could be avoided. The procedure was well tolerated and easy to perform, and no complications were recorded....

  6. Usefulness of normal saline for sealing the needle track after CT-guided lung biopsy

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Luo, T.Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.; Zheng, H.J.; Li, B.

    2015-01-01

    Aim: To determine whether the use of normal saline for sealing the needle track can reduce the incidence of pneumothorax and chest tube placement after computed tomography (CT)-guided lung biopsy. Materials and methods: A prospective, randomised, controlled trial enrolling 322 patients was conducted. All patients were randomly assigned to one of two groups: those in whom the needle track was not sealed with normal saline (n=161, Group A) and those who did receive normal saline (n=161, Group B). CT-guided biopsy was performed with coaxial technique. Normal saline, which ranged from 1–3 ml, was injected while the trocar needle was being withdrawn. Patient characteristics, lesion, and procedure variables were analysed as potential risk variables for occurrence of pneumothorax and chest tube placement. Results: The incidence of pneumothorax was 26.1% in Group A and 6.2% in Group B (p<0.001). Nine patients in Group A and one patient in Group B required chest tube placement (p=0.010). Using multiple logistic regression analysis, smaller lesion size, greater needle–pleural angle, longer lesion–pleural distance, presence of emphysema, and no sealing the needle track with normal saline were significantly associated with an increased risk of pneumothorax, and that the latter three factors were also associated with an increased risk of pneumothorax requiring chest tube placement. Conlusion: Normal saline for sealing the needle track significantly reduces the incidence of pneumothorax and prevents subsequent chest tube placement after CT-guided lung biopsy. - Highlights: • Normal saline is an effective sealant for use in lung biopsy. • This technique reduced the incidence of pneumothorax and chest tube placement. • This technique should be recommended for CT-guided lung biopsy.

  7. EUS-Guided Needle-Based Confocal Laser Endomicroscopy

    DEFF Research Database (Denmark)

    Bhutani, Manoop S; Koduru, Pramoda; Joshi, Virendra

    2015-01-01

    Endoscopic ultrasound (EUS) has emerged as an excellent tool for imaging the gastrointestinal tract, as well as surrounding structures. EUS-guided fine-needle aspiration (EUS-FNA) has become the standard of care for the tissue sampling of a variety of masses and lymph nodes within and around...... the gut, providing further diagnostic and staging information. Confocal laser endomicroscopy (CLE) is a novel endoscopic method that enables imaging at a subcellular level of resolution during endoscopy, allowing up to 1000-fold magnification of tissue and providing an optical biopsy. A new procedure...... that has been developed in the past few years is needle-based confocal laser endomicroscopy (nCLE), which involves a mini-CLE probe that can be passed through a 1 9-gauge needle during EUS-FNA. This enables the real-time visualization of tissue at a microscopic level, with the potential to further improve...

  8. Design and Production of an Articulating Needle Guide for Ultrasound-Guided Needle Block Manufactured With a Three-Dimensional Printer: Technical Communication.

    Science.gov (United States)

    Bigeleisen, Paul E

    2017-05-15

    Needle guides may allow the practitioner to align the needle with the probe when ultrasound-guided nerve block is performed. The author's goal was to design and fabricate an inexpensive ($1.90), disposable, needle guide that could articulate over a range from 85 degrees to 0 degrees with a three-dimension printer. Three-dimensional representations of an L50, L25, and C 60 ultrasound probe (Sono Site, Bothell, WA) were created using a laser scanner. Computer-aided design software (Solid Works, Waltham, MA) was used to design a needle bracket and needle guide to attach to these probes. A three-dimensional printer was used to fabricate the needle bracket and guide with acrylonitrile polybutadiene polystyrene. An echogenic needle was held in plane with the needle guide. The author performed a supraclavicular block in a morbidly obese patient. The needle was easily visualized. Similar guides that are commercially available cost as much as $400. A knowledge of computer-aided design is necessary for this work.

  9. A new stereotactic apparatus guided by computed tomography

    International Nuclear Information System (INIS)

    Huk, W.J.

    1981-01-01

    The accurate information provided by computer tomography about existence, shape, and localization of intracranial neoplasms in an early phase and in inaccessible regions have improved the diagnostics greatly, so that these lie far ahead of the therapeutic possibilities for brain tumors. To reduce this wide margin we have developed a new targeting device which makes a stereotactic approach to central lesions under sight-control by computed tomography within the computed tomography-scanner possible. With the help of this simple device we are now able to perform stereotactic procedures for tumor biopsy guided by computed tomography, needling and drainage of abscesses and cysts, and finally for the implantation of radioactive material for the interstitial radiotherapy of inoperable cysts and tumors. (orig.) [de

  10. CT-guided core-needle biopsy in omental pathology

    International Nuclear Information System (INIS)

    Pombo, F.; Rodriguez, E.; Martin, R.; Lago, M.

    1997-01-01

    Purpose: To assess the accuracy and clinical usefulness of CT-guided core-needle biopsy in the diagnosis of omental pathology. Material and Methods: We retrospectively reviewed the results of CT-guided percutaneous core biopsies in 25 patients with focal (n=2) or diffuse (n=23) omental pathology. These results were compared to the final diagnoses as determined by laparotomy (n=15), laparoscopic biopsy (n=3), endoscopic biopsy (n=1), or by the results of percutaneous biopsy and clinical-radiological and bacteriological modalities (n=6). The final diagnoses showed 4 patients with isolated omental pathology and 21 with widespread peritoneal involvement. The CT-guided biopsies were performed with 1.0=1.8-mm Surecut core-needles. Results: In 16 patients, the final diagnosis was metastatic adenocarcinoma - with the primary tumor sites in the ovary (n=3), stomach (n=1), appendix (n=2), and unknown (n=10). In the remaining 9 patients, the final diagnosis was hepatocellular carcinoma, lymphoma, and mesothelioma in 1 patient each; tuberculosis in 5; and actinomycosis in 1. Sufficient histological (n=16) or cytological (n=8) material was obtained by CT biopsy in 24/25 (96%) cases; the specimen was insufficient for diagnosis in 1 case. In differentiating benign from malignant disease, CT-guided biopsy showed a sensitivity, specificity and accuracy of respectively 89.5%, 100% and 92%. It gave a specific diagnosis in 78.9% (15/19) of patients with malignant conditions and in 50% (3/6) of patients with benign disorders. There were no biopsy-related complications. Conclusion: CT-guided percutaneous core-needle biopsy of the omentum is a safe, useful and highly accurate procedure for diagnosing malignant omental pathology. (orig.)

  11. Accuracy of biopsy needle navigation using the Medarpa system - computed tomography reality superimposed on the site of intervention

    International Nuclear Information System (INIS)

    Khan, M. Fawad; Maataoui, Adel; Gurung, Jessen; Schiemann, Mirko; Vogl, Thomas J.; Dogan, Selami; Ackermann, Hanns; Wesarg, Stefan; Sakas, Georgios

    2005-01-01

    The aim of this work was to determine the accuracy of a new navigational system, Medarpa, with a transparent display superimposing computed tomography (CT) reality on the site of intervention. Medarpa uses an optical and an electromagnetic tracking system which allows tracking of instruments, the radiologist and the transparent display. The display superimposes a CT view of a phantom chest on a phantom chest model, in real time. In group A, needle positioning was performed using the Medarpa system. Three targets (diameter 1.5 mm) located inside the phantom were punctured. In group B, the same targets were used to perform standard CT-guided puncturing using the single-slice technique. The same needles were used in both groups (15 G, 15 cm). A total of 42 punctures were performed in each group. Post puncture, CT scans were made to verify needle tip positions. The mean deviation from the needle tip to the targets was 6.65±1.61 mm for group A (range 3.54-9.51 mm) and 7.05±1.33 mm for group B (range 4.10-9.45 mm). No significant difference was found between group A and group B for any target (p>0.05). No significant difference was found between the targets of the same group (p>0.05). The accuracy in needle puncturing using the augmented reality system, Medarpa, matches the accuracy achieved by CT-guided puncturing technique. (orig.)

  12. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.

    Science.gov (United States)

    Chami, H A; Faraj, W; Yehia, Z A; Badour, S A; Sawan, P; Rebeiz, K; Safa, R; Saade, C; Ghandour, B; Shamseddine, A; Mukherji, D; Haydar, A A

    2015-12-01

    To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  13. Factors influencing diagnostic yield of CT-guided percutaneous core needle biopsy for bone lesions

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Luo, T.Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.; Zheng, H.J.; Li, B.

    2014-01-01

    Aim: To evaluate the factors influencing diagnostic yield of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for bone lesions. Materials and methods: Between September 2005 and July 2011, 162 consecutive CT-guided CNB procedures were performed in 155 patients. The variables analysed were age, sex, lesion location, lesion type, lesion size, specimen size, biopsy needle gauge, and individual radiologist. The factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were determined by multivariate analysis of variables. Results: The diagnostic yield was 81.5%. Diagnostic yield was 89.9% for lytic bone lesions and 48.5% for sclerotic bone lesions (p < 0.001), and 89.2% for lesions ≥3 cm and 73.4% for lesions <3 cm (p = 0.010). The significant factors influencing diagnostic yield of CT-guided percutaneous CNB for bone lesions were lesion type [p < 0.001; odds ratio (OR) for a lytic lesion was approximately 12 times higher than that for a sclerotic lesion; 95% confidence interval (CI): 4.22–34.01], and lesion size (p = 0.012; OR for a lesion size ≥3 cm was about five-times higher than that for a lesion size <3 cm; 95% CI: 1.42–16.71). Conclusion: Lesion type and lesion size are determining factors in diagnostic yield. The higher diagnostic yield is correlated with lytic lesion and lesion size ≥3 cm

  14. CT-guided transthoracic cutting needle biopsy of intrathoracic lesions: Comparison between coaxial and single needle technique

    International Nuclear Information System (INIS)

    Wu, Reng-Hong; Tzeng, Wen-Sheng; Lee, Wei-Jing; Chang, Shih-Chin; Chen, Chia-Huei; Fung, Jui-Lung; Wang, Yen-Jen; Mak, Chee-Wai

    2012-01-01

    Purpose: To evaluate the complication rates and diagnostic accuracy of two different CT-guided transthoracic cutting needle biopsy techniques: coaxial method and single needle method. Methods: This study involved 198 consecutive subjects with 198 intrathoracic lesions. The first 98 consecutive subjects received a single needle cutting technique and the next 100 consecutive subjects received a coaxial technique. Both groups were compared in relation the diagnostic accuracy and complication rates. Results: No significant difference was found between the two groups concerning patient characteristics, lesions and procedure variables. There was a borderline statistical difference in the incidence of pneumothorax at within 24-h post biopsy between patients in the single needle group (5%) and the coaxial group (13%) (P = 0.053). Little difference was found in the pneumothorax rate at immediately post biopsy between the two groups, which was 28% in the single needle group and 31% in the coaxial group. There was no significant difference in the hemoptysis rate between the two groups, which was 9.2% in the single needle group and 11% in the coaxial group. Both techniques yielded an overall diagnostic accuracy of 98% for malignant lesions with similar sensitivity (single needle: 96.9% vs. coaxial: 96.4%) and specificity (single needle: 100% vs. coaxial: 100%). Conclusion: There is little difference in the pneumothorax rates and bleeding complications between patients who either received a single needle or a coaxial transthoracic cutting biopsy. Both techniques produce an overall diagnostic accuracy of 98% for malignant lesions.

  15. A retrospective analysis of ultrasound-guided large core needle ...

    African Journals Online (AJOL)

    2016-07-27

    Jul 27, 2016 ... The different types of non-surgical breast biopsy procedures include: fine needle aspiration biopsy. (FNAB), core needle ... needle biopsies of breast lesions at a regional public hospital in ..... NCR_2009_FINAL.pdf. 2. Parikh J ...

  16. CT guided fine needle aspiration biopsy of biliopancreatic lesions

    International Nuclear Information System (INIS)

    Geng, Jia-Zheng; Qin, Pan-Rui; Hui, Liu-De; Po, Pei-Dong

    1987-01-01

    CT guided percutaneous fine needle aspiration biopsy was performed on 30 patients with pancreatic and periampullary neoplasms, in the Department of Surgery, China-Japan Friendship Hospital, between March 1985 and January 1986. We obtained positive cytodiagnosis from all cases of carcinoma of the pancreatic head (9 cases), body and tail (4 cases), and ampullary carcinomas (5 cases) (100 per cent). In 2 of 3 duodenal carcinomas (66.6 per cent), and 6 of 7 distal common duct carcinomas (86 per cent), a positive cytodiagnosis was also obtained. On the other hand, 2 cases of pancreatitis both gave a negative cytodiagnosis, i.e. no false positives were obtained. Out of the 30 cases who underwent CT guided biopsy, a correct diagnosis was obtained in 28, i.e. a diagnostic accuracy of 93.3 per cent. The cytodiagnosis of the other two cases was either suspicious or false negative. There have been no clinical complications noted. (author)

  17. Guided fine needle aspiration cytology of retroperitoneal masses - Our experience

    Directory of Open Access Journals (Sweden)

    Mimi Gangopadhyay

    2011-01-01

    Full Text Available Background : Early pathological classification of retroperitoneal masses is important for pin-point diagnosis and timely management. Aims : This study was done to evaluate the usefulness and drawbacks of guided fine needle aspiration cytology (FNAC of retroperitoneal masses covering a period of two years with an intention to distinguish between neoplastic and non-neoplastic lesions and to correlate with histologic findings. Materials and Methods : FNAC was done under radiological guidance in all cases using long needle fitted with disposable syringe. Appropriate staining was done and cytology was correlated with histology which was taken as the gold standard for comparison. Results : Fifty-one patients who presented with retroperitoneal masses were studied. Forty-four lesions were malignant cytologically and 7 were inflammatory (tuberculous. According to radiological and cytologic findings, we classified our cases into four groups: renal tumors, retroperitoneal lymphadenopathy, germ cell tumors, soft tissue tumors. Except for cases of non-Hodgkin lymphoma (NHL and metastatic lesions, we had sensitivity and specificity of 100%. In NHL the sensitivity and specificity were both 50%. In cases of metastatic adenocarcinoma, the sensitivity and specificity were 84.6% and 81.8%, respectively. Conclusions : Ignoring the pitfalls, guided FNAC is still an inexpensive and reliable method of early diagnosis of retroperitoneal lesions.

  18. Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Percutaneous Ultrasound-Guided Fine Needle Aspiration in Diagnosis of Focal Pancreatic Masses.

    Science.gov (United States)

    Okasha, Hussein Hassan; Naga, Mazen Ibrahim; Esmat, Serag; Naguib, Mohamed; Hassanein, Mohamed; Hassani, Mohamed; El-Kassas, Mohamed; Mahdy, Reem Ezzat; El-Gemeie, Emad; Farag, Ali Hassan; Foda, Ayman Mohamed

    2013-10-01

    Pancreatic carcinoma is one of the leading cancer morbidity and mortality world-wide. Controversy has arisen about whether the percutaneous approach with computed tomography/ultrasonography-guidance fine needle aspiration (US-FNA) or endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the preferred method to obtain diagnostic tissue. Our purpose of this study is to compare between the diagnostic accuracy of EUS-FNA and percutaneous US-FNA in diagnosis of pancreatic cancer. A total of 197 patients with pancreatic masses were included in the study, 125 patients underwent US-FNA (Group 1) and 72 patients underwent EUS-FNA (Group 2). EUS-FNA has nearly the same accuracy (88.9%) as US-FNA (87.2%) in diagnosis of pancreatic cancer. The sensitivity, specificity, positive predictive value and negative predictive value for EUS-FNA was 84%, 100%, 100%, 73.3% respectively. It was 85.5%, 90.4%, 94.7%, 76% respectively for US-FNA. EUS-FNA had a lower complication rate (1.38%) than US-FNA (5.6%). EUS-FNA has nearly the same accuracy as US-FNA of pancreatic masses with a lower complication rate.

  19. [Novel echogenic needle for ultrasound-guided peripheral nerve block "Hakko type CCR"].

    Science.gov (United States)

    Takayama, Wataru; Yasumura, Rie; Kaneko, Takehiko; Kobayashi, Yoshiro; Kamada, Takaaki; Yoshikawa, Tamotsu; Aoyama, Yasuhiko

    2009-04-01

    A novel echogenic insulated nerve block needle (CCR-needle: Echogenic Needle Type CCR; Hakko, Japan) is commercially available since 2006 in Japan. This needle has three echogenic dimples, namely corner cube reflectors (CCR) on its tip. The CCR-needle will potentially provide a significant advantage for detecting the needle tip. In this report, we firstly evaluated this new disposable echogenic needle in simulation phantom, and demonstrated improved visibility of the needle tip. Afterwards, an interscalene brachial plexus block was performed on a male patient undergoing shoulder surgery. The needle insertion procedure was the "out of plane" ultrasound-guided technique using simultaneous electrical nerve stimulation. The surgery was successfully conducted without any complications.

  20. Endoscopic Ultrasound Guided Rendezvous Drainage of Biliary Obstruction Using a New Flexible 19-Gauge Fine Needle Aspiration Needle.

    Science.gov (United States)

    Tang, Zhouwen; Igbinomwanhia, Efehi; Elhanafi, Sherif; Othman, Mohamed O

    2016-01-01

    Background and Aim. A successful endoscopic ultrasound guided rendezvous (EUS-RV) biliary drainage is dependent on accurate puncture of the bile duct and precise guide wire manipulation across the ampulla of Vater. We aim to study the feasibility of using a flexible 19-gauge fine aspiration needle in the performance of EUS-RV biliary drainage. Method. This is a retrospective case series of EUS-RV biliary drainage procedures at a single center. Patients who failed ERCP during the same session for benign or malignant biliary obstruction underwent EUS-RV using a flexible, nitinol covered, 19-gauge needle for biliary access and guide wire manipulation. Result. 24 patients underwent EUS-RV biliary drainage via extrahepatic access while 1 attempt was via intrahepatic access. The technical success rate was 80%, including 83.3% of cases via extrahepatic access. There was no significant difference in success rate of inpatient and outpatient procedures, benign or malignant indications, or type of guide wire used. Adverse events included mild pancreatitis (3 patients) and cholangitis (1 patient). Conclusion. A flexible 19-gauge needle for biliary access can be safe and effective when used to perform EUS-RV biliary drainage. Direct comparison between the nitinol needle and conventional metal needles in the performance of EUS guided biliary drainage is needed.

  1. A comparison of ultrasound guided fine needle aspiration cytology and core needle biopsy in evaluation of palpable breast lesions

    International Nuclear Information System (INIS)

    Altaf, H.N.; Farooqui, F.

    2015-01-01

    Objective: To compare ultrasound guided fine-needle aspiration cytology (FNAC) and core needle biopsy (CNB) in patients presenting with palpable breast lumps (PBLs), in terms of sensitivity and specificity, taking final histopathology as gold standard. Methodology: This cross-sectional study was conducted at Holy Family Hospital, Rawalpindi, Pakistan. Ultrasound guided FNAC and CNB were taken of all female patients with PBLs. The results were compared with final histopathology as gold standard. Data analysis was performed using SPSS software and chi-square test. Results: A total of 60 patients were included in the study. The mean age was 33.8 yrs. The sensitivity and specificity of ultrasound guided FNAC were 68.7% and 93.1%, respectively. The sensitivity and specificity of ultrasound guided CNB was 93.7% and 100%. The accuracy of FNAC was 86.2% and that of core needle biopsy was 98.3%. Conclusion: The ultrasound guided core needle biopsy can be used as an initial diagnostic test for the evaluation of all PBLs. Because of high negative predictive value core needle biopsy can replace surgical excision biopsy for benign lesions. (author)

  2. Accuracy and speed of robotic assisted needle interventions using a modern cone beam computed tomography intervention suite: a phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, Boris [Goethe University Hospital, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Goethe University Hospital, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Eichler, Katrin; Siebenhandl, Petra; Gruber-Rouh, Tatjana; Vogl, Thomas Josef; Zangos, Stephan [Goethe University Hospital, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Czerny, Christoph [Goethe University Hospital, Department of Trauma Surgery, Frankfurt (Germany)

    2013-01-15

    To analyse the feasibility and accuracy of robotic aided interventions on a phantom when using a modern C-arm-mounted cone beam computed tomography (CBCT) device in combination with needle guidance software. A small robotic device capable of holding and guiding needles was attached to the intervention table. After acquiring a 3D data set the access path was planned on the CBCT workstation and shown on the intervention monitor. Then the robot was aligned to the live fluoroscopic image. A total of 40 punctures were randomly conducted on a phantom armed with several targets (diameter 2 mm) in single and double oblique trajectory (n = 20 each). Target distance, needle deviation and time for the procedures were analysed. All phantom interventions (n = 40) could be performed successfully. Mean target access path within the phantom was 8.5 cm (min 4.2 cm, max 13.5 cm). Average needle tip deviation was 1.1 mm (min 0 mm, max 4.5 mm), time duration was 3:59 min (min 2:07 min, max 10:37 min). When using the proposed robot device in a CBCT intervention suite, highly accurate needle-based interventional punctures are possible in a reasonable timely manner in single as well as in double oblique trajectories. (orig.)

  3. Accuracy and speed of robotic assisted needle interventions using a modern cone beam computed tomography intervention suite: a phantom study

    International Nuclear Information System (INIS)

    Schulz, Boris; Eichler, Katrin; Siebenhandl, Petra; Gruber-Rouh, Tatjana; Vogl, Thomas Josef; Zangos, Stephan; Czerny, Christoph

    2013-01-01

    To analyse the feasibility and accuracy of robotic aided interventions on a phantom when using a modern C-arm-mounted cone beam computed tomography (CBCT) device in combination with needle guidance software. A small robotic device capable of holding and guiding needles was attached to the intervention table. After acquiring a 3D data set the access path was planned on the CBCT workstation and shown on the intervention monitor. Then the robot was aligned to the live fluoroscopic image. A total of 40 punctures were randomly conducted on a phantom armed with several targets (diameter 2 mm) in single and double oblique trajectory (n = 20 each). Target distance, needle deviation and time for the procedures were analysed. All phantom interventions (n = 40) could be performed successfully. Mean target access path within the phantom was 8.5 cm (min 4.2 cm, max 13.5 cm). Average needle tip deviation was 1.1 mm (min 0 mm, max 4.5 mm), time duration was 3:59 min (min 2:07 min, max 10:37 min). When using the proposed robot device in a CBCT intervention suite, highly accurate needle-based interventional punctures are possible in a reasonable timely manner in single as well as in double oblique trajectories. (orig.)

  4. Smartphone-Guided Needle Angle Selection During CT-Guided Procedures.

    Science.gov (United States)

    Xu, Sheng; Krishnasamy, Venkatesh; Levy, Elliot; Li, Ming; Tse, Zion Tsz Ho; Wood, Bradford John

    2018-01-01

    In CT-guided intervention, translation from a planned needle insertion angle to the actual insertion angle is estimated only with the physician's visuospatial abilities. An iPhone app was developed to reduce reliance on operator ability to estimate and reproduce angles. The iPhone app overlays the planned angle on the smartphone's camera display in real-time based on the smartphone's orientation. The needle's angle is selected by visually comparing the actual needle with the guideline in the display. If the smartphone's screen is perpendicular to the planned path, the smartphone shows the Bull's-Eye View mode, in which the angle is selected after the needle's hub overlaps the tip in the camera. In phantom studies, we evaluated the accuracies of the hardware, the Guideline mode, and the Bull's-Eye View mode and showed the app's clinical efficacy. A proof-of-concept clinical case was also performed. The hardware accuracy was 0.37° ± 0.27° (mean ± SD). The mean error and navigation time were 1.0° ± 0.9° and 8.7 ± 2.3 seconds for a senior radiologist with 25 years' experience and 1.5° ± 1.3° and 8.0 ± 1.6 seconds for a junior radiologist with 4 years' experience. The accuracy of the Bull's-Eye View mode was 2.9° ± 1.1°. Combined CT and smart-phone guidance was significantly more accurate than CT-only guidance for the first needle pass (p = 0.046), which led to a smaller final targeting error (mean distance from needle tip to target, 2.5 vs 7.9 mm). Mobile devices can be useful for guiding needle-based interventions. The hardware is low cost and widely available. The method is accurate, effective, and easy to implement.

  5. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT

    International Nuclear Information System (INIS)

    Chami, H.A.; Faraj, W.; Yehia, Z.A.; Badour, S.A.; Sawan, P.; Rebeiz, K.; Safa, R.; Saade, C.; Ghandour, B.; Shamseddine, A.; Mukherji, D.; Haydar, A.A.

    2015-01-01

    Aim: To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. Materials and methods: One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below −950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Results: Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01–1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Conclusion: Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. - Highlights: • Examine the association between quantitative emphysema measures & post NLB pneumothorax. • The risk of post-NLB pneumothorax increases with every unit increase in percent emphysema. • Percent emphysema is a significant predictor of pneumothorax post transthoracic NLB. • Quantitative analysis of chest CT offers clinicians' objective measures to assess pneumothorax risk.

  6. CT fluoroscopy-guided core needle biopsy of anterior mediastinal masses.

    Science.gov (United States)

    Iguchi, T; Hiraki, T; Matsui, Y; Fujiwara, H; Sakurai, J; Masaoka, Y; Uka, M; Tanaka, T; Gobara, H; Kanazawa, S

    2018-02-01

    To retrospectively evaluate the safety, diagnostic yield, and risk factors of diagnostic failure of computed tomography (CT) fluoroscopy-guided biopsies of anterior mediastinal masses. Biopsy procedures and results of anterior mediastinal masses in 71 patients (32 women/39 men; mean [±standard deviation] age, 53.8±20.0years; range, 14-88years) were analyzed. Final diagnoses were based on surgical outcomes, imaging findings, or clinical follow-up findings. The biopsy results were compared with the final diagnosis, and the biopsy procedures grouped by pathologic findings into diagnostic success and failure groups. Multiple putative risk factors for diagnostic failure were then assessed. Seventy-one biopsies (71 masses; mean size, 67.5±27.3mm; range 8.6-128.2mm) were analyzed. We identified 17 grade 1 and one grade 2 adverse events (25.4% overall) according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Sixty-nine biopsies (97.2%) provided samples fit for pathologic analysis. Diagnostic failure was found for eight (11.3%) masses; the 63 masses diagnosed successfully included thymic carcinoma (n=17), lung cancer (n=14), thymoma (n=12), malignant lymphoma (n=11), germ cell tumor (n=3), and others (n=6). Using a thinner needle (i.e., a 20-gauge needle) was the sole significant risk factor for diagnostic failure (P=0.039). CT fluoroscopy-guided biopsy of anterior mediastinal masses was safe and had a high diagnostic yield; however, using a thinner biopsy needle significantly increased the risk of a failed diagnosis. Copyright © 2017 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  7. Percutaneous image-guided needle biopsy in children - summary of our experience with 57 children

    International Nuclear Information System (INIS)

    Sklair-Levy, M.; Lebensart, P.D.; Applbaum, Y.H.; Bar-Ziv, J.; Libson, E.; Ramu, N.; Freeman, A.; Gozal, D.; Gross, E.; Sherman, Y.

    2001-01-01

    Background: Percutaneous image-guided needle biopsy in children has been slower to gain acceptance than in adults where it is regarded as the standard clinical practice in screening suspicious masses. Objectives: To report our experience with percutaneous image-guided needle biopsy in the pediatric population and assess its clinical use, efficacy and limitations. Material and methods: Sixty-nine percutaneous image-guided needle biopsies were performed in 57 children. The age of the children ranged from 4 days to 14 years (mean 5.6 years). We used 16- to-20-gauge cutting-edge needles. Sixty-two biopsies were core-needle biopsies and 7 fine-needle aspiration biopsies. Results: There were 50 malignant lesions, 10 benign lesions and 2 infectious lesions. In 55 (88.7 %) lesions the needle biopsy was diagnostic. In 7 (11.3 %) the biopsy was non-diagnostic and the diagnosis was made by surgery. Core-needle biopsy was diagnostic in 47 of 50 (94 %) of the malignant solid tumors. In 3 out of 5 children with lymphoma, an accurate diagnosis was obtained with needle aspiration. Seven children underwent a repeated core-needle biopsy, (5 for Wilms' tumor and 2 for neuroblastoma) that was diagnostic in all cases. All the biopsies were performed without complications. Conclusion: Percutaneous image-guided needle biopsy is a simple, minimally invasive, safe and accurate method for the evaluation of children with suspicious masses. These data suggest that image-guided needle biopsy is an excellent tool for diagnosing solid tumors in the pediatric population. Negative studies should be considered nondiagnostic and followed by excisional surgical biopsies when clinical suspicion of malignancy is high. (orig.)

  8. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

    Directory of Open Access Journals (Sweden)

    Chiang Jeng Tyng

    2013-06-01

    Full Text Available Objective To describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and Methods In the period from June 2011 to May 2012, seven computed tomography-guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results In all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible.

  9. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection

    International Nuclear Information System (INIS)

    Tyng, Chiang Jeng; Bitencourt, Almir Galvao Vieira; Almeida, Maria Fernanda Arruda; Barbosa, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Junior, Joao Paulo Kawaoka Matushita; Chojniak, Rubens; Coimbra, Felipe Jose Fernandez

    2013-01-01

    Objective: to describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and methods: in the period from June 2011 to May 2012, seven computed tomography guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results: in all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion: Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible. (author)

  10. Computer-Aided Design/Computer-Assisted Manufacture-Derived Needle Guide for Injection of Botulinum Toxin into the Lateral Pterygoid Muscle in Patients with Oromandibular Dystonia.

    Science.gov (United States)

    Yoshida, Kazuya

    2018-01-01

    To evaluate the effectiveness and safety of botulinum toxin administration into the inferior head of the lateral pterygoid muscle of patients with jaw opening dystonia by using a computer-aided design/computer-assisted manufacture (CAD/CAM)-derived needle guide. A total of 17 patients with jaw opening dystonia were enrolled. After the patient's computed tomography (CT) scan was imported and fused with a scan of a plaster cast model of the maxilla, the optimal needle insertion site over the lateral pterygoid muscle was determined using the NobelClinician software. A total of 13 patients were injected both with and without the guide, and 4 patients underwent guided injection alone. The therapeutic effects of botulinum toxin injection and its associated complications were statistically compared between the guided and unguided procedures using paired t test. Botulinum toxin therapy was performed 42 and 32 times with and without the guides, respectively. The needle was easily inserted without any complications in all procedures. There was a significant difference (P < .001) between the mean comprehensive improvements observed with (66.3%) and without (54.4%) the guides. The findings suggest that the use of needle guides during the injection of botulinum toxin into the inferior head of the lateral pterygoid muscle is very useful for aiding the accurate and safe administration of botulinum toxin therapy for jaw opening dystonia.

  11. Ultrasound guided percutaneous fine needle aspiration biopsy of the liver with focal lesion

    International Nuclear Information System (INIS)

    Ko, Gang Seok; Yang, Hyun Cheol; Park, Byoung Lan; Kim, Byoung Geun; Sohn, Jang Sihn

    1985-01-01

    The ultrasound-guided fine needle aspirations were performed in order to diagnose a suspected neoplastic or infectious disease in 52 patients with focal liver disease. Of these, neoplastic lesions were suspected in 31 patients and infectious lesions in 21 patients ultrasonically and/or clinically. The overall accuracy for both suspected malignant and infectious disease was 79% (41/52). The primary indication for fine needle aspiration was to document the presence of malignancy and to avoid a diagnostic laparotomy, and to drain hepatic abscess. Consequently we were convinced that the ultrasound-guided percutaneous fine needle aspiration biopsy in the focal liver disease is the best method for a conclusive diagnosis

  12. Needle segmentation using 3D Hough transform in 3D TRUS guided prostate transperineal therapy

    International Nuclear Information System (INIS)

    Qiu Wu; Yuchi Ming; Ding Mingyue; Tessier, David; Fenster, Aaron

    2013-01-01

    Purpose: Prostate adenocarcinoma is the most common noncutaneous malignancy in American men with over 200 000 new cases diagnosed each year. Prostate interventional therapy, such as cryotherapy and brachytherapy, is an effective treatment for prostate cancer. Its success relies on the correct needle implant position. This paper proposes a robust and efficient needle segmentation method, which acts as an aid to localize the needle in three-dimensional (3D) transrectal ultrasound (TRUS) guided prostate therapy. Methods: The procedure of locating the needle in a 3D TRUS image is a three-step process. First, the original 3D ultrasound image containing a needle is cropped; the cropped image is then converted to a binary format based on its histogram. Second, a 3D Hough transform based needle segmentation method is applied to the 3D binary image in order to locate the needle axis. The position of the needle endpoint is finally determined by an optimal threshold based analysis of the intensity probability distribution. The overall efficiency is improved through implementing a coarse-fine searching strategy. The proposed method was validated in tissue-mimicking agar phantoms, chicken breast phantoms, and 3D TRUS patient images from prostate brachytherapy and cryotherapy procedures by comparison to the manual segmentation. The robustness of the proposed approach was tested by means of varying parameters such as needle insertion angle, needle insertion length, binarization threshold level, and cropping size. Results: The validation results indicate that the proposed Hough transform based method is accurate and robust, with an achieved endpoint localization accuracy of 0.5 mm for agar phantom images, 0.7 mm for chicken breast phantom images, and 1 mm for in vivo patient cryotherapy and brachytherapy images. The mean execution time of needle segmentation algorithm was 2 s for a 3D TRUS image with size of 264 × 376 × 630 voxels. Conclusions: The proposed needle segmentation

  13. Initial experience with new dedicated needles for laparoscopic ultrasound-guided fine-needle aspiration and histological biopsies

    DEFF Research Database (Denmark)

    Mortensen, M B; Durup, J; Pless, T

    2001-01-01

    BACKGROUND AND STUDY AIMS: Laparoscopic ultrasonography (LUS) is an important imaging modality during laparoscopic staging of intra-abdominal malignancies, but LUS-assisted biopsy is often difficult or impossible. We report a newly developed inbuilt biopsy system for direct LUS-guided fine......-needle aspiration (FNA) and Tru-cut biopsies. PATIENTS AND METHODS: LUS-guided biopsy was performed in 20 patients with upper gastrointestinal tract tumors. The biopsied lesions had either not been previously detected by other imaging modalities or had been inaccessible, or the biopsy sample had been inadequate...... were good or acceptable in 18 patients (90%). Slight needle deviation (material was obtained, but pathological examination was impossible owing...

  14. CT Scan-Guided Abrams' Needle Pleural Biopsy versus Ultrasound-Assisted Cutting Needle Pleural Biopsy for Diagnosis in Patients with Pleural Effusion: A Randomized, Controlled Trial.

    Science.gov (United States)

    Metintas, Muzaffer; Yildirim, Huseyin; Kaya, Tamer; Ak, Guntulu; Dundar, Emine; Ozkan, Ragip; Metintas, Selma

    2016-01-01

    Image-guided pleural biopsies, both using ultrasound (US) or computed tomography (CT), are important in the diagnosis of pleural disease. However, no consensus exists regarding which biopsy needles are appropriate for specific procedures. In this randomized, prospective study, we aimed to compare CT scan-guided pleural biopsy using an Abrams' needle (CT-ANPB) with US-assisted pleural biopsy using a cutting needle (US-CNPB) with respect to both diagnostic yield and safety. Between February 2009 and April 2013, 150 patients with exudative pleural effusion who could not be diagnosed by cytological analysis were included in the study. The patients were randomized into either the US-CNPB group or the CT-ANPB group. The two groups were compared in terms of diagnostic sensitivity and complications. Of the 150 patients enrolled in this study, 45 were diagnosed with malignant mesothelioma, 46 were diagnosed with metastatic pleural disease, 18 were diagnosed with pleural tuberculosis, 34 were diagnosed with benign pleural disease, and 7 were lost to follow-up. In the US-CNPB group, the diagnostic sensitivity was 66.7%, compared with 82.4% in the CT-ANPB group; the difference between the two groups was statistically significant (p = 0.029). The sensitivity of CT-ANPB increased to 93.7% for patients with a pleural thickness ≥1 cm. The complication rates were low and acceptable. The first diagnostic intervention that should be preferred in patients with pleural effusion and associated pleural thickening on a CT scan is CT-ANPB. US-CNPB should be used primarily in cases for which only pleural thickening but no pleural effusion is noted. © 2016 S. Karger AG, Basel.

  15. MDCT-Guided Transthoracic Needle Aspiration Biopsy of the Lung Using the Transscapular Approach

    International Nuclear Information System (INIS)

    Rossi, Umberto G.; Seitun, Sara; Ferro, Carlo

    2011-01-01

    The purpose of this study is to report our preliminary experience using MDCT-guided percutaneous transthoracic needle aspiration biopsy using the transscapular approach in the upper posterolateral lung nodules, an area that it is difficult or hazardous to reach with the conventional approach. Five patients underwent CT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach. A coaxial needle technique was used in all patients. Biopsy was successful in all patients. No major complications were encountered. One patient developed a minimal pneumothorax next to the lesion immediately after biopsy, which resolved spontaneously. MDCT-guided percutaneous transthoracic needle aspiration biopsy of the lung via the transscapular approach is an effective and safe procedure that reduces the risk of pneumothorax in selected patients.

  16. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method.

    Science.gov (United States)

    Kakizawa, Hideaki; Toyota, Naoyuki; Hieda, Masashi; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Oda, Miyo; Ito, Katsuhide

    2010-09-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.

  17. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method

    International Nuclear Information System (INIS)

    Kakizawa, Hideaki; Hieda, Masashi; Oda, Miyo; Toyota, Naoyuki; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Ito, Katsuhide

    2010-01-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: 'none', 'mild', 'moderate' and 'severe'. The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p<0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax. (author)

  18. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice.

    Science.gov (United States)

    Scholten, H J; Pourtaherian, A; Mihajlovic, N; Korsten, H H M; A Bouwman, R

    2017-07-01

    Ultrasound guidance is becoming standard practice for needle-based interventions in anaesthetic practice, such as vascular access and peripheral nerve blocks. However, difficulties in aligning the needle and the transducer can lead to incorrect identification of the needle tip, possibly damaging structures not visible on the ultrasound screen. Additional techniques specifically developed to aid alignment of needle and probe or identification of the needle tip are now available. In this scoping review, advantages and limitations of the following categories of those solutions are presented: needle guides; alterations to needle or needle tip; three- and four-dimensional ultrasound; magnetism, electromagnetic or GPS systems; optical tracking; augmented (virtual) reality; robotic assistance; and automated (computerised) needle detection. Most evidence originates from phantom studies, case reports and series, with few randomised clinical trials. Improved first-pass success and reduced performance time are the most frequently cited benefits, whereas the need for additional and often expensive hardware is the greatest limitation to widespread adoption. Novice ultrasound users seem to benefit most and great potential lies in education. Future research should focus on reporting relevant clinical parameters to learn which technique will benefit patients most in terms of success and safety. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  19. CT-guided spinal injection: initial experience with Sprotte tip needles

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei [Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore (Singapore)

    2010-09-15

    The purpose of this paper is to describe our initial experience and to illustrate the potential benefits of using small caliber (25 and 27 G), noncutting pencil point needles (Sprotte) with single puncture coaxial technique in CT-guided spinal intervention (CTSI). From January 2009 to June 2009, Sprotte needles with single puncture coaxial technique were used in a total of ten patients for selective nerve root block (SNRB), facet joint block, and pars block under CT fluoroscopy (total of 16 target structures). All procedures were performed without conscious sedation, and visual analog scale (VAS) scores were recorded to determine pain related to needle placement. Total CT fluoroscopy time and out-of-plane needle deviation were obtained. Final needle position was documented by contrast injection for SNRBs and image capture for joint space cannulation. Sixteen out of the 16 structures were successfully targeted. No increase in VAS scores associated with needle placement was recorded, after infiltration of local anesthesia. Optimal peri-neurograms were obtained in all cases of SNRB, despite the side-hole opening in the Sprotte needles. Mean CT fluoroscopy time was 2 s (range 2-8 s per structure), and there was no case of out-of-plane needle deviation that required adjustment of the CT gantry. The use of small caliber Sprotte needles in CTSI is technically feasible and represents a potential refinement to current techniques in the management of chronic spinal pain. (orig.)

  20. Dedifferentiated chondrosarcoma: use of MRI to guide needle biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Saifuddin, A. E-mail: asaifuddin@aol.com; Mann, B.S.; Mahroof, S.; Pringle, J.A.S.; Briggs, T.W.R.; Cannon, S.R

    2004-03-01

    AIM: To describe the use of MRI to identify and biopsy areas of dedifferentiation in patients with a suspected diagnosis of dedifferentiated chondrosarcoma. MATERIALS AND METHODS: Low-grade chondrosarcoma is characterized at magnetic resonance imaging (MRI) as having a lobulate, hyperintense appearance on T2-weighted spin-echo sequences. T2-weighted MR images were assessed in 15 patients with a final pathological diagnosis of dedifferentiated chondrosarcoma for regions of atypical reduced signal intensity. Information regarding the site of ultrasound or computed tomography (CT)-guided biopsy was available in 10 cases. RESULTS: Nine patients were male and six female with a mean age of 60 years (range 25-77 years). The sites involved were the distal femur (n=4), pelvis (n=3), proximal femur (n=4), femoral diaphysis (n=1), proximal humerus (n=2) and proximal tibia (n=1). The dedifferentiated component consisted of osteosarcoma (n=5), malignant fibrous histiocytoma (n=6), spindle cell sarcoma (n=1), leiomyosarcoma (n=1) and pleomorphic sarcoma (n=1). In 14 of the 15 cases, areas of lower signal intensity lacking in lobulation were identified. In nine of the 10 cases, biopsy site included such areas and yielded high-grade sarcoma. CONCLUSIONS: Dedifferentiation within chondrosarcoma may be identified on T2-weighted MRI as areas of reduced signal intensity. These areas should be the preferred site of biopsy.

  1. Nodular fasciitis of the face diagnosed by US-guided core needle biopsy: a case report

    International Nuclear Information System (INIS)

    Lee, Sang Kwon; Kwon, Sun Young

    2006-01-01

    We report here on a case of nodular fasciitis (NF) that was diagnosed by ultrasonography (US)-guided core needle biopsy in a 31-year-old man, and we include the US and computed tomographic (CT) findings and the histopathologic findings at US-guided core needle biopsy (CNB). We suggest that high-resolution US is useful for the detailed evaluation of NF in the superficial regions, such as the face, and US-guided CNB is useful for the definitive histologic diagnosis of NF without causing scarring

  2. The efficacy of an ultrasound-guided core needle biopsy with an 18G cutting needle for the diagnosis of pancreatic diseases

    International Nuclear Information System (INIS)

    Jung, Sung Hwa; Park, Won Kyu; Chang, Jay Chun; Kim, Jae Woon; Cho, Jae Ho; Jang, Han Won; Lee, Jae Kyo; Choi, Joon Hyuk

    2008-01-01

    The objective of this study is to evaluate the efficacy and safety of an ultrasound-guided core needle biopsy with an 18G cutting needle in patients suspected of having a pancreatic disease by analyzing the diagnostic performance and complication rate. The study population comprised 35 consecutive patients who underwent an ultrasound-guided core needle biopsy using a high-speed biopsy gun accompanied with an 18G cutting-type needle between May of 2001 and October of 2005. The diagnostic performance (i.e., the acquisition rate and diagnostic accuracy) and complications associated with core needle biopsies were evaluated for its efficacy and safety. Thirty-six sessions of ultrasound-guided core needle biopsies were performed in 35 consecutive patients. All patients, except two (serous cystadenoma and autoimmune pancreatitis) were diagnosed with various subtypes of pancreatic cancer. The acquisition rate and diagnostic accuracy were 97% (35/36) and 94% (34/36), respectively. A complication occurred only in one patient (3%), which further proved to be a delayed complication (i.e., needle tract implantation). According to our findings, the ultrasound-guided core needle biopsy is a viable and safe method for the diagnosis of pancreatic diseases. Moreover, it enables the diagnosis of the pancreatic cancer subtype

  3. CT fluoroscopy guided transpleural cutting needle biopsy of small ({<=}2.5 cm) subpleural pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Prosch, Helmut; Oschatz, Elisabeth; Eisenhuber, Edith; Wohlschlager, Helmut [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria); Mostbeck, Gerhard H., E-mail: gerhard.mostbeck@wienkav.at [Otto Wagner Hospital, Department of Radiology, Sanatoriumsstrasse 2, 1140 Vienna (Austria)

    2011-01-15

    Purpose: Small subpleural pulmonary lesions are difficult to biopsy. While the direct, short needle path has been reported to have a lower rate of pneumothorax, the indirect path provides a higher diagnostic yield. Therefore, we tried to optimize the needle pathway and minimize the iatrogenic pneumothorax risk by evaluating a CT fluoroscopy guided direct approach to biopsy subpleural lesions. Material and methods: Between 01/2005 and 01/2007, CT fluoroscopy guided core biopsies were performed in 24 patients. Using our technique, the tip of the guide needle remains outside the visceral pleura (17 G coaxial guide needle, 18 G Biopsy-gun, 15 or 22 mm needle path). The position of the lesion relative to the needle tip can be optimized using CT fluoroscopy by adjusting the breathing position of the patient. The Biopty gun is fired with the needle tip still outside the pleural space. Cytological smears are analyzed by a cytopathologist on-site, and biopsies are repeated as indicated with the coaxial needle still outside the pleura. Results: Median nodule size was 1.6 cm (0.7-2.3 cm). A definitive diagnosis was obtained in 22 patients by histology and/or cytology. In one patient, only necrotic material could be obtained. In another patient, the intervention had to be aborted as the dyspnoic patient could not follow breathing instructions. An asymptomatic pneumothorax was present in seven patients; chest tube placement was not required. Conclusion: The presented biopsy approach has a high diagnostic yield and is especially advantageous for biopsies of small subpleural lesions in the lower lobes.

  4. Robotic Needle Guide for Prostate Brachytherapy: Clinical Testing of Feasibility and Performance

    Science.gov (United States)

    Song, Danny Y; Burdette, Everette C; Fiene, Jonathan; Armour, Elwood; Kronreif, Gernot; Deguet, Anton; Zhang, Zhe; Iordachita, Iulian; Fichtinger, Gabor; Kazanzides, Peter

    2010-01-01

    Purpose Optimization of prostate brachytherapy is constrained by tissue deflection of needles and fixed spacing of template holes. We developed and clinically tested a robotic guide towards the goal of allowing greater freedom of needle placement. Methods and Materials The robot consists of a small tubular needle guide attached to a robotically controlled arm. The apparatus is mounted and calibrated to operate in the same coordinate frame as a standard template. Translation in x and y directions over the perineum ±40mm are possible. Needle insertion is performed manually. Results Five patients were treated in an IRB-approved study. Confirmatory measurements of robotic movements for initial 3 patients using infrared tracking showed mean error of 0.489 mm (SD 0.328 mm). Fine adjustments in needle positioning were possible when tissue deflection was encountered; adjustments were performed in 54/179 (30.2%) needles placed, with 36/179 (20.1%) adjustments of > 2mm. Twenty-seven insertions were intentionally altered to positions between the standard template grid to improve the dosimetric plan or avoid structures such as pubic bone and blood vessels. Conclusions Robotic needle positioning provided a means of compensating for needle deflections as well as the ability to intentionally place needles into areas between the standard template holes. To our knowledge, these results represent the first clinical testing of such a system. Future work will be incorporation of direct control of the robot by the physician, adding software algorithms to help avoid robot collisions with the ultrasound, and testing the angulation capability in the clinical setting. PMID:20729152

  5. Are needles of Pinus pinaster more vulnerable to xylem embolism than branches? New insights from X-ray computed tomography.

    Science.gov (United States)

    Bouche, Pauline S; Delzon, Sylvain; Choat, Brendan; Badel, Eric; Brodribb, Timothy J; Burlett, Regis; Cochard, Hervé; Charra-Vaskou, Katline; Lavigne, Bruno; Li, Shan; Mayr, Stefan; Morris, Hugh; Torres-Ruiz, José M; Zufferey, Vivian; Jansen, Steven

    2016-04-01

    Plants can be highly segmented organisms with an independently redundant design of organs. In the context of plant hydraulics, leaves may be less embolism resistant than stems, allowing hydraulic failure to be restricted to distal organs that can be readily replaced. We quantified drought-induced embolism in needles and stems of Pinus pinaster using high-resolution computed tomography (HRCT). HRCT observations of needles were compared with the rehydration kinetics method to estimate the contribution of extra-xylary pathways to declining hydraulic conductance. High-resolution computed tomography images indicated that the pressure inducing 50% of embolized tracheids was similar between needle and stem xylem (P50 needle xylem  = -3.62 MPa, P50 stem xylem  = -3.88 MPa). Tracheids in both organs showed no difference in torus overlap of bordered pits. However, estimations of the pressure inducing 50% loss of hydraulic conductance at the whole needle level by the rehydration kinetics method were significantly higher (P50 needle  = -1.71 MPa) than P50 needle xylem derived from HRCT. The vulnerability segmentation hypothesis appears to be valid only when considering hydraulic failure at the entire needle level, including extra-xylary pathways. Our findings suggest that native embolism in needles is limited and highlight the importance of imaging techniques for vulnerability curves. © 2015 John Wiley & Sons Ltd.

  6. High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.

    Science.gov (United States)

    Ahmed, Zeeshan; Patel, Pinakin; Singh, Suresh; Sharma, Raj Govind; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Shiv

    2016-01-01

    Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days. Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. CT-guided core biopsy of malignant lung lesions: how many needle passes are needed?

    International Nuclear Information System (INIS)

    Lim, Chaehun; Han, Dae Hee; Lee, Kyo Young; Kim, Young Kyoon; Ko, Jeong Min

    2013-01-01

    The study aims to determine the number of needle pass in the CT-guided core needle biopsy (CNB) in making a diagnosis of pulmonary malignancy. A total of 434 CNB records were retrospectively reviewed. The specimen obtained from each needle pass was put in a formalin container and then labelled for separate histopathological reporting. The patients were divided into five groups according to the total number of needle passes (n=1, n=2, n=3, n=4 and n≥5). In each of the groups 2–4, it was analysed how many needle passes are required before a plateau in diagnostic yield is achieved. CNB produced 283 true-positive and 23 false-negative diagnosis of malignancy. Cumulative sensitivity significantly (P<0.05) increased between the first and second as well as the second and the third (if done) needle passes, but not between the third and fourth ones. Three coaxial needle passes might be optimal in the diagnosis of lung malignancy.

  8. Needle segmentation using 3D Hough transform in 3D TRUS guided prostate transperineal therapy

    Energy Technology Data Exchange (ETDEWEB)

    Qiu Wu [Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074 (China); Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario N6A 5K8 (Canada); Yuchi Ming; Ding Mingyue [Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074 (China); Tessier, David; Fenster, Aaron [Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada)

    2013-04-15

    Purpose: Prostate adenocarcinoma is the most common noncutaneous malignancy in American men with over 200 000 new cases diagnosed each year. Prostate interventional therapy, such as cryotherapy and brachytherapy, is an effective treatment for prostate cancer. Its success relies on the correct needle implant position. This paper proposes a robust and efficient needle segmentation method, which acts as an aid to localize the needle in three-dimensional (3D) transrectal ultrasound (TRUS) guided prostate therapy. Methods: The procedure of locating the needle in a 3D TRUS image is a three-step process. First, the original 3D ultrasound image containing a needle is cropped; the cropped image is then converted to a binary format based on its histogram. Second, a 3D Hough transform based needle segmentation method is applied to the 3D binary image in order to locate the needle axis. The position of the needle endpoint is finally determined by an optimal threshold based analysis of the intensity probability distribution. The overall efficiency is improved through implementing a coarse-fine searching strategy. The proposed method was validated in tissue-mimicking agar phantoms, chicken breast phantoms, and 3D TRUS patient images from prostate brachytherapy and cryotherapy procedures by comparison to the manual segmentation. The robustness of the proposed approach was tested by means of varying parameters such as needle insertion angle, needle insertion length, binarization threshold level, and cropping size. Results: The validation results indicate that the proposed Hough transform based method is accurate and robust, with an achieved endpoint localization accuracy of 0.5 mm for agar phantom images, 0.7 mm for chicken breast phantom images, and 1 mm for in vivo patient cryotherapy and brachytherapy images. The mean execution time of needle segmentation algorithm was 2 s for a 3D TRUS image with size of 264 Multiplication-Sign 376 Multiplication-Sign 630 voxels. Conclusions

  9. Learning Ultrasound-Guided Needle Insertion Skills through an Edutainment Game

    Science.gov (United States)

    Chan, Wing-Yin; Ni, Dong; Pang, Wai-Man; Qin, Jing; Chui, Yim-Pan; Yu, Simon Chun-Ho; Heng, Pheng-Ann

    Ultrasound-guided needle insertion is essential in many of minimally invasive surgeries or procedures, such as biopsy, drug delivery, spinal anaesthesia, etc. Accurate and safe needle insertion is a difficult task due to the high requirement of hand-eye coordination skills. Many proposed virtual reality (VR) based training systems put their emphasis on realistic simulation instead of pedagogical efficiency. The lack of schematic training scenario leads to boredom of repetitive operations. To solve this, we present our novel training system with the integration of game elements in order to retain the trainees' enthusiasm. Task-oriented scenarios, time attack scenarios and performance evaluation are introduced. Besides, some state-of-art technologies are also presented, including ultrasound simulation, needle haptic rendering as well as a mass-spring-based needle-tissue interaction simulation. These works are shown to be effective to keep the trainees up with learning.

  10. Accuracy of CT-guided percutaneous core needle biopsy for assessment of pediatric musculoskeletal lesions

    International Nuclear Information System (INIS)

    Hryhorczuk, Anastasia L.; Strouse, Peter J.; Biermann, J.S.

    2011-01-01

    CT-guided percutaneous core needle biopsy has been shown in adults to be an effective diagnostic tool for a large number of musculoskeletal malignancies. To characterize our experience with CT-guided percutaneous core needle biopsy of pediatric bone lesions and determine its utility in diagnosing pediatric osseous lesions, in a population where such lesions are commonly benign. From 2000 to 2009, 61 children underwent 63 CT-guided percutaneous biopsies. Radiological, pathological and clinical records were reviewed. Fourteen biopsies (22%) were performed on malignant lesions, while 49 biopsies (78%) were performed on benign lesions. Forty-nine of the 63 biopsies (78%) were adequate; these children underwent no further tissue sampling. Fourteen of the 63 biopsies (22%) were inadequate or non-conclusive. Of these patients, 12 underwent open biopsy. Retrospective analysis of percutaneous biopsies in these patients demonstrates that 9/12 provided clinically relevant information, and 4/12 patients received final diagnoses that confirmed initial core biopsy findings. No malignancies were diagnosed as benign on percutaneous biopsy. Overall, percutaneous core needle biopsy provided accurate diagnostic information in 84% (53/63) of biopsies. Our results demonstrate that CT-guided percutaneous biopsy is safe and beneficial in children. This study supports the use of CT-guided percutaneous core needle biopsy for primary diagnosis of pediatric bone lesions. (orig.)

  11. Ultrasound-Guided Miniscalpel-Needle Release versus Dry Needling for Chronic Neck Pain: A Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Yongjun Zheng

    2014-01-01

    Full Text Available Objective. To compare ultrasound-guided miniscalpel-needle (UG-MSN release versus ultrasound-guided dry needling (UG-DN for chronic neck pain. Methods. A total of 169 patients with chronic neck pain were randomized to receive either UG-MSN release or UG-DN. Before treatment and at 3 and 6 months posttreatment, pain was measured using a 10-point visual analogue scale (VAS. Neck function was examined using the neck disability index. Health-related quality of life was examined using the physical component score (PCS and mental component score (MCS of the SF-36 health status scale. Results. Patients in the UG-MSN release had greater improvement on the VAS (by 2 points at 3 months and 0.9 points at 6 months versus in the UG-DN arm; (both P<0.0001. Patients receiving UG-MSN release also showed significantly lower scores on the adjusted neck disability index, as well as significantly lower PCS. No severe complications were observed. Conclusion. UG-MSN release was superior to UG-DN in reducing pain intensity and neck disability in patients with chronic neck pain and was not associated with severe complications. The procedural aspects in the two arms were identical; however, we did not verify the blinding success. As such, the results need to be interpreted with caution.

  12. Diagnosis of invasive aspergillus tracheobronchitis facilitated by endobronchial ultrasound-guided transbronchial needle aspiration: a case report

    Directory of Open Access Journals (Sweden)

    Casal Roberto F

    2009-11-01

    Full Text Available Abstract Introduction Invasive pulmonary aspergillosis is the most common form of infection by Aspergillus species among immunocompromised patients. Although this infection frequently involves the lung parenchyma, it is unusual to find it limited to the tracheobronchial tree, a condition known as invasive aspergillus tracheobronchitis. Case presentation A 65 year-old Hispanic man from Bolivia with a history of chronic lymphocytic leukemia developed cough and malaise eight months after having an allogenic stem cell transplant. A computed tomography of the chest revealed an area of diffuse soft tissue thickening around the left main stem bronchus, which was intensely fluorodeoxyglucose-avid on positron emission tomography scanning. An initial bronchoscopic exam revealed circumferential narrowing of the entire left main stem bronchus with necrotic and friable material on the medial wall. Neither aspirates from this necrotic area nor bronchial washing were diagnostic. A second bronchoscopy with endobronchial ultrasound evidenced a soft tissue thickening on the medial aspect of the left main stem bronchus underlying the area of necrosis visible endoluminally. Endobronchial ultrasound-guided transbronchial needle aspiration performed in this area revealed multiple fungal elements suggestive of Aspergillus species. Conclusion We describe the first case of invasive aspergillus tracheobronchitis in which the diagnosis was facilitated by the use of endobronchial ultrasound guided trans-bronchial needle aspiration. To the best of our knowledge, we are also presenting the first positron emission tomography scan images of this condition in the literature. We cautiously suggest that endobronchial ultrasound imaging may be a useful tool to evaluate the degree of invasion and the involvement of vascular structures in these patients prior to bronchoscopic manipulation of the affected areas in an effort to avoid potentially fatal hemorrhage.

  13. Usefulness of sono-guided needle puncture for MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    Choi, Jae Woong; Hong, Suk Ju; Suh, San Il; Yong, Hwan Suk; Kim, Jung Hyuk; Park, Cheol Min; Suh, Won Hyuck; Kim, Myung Gyu

    2000-01-01

    To evaluate the usefulness of sono-guided needle puncture for MR arthrography of the shoulder to locate the path of access and to control the correct placement of the needle into the shoulder. Fifteen patients with suspicion of shoulder pathology were included in this study. Patients were laid in supine positions with the arm extended and slightly abducted, the palm of the hand facing upward. A sonographic unit with a high resolution transducer with 7.5 MHz linear array was used. Axial images in the anterior aspect of the shoulder were obtained to localize the coracoid process and the anteromedical portion of the humerus. Using an aseptic technique, a 21-guage needle was advanced into the shoulder joint under ultrasonographic guidance. When the needle made contract with the articular cartilage of the humeral head, the needle was tiled to position is point in the articular cavity. Solution of 0.1 ml gadopentetate dimeglumine in 25 ml of normal saline was prepared and 12-16 ml was injected into the joint cavity. The intra-articular position of the needle and the compete distension of the shoulder joint were again confirmed by sonography. The needle was accurately placed in 14 out of 15 patients without damage to neighboring structures. It took 10 to 15 minutes to complete the procedure in 14 patients. No side effects attributable to gadopentetate dimeglumine were found. Sono-guided needle puncture for the shoulder MR arthrography can be a substitutable method for fluoroscopic guidance, with easy access, advantages of lacking radiation hazard and eliminating the need for iodized contrast agents.

  14. Use of percutaneous image-guided coaxial core-needle biopsy for diagnosis of intraabdominal lymphoma

    International Nuclear Information System (INIS)

    Shimizu, Ikuo; Okazaki, Yoichi; Takeda, Wataru; Kirihara, Takehiko; Sato, Keijiro; Fujikawa, Yuko; Ueki, Toshimitsu; Hiroshima, Yuki; Sumi, Masahiko; Ueno, Mayumi; Ichikawa, Naoaki; Kobayashi, Hikaru

    2014-01-01

    Although pathological diagnosis is essential for managing malignant lymphoma, intraabdominal lesions are generally difficult to approach due to the invasiveness of abdominal surgery. Here, we report the use of percutaneous image-guided coaxial core-needle biopsy (CNB) to obtain intraabdominal specimens for diagnosing intraabdominal lymphomas, which typically requires histopathological and immunohistochemical evaluation. We retrospectively reviewed consecutive cases involving computed tomography (CT)- or ultrasonography (US)-guided CNB to obtain pathological specimens for intraabdominal lesions from 1999 to 2011. Liver, spleen, kidney, and inguinal node biopsies were excluded. We compared CNBs with laparotomic biopsies. A total of 66 CNBs were performed for 59 patients (32 males, 27 females; median age, 63.5), including second or third repeat procedures. Overall diagnostic rate was 88.5%. None of the patients required additional surgical biopsies. Notably, the median interval between recognition of an intraabdominal mass and biopsy was only 1 day. Forty-five procedures were performed for hematological malignancies. Adequate specimens were obtained for histopathological diagnosis in 86% of cases. Flow cytometry detected lymphoma cells in 79.5% of cases. Twelve patients (nine males, three females; median age, 60) were eligible for surgical biopsy. While every postoperative course was satisfactory, median duration from lesion recognition to therapy initiation for lymphoma cases was significantly shorter for CNB than for surgical biopsy (14 vs. 35 days). While one-fourth of the patients were not eligible for the procedures, CNB is safe and highly effective for diagnosis of intraabdominal lymphomas. This method significantly improves sampling and potentially helps attain immunohistological distinction, allowing for more timely therapy initiation

  15. MRI-guided prostate focal laser ablation therapy using a mechatronic needle guidance system

    Science.gov (United States)

    Cepek, Jeremy; Lindner, Uri; Ghai, Sangeet; Davidson, Sean R. H.; Trachtenberg, John; Fenster, Aaron

    2014-03-01

    Focal therapy of localized prostate cancer is receiving increased attention due to its potential for providing effective cancer control in select patients with minimal treatment-related side effects. Magnetic resonance imaging (MRI)-guided focal laser ablation (FLA) therapy is an attractive modality for such an approach. In FLA therapy, accurate placement of laser fibers is critical to ensuring that the full target volume is ablated. In practice, error in needle placement is invariably present due to pre- to intra-procedure image registration error, needle deflection, prostate motion, and variability in interventionalist skill. In addition, some of these sources of error are difficult to control, since the available workspace and patient positions are restricted within a clinical MRI bore. In an attempt to take full advantage of the utility of intraprocedure MRI, while minimizing error in needle placement, we developed an MRI-compatible mechatronic system for guiding needles to the prostate for FLA therapy. The system has been used to place interstitial catheters for MRI-guided FLA therapy in eight subjects in an ongoing Phase I/II clinical trial. Data from these cases has provided quantification of the level of uncertainty in needle placement error. To relate needle placement error to clinical outcome, we developed a model for predicting the probability of achieving complete focal target ablation for a family of parameterized treatment plans. Results from this work have enabled the specification of evidence-based selection criteria for the maximum target size that can be confidently ablated using this technique, and quantify the benefit that may be gained with improvements in needle placement accuracy.

  16. CT-guided preoperative needle localization of MRI-detected breast lesions

    Energy Technology Data Exchange (ETDEWEB)

    Giagounidis, Elektra M. E-mail: giagounjdis@online.de; Markus, Ruwe; Josef, Luetzeler; Wemer, Audretsch; Mahdi, Rezai; Bernward, Kurtz

    2001-08-01

    To assess the value of accurate preoperative CT-guided needle localization of occult breast lesions, we reviewed a total of 39 needle-directed biopsies of breast tumors in 24 women. The average age was 52.9 years (range 31-67). All lesions were nonpalpable and mammographically, as well as sonographically occult. They were solely seen on MR-images. After demonstrating the suspicious region on CT scans, a hookwire was inserted. The correct position was confirmed by a control scan. The subsequent histopathological examination showed that 28 of the lesions (71.8%) were benign, among them mastopathy, fibrosis, fibroadenoma, papilloma, intramammary lymph node, liponecrosis and epitheliosis. Eleven lesions (28%) were malignant and showed either lobular, ductal or tubular cancer. Our results endorse that CT guided needle localization is a helpful method that allows a precise surgical excision of the suspect area with the removal of a minimal amount of breast tissue.

  17. Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement: A randomised controlled trial.

    Science.gov (United States)

    Turan, Alparslan; Babazade, Rovnat; Elsharkawy, Hesham; Esa, Wael Ali Sakr; Maheshwari, Kamal; Farag, Ehab; Zimmerman, Nicole M; Soliman, Loran Mounir; Sessler, Daniel I

    2017-03-01

    Ultrasound-guided nerve blocks have become the standard when performing regional nerve blocks in anaesthesia. Infiniti Plus (CIVCO Medical Solutions, Kalona, Iowa, USA) is a needle guide that has been recently developed to help clinicians in performing ultrasound-guided nerve blocks. We tested the hypothesis that femoral nerve catheter placement carried out with the Infiniti Plus needle guide will be quicker to perform than without the Infiniti Plus. Secondary aims were to assess whether the Infiniti Plus needle guide decreased the number of block attempts and also whether it improved needle visibility. A randomised, controlled trial. Cleveland Clinic, Cleveland, Ohio, USA. We enrolled adult patients having elective total knee arthroplasty with a femoral nerve block and femoral nerve catheter. Patients, who were pregnant or those who had preexisting neuropathy involving the surgical limb, coagulopathy, infection at the block site or allergy to local anaesthetics were excluded. Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide. The time taken to place the femoral nerve catheter, the number of attempts, the success rate and needle visibility were recorded. We used an overall α of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons. The median (interquartile range Q1 to Q3) time to perform the femoral nerve catheter placement was 118 (100 to 150) s with Infiniti Plus and 177 (130 to 236) s without Infiniti Plus. Infiniti Plus significantly reduced the time spent performing femoral nerve catheterisation, with estimated ratio of means [(95% confidence interval), P value] of 0.67 [(0.60 to 0.75), P Infiniti Plus compared with no Infiniti Plus. However, Infiniti Plus had no effect on the odds of a successful femoral nerve catheter placement, number of attempts or percentage of perfect

  18. Usefulness of CT fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy

    International Nuclear Information System (INIS)

    O, Dong Hyun; Cho, Young Jun; Park, Yong Sung; Hwang, Cheol Mok; Kim, Keum Won; Kim, Ji Hyung

    2006-01-01

    When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothorax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: ≤ 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), ρ 0.05). When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule

  19. Ultrasound-guided percutaneous core needle biopsy of abdominal viscera: Tips to ensure safe and effective biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jin Woong; Shin, Sang Soo [Chonnam National University Hospital, Chonnam National University Medical School, Gwangju(Korea, Republic of)

    2017-04-15

    Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications.

  20. Ultrasound-guided percutaneous core needle biopsy of abdominal viscera: Tips to ensure safe and effective biopsy

    International Nuclear Information System (INIS)

    Kim, Jin Woong; Shin, Sang Soo

    2017-01-01

    Ultrasound-guided percutaneous core needle biopsy (USPCB) is used extensively in daily clinical practice for the pathologic confirmation of both focal and diffuse diseases of the abdominal viscera. As a guidance tool, US has a number of clear advantages over computerized tomography or magnetic resonance imaging: fewer false-negative biopsies, lack of ionizing radiation, portability, relatively short procedure time, real-time intra-procedural visualization of the biopsy needle, ability to guide the procedure in almost any anatomic plane, and relatively lower cost. Notably, USPCB is widely used to retrieve tissue specimens in cases of hepatic lesions. However, general radiologists, particularly beginners, find USPCB difficult to perform in abdominal organs other than the liver; indeed, a full understanding of the entire USPCB process and specific considerations for specific abdominal organs is necessary to safely obtain adequate specimens. In this review, we discuss some points and techniques that need to be borne in mind to increase the chances of successful USPCB. We believe that the tips and considerations presented in this review will help radiologists perform USPCB to successfully retrieve target tissue from different organs with minimal complications

  1. Automated tru-cut imaging-guided core needle biopsy of canine ...

    African Journals Online (AJOL)

    The purpose of this study was to evaluate the diagnostic value of imaging-guided core needle biopsy for canine orbital mass diagnosis. A second excisional biopsy obtained during surgery or necropsy was used as the reference standard. A prospective feasibility study was conducted in 23 canine orbital masses at a single ...

  2. Prospective evaluation of EUS-guided fine needle biopsy in pancreatic mass lesions

    DEFF Research Database (Denmark)

    Larsen, M H; Fristrup, C W; Detlefsen, S

    2018-01-01

    Background and study aim : Due to the scarcity of specific data on endoscopic ultrasound (EUS)-guided fine-needle biopsies (SharkCore) FNB in the evaluation of pancreatic lesions, we performed a prospective study of the diagnostic performance of EUS SharkCore FNB in patients with pancreatic lesions...

  3. Bowel lesions: percutaneous US-guided 18-gauge needle biopsy--preliminary experience.

    Science.gov (United States)

    Tudor, G R; Rodgers, P M; West, K P

    1999-08-01

    Ultrasonography-guided percutaneous biopsy was performed with local anesthesia and an 18-gauge needle in 10 patients with bowel-wall lesions. All patients underwent clinical review within 1 month. Biopsy was diagnostic in all patients. There were no complications, and all patients tolerated the procedure well. The technique appears to be safe and had an excellent diagnostic yield in our series.

  4. Diagnosis of mediastinal neoplasms using mediastinoscopy and CT-guided needle biopsy supported by gene analysis

    International Nuclear Information System (INIS)

    Chiba, Wataru; Sawai, Satoru; Ishida, Hisao; Hanawa, Takeshi; Matsubara, Yoshito; Ikeda, Sadao; Kinoshita, Moritoshi; Ikei, Nobuhiro.

    1993-01-01

    Of 140 cases of mediastinal neoplasms in our hospital, histological diagnosis was confirmed in 129 cases. We examined the methods of preoperative biopsy with those 129 cases. Biopsy had been performed in 25 cases. Mediastinoscopy was performed in seven cases, needle biopsy in eight cases, lymph node biopsy in eight cases, esophageal biopsy using a gastrofiberscope in one case, transbronchial biopsy using a bronchoscope in one case. The true positive rates of those methods were 100% for both mediastinoscopy and lymph node biopsy, and 75% for needle biopsy. Preoperative misdiagnosis occurred in two cases of needle biopsy. The postoperative histological diagnosis was malignant lymphoma in both cases. We performed gene analysis of the immunoglobulin heavy chain gene, light chain κ and λ genes, and the T-cell receptor β gene by use of biopsied specimens, and we found rearrangement bands of these genes in the cases of malignant lymphoma. Therefore, we summarize that gene analysis is a reliable method if malignant lymphoma is suspected. If a needle biopsy is performed under CT guidance, the needle is sure to puncture the tumor. We concluded, therefore, that if a tumor is located in the anterior mediastinum, CT-guided needle biopsy should be performed first of all. Mediastinoscopy is a useful method if the tumor is located in the mid-mediastinum. (author)

  5. Sonographically guided fine-needle biopsy of thyroid nodules: the effects of nodule characteristics, sampling technique, and needle size on the adequacy of cytological material

    International Nuclear Information System (INIS)

    Degirmenci, B.; Haktanir, A.; Albayrak, R.; Acar, M.; Sahin, D.A.; Sahin, O.; Yucel, A.; Caliskan, G.

    2007-01-01

    Aim: To evaluate the effects of sonographic characteristics of thyroid nodules, the diameter of needle used for sampling, and sampling technique on obtaining sufficient cytological material (SCM). Materials and methods: We performed sonography-guided fine-needle biopsy (FNB) in 232 solid thyroid nodules. Size-, echogenicity, vascularity, and localization of all nodules were evaluated by Doppler sonography before the biopsy. Needles of size 20, 22, and 24 G were used for biopsy. The biopsy specimen was acquired using two different methods after localisation. In first method, the needle tip was advanced into the nodule in various positions using a to-and-fro motion whilst in the nodule, along with concurrent aspiration. In the second method, the needle was advanced vigorously using a to-and-fro motion within the nodule whilst being rotated on its axis (capillary-action technique). Results: The mean nodule size was 2.1 ± 1.3 cm (range 0.4-7.2 cm). SCM was acquired from 154 (66.4%) nodules by sonography-guided FNB. In 78 (33.6%) nodules, SCM could not be collected. There was no significant difference between nodules with different echogenicity and vascularity for SCM. Regarding the needle size, the lowest rate of SCM was obtained using 20 G needles (56.6%) and the highest rate of adequate material was obtained using 24 G needles (82.5%; p = 0.001). The SCM rate was 76.9% with the capillary-action technique versus 49.4% with the aspiration technique (p < 0.001). Conclusion: Selecting finer needles (24-25 G) for sonography-guided FNB of thyroid nodules and using the capillary-action technique decreased the rate of inadequate material in cytological examination

  6. The factor analysis of the incidence of pneumothorax after CT-guided transthoracic needle aspiration biopsy

    International Nuclear Information System (INIS)

    Zhong Tao; Yu Hongguang; Wang Yong; Yang Sifu; Wang Xiaoxuan

    2007-01-01

    Objective: To analyze the impact of multiple factors on the incidence of pneumothorax associated with CT-guided transthoracic needle aspiration biopsy. Methods: The sign of pneumothorax after 162 cases (lesion diameter from 1 cm to 6 cm) CT-guided transthoracic needle aspiration biopsy was observed and its relationship with multivariate factors were analyzed by multivariate logistic regression model. Results: Thirty-two cases presented pneumothorax accounting for 19. 8%. Single variate analysis showed that the sign of pneumothorax related to intercurrent COPD, distance from lesion and chest wall, needle dwelling time and lesion diameter. 67 patients of intercurrent COPD with postoperative pneumothorax occurred in 22 cases (32.8%); With respect to those having lesions close to the chest wall (48 cases), and the cases with the distance between the chest wall and lesions less than 2 cm (55 cases) and greater than 2 cm (59 cases), the postoperative pneumothorax occurred in 0, 14 (25.5%), 18 (30.5%) cases respectively; For those patients with needle in the chest residence time of less than 10 minutes (82 cases), 10-20 minutes (51 cases), more than 20 minutes (28 cases) after the occurrence of pneumothorax were 8 (9.6%), 10(19.6%), 14 (50%) cases respectively; In contrast, those with lesion diameter less than 2 cm (65 cases), 2-4 cm(52 cases), more than 4cm(45 cases) were 19 (29.2%), 8 (15.4%) and 5 (11.1% ) respectively. The multivariate logistic regression analysis showed that the prior three factor's were risk factors of pneumothorax (OR=4.652, 4.030, 2.855 respectively). Conclusions: To avoid the pneumothorax, caution must be taken with respect to CT-guided transthoracic needle aspiration biopsy, patients with intercurrent COPD, long distance between lesion and chest wall, and smaller lesion diameter. For operation the needle dwell time within thorax should be minimized. (authors)

  7. A Comparison of Endoscopic Ultrasound Guided Biopsy and Positron Emission Tomography with Integrated Computed Tomography in Lung Cancer Staging

    DEFF Research Database (Denmark)

    Larsen, Stine Schmidt; Vilmann, P; Krasnik, K

    2009-01-01

    BACKGROUND AND STUDY AIMS: Exact staging of patients with non-small-cell lung cancer (NSCLC) is important to improve selection of resectable and curable patients for surgery. Positron emission tomography with integrated computed tomography (PET/CT) and endoscopic ultrasound guided fine needle...... aspiration biopsy (EUS-FNA) are new and promising methods, but indications in lung cancer staging are controversial. Only few studies have compared the 2 methods. The aim of this study was to assess and compare the diagnostic values of PET/CT and EUS-FNA for diagnosing advanced lung cancer in patients, who...... had both procedures performed. PATIENTS AND METHODS: 27 patients considered to be potential candidates for resection of NSCLC underwent PET/CT and EUS-FNA. Diagnoses were confirmed either by open thoracotomy, mediastinoscopy or clinical follow-up. Advanced lung cancer was defined as tumour...

  8. CT-guided percutaneous core needle biopsy for small (≤20 mm) pulmonary lesions

    International Nuclear Information System (INIS)

    Li, Y.; Du, Y.; Yang, H.F.; Yu, J.H.; Xu, X.X.

    2013-01-01

    Aim: To assess the accuracy and risk factors for complications of computed tomography (CT)-guided percutaneous core needle biopsy (CNB) for small (≤20 mm) pulmonary lesions. Materials and methods: A retrospective study was undertaken comprising 169 patients who underwent CT-guided CNB for small (≤20 mm) pulmonary lesions. To assess the accuracy of the procedure, the diagnosis at biopsy was compared with the diagnosis after definitive surgery or clinical follow-up. The risk factors for pneumothorax and bleeding were determined by multivariate analysis of variables. Results: The overall diagnostic accuracy was 93.5%. The sensitivity for malignancy and specificity for benign lesions were 90.4% and 100%, respectively. Positive and negative predictive values were 100% and 83.3%, respectively. Twenty-five patients (14.8%) had pneumothorax after CT percutaneous CNB of the lung. The significant risk factors affecting the incidence of pneumothorax were lesion–pleural distance (p = 0.008) and needle–pleural angle (p = 0.012). The highest rate of pneumothorax correlated with a lesion–pleural distance ≥21 mm (OR = 18.46; 95%CI: 2.27–149.95) and a needle–pleural angle ≥51° (OR = 8.22; 95%CI: 2.14–31.49). Bleeding occurred in 30 patients (17.8%). The only significant risk factor affecting the incidence of bleeding was lesion–pleural distance (p = 0.011). The highest bleeding rate correlated with a lesion–pleural distance ≥21 mm (OR = 7.93; 95%CI: 1.73–36.43). Conclusion: CT-guided percutaneous CNB of small (≤20 mm) pulmonary lesions provides high diagnostic accuracy with acceptable complications. A lesion–pleural distance of ≥21 mm and needle–pleural angle of ≥51° are identified as the risk factors for highest pneumothorax rate. In addition, the needle–pleural angle is a novel predictor of pneumothorax. A lesion–pleural distance of ≥21 mm is also identified as a risk factor for the highest bleeding rate.

  9. Greater physician involvement improves coding outcomes in endobronchial ultrasound-guided transbronchial needle aspiration procedures.

    Science.gov (United States)

    Pillai, Anilkumar; Medford, Andrew R L

    2013-01-01

    Correct coding is essential for accurate reimbursement for clinical activity. Published data confirm that significant aberrations in coding occur, leading to considerable financial inaccuracies especially in interventional procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Previous data reported a 15% coding error for EBUS-TBNA in a U.K. service. We hypothesised that greater physician involvement with coders would reduce EBUS-TBNA coding errors and financial disparity. The study was done as a prospective cohort study in the tertiary EBUS-TBNA service in Bristol. 165 consecutive patients between October 2009 and March 2012 underwent EBUS-TBNA for evaluation of unexplained mediastinal adenopathy on computed tomography. The chief coder was prospectively electronically informed of all procedures and cross-checked on a prospective database and by Trust Informatics. Cost and coding analysis was performed using the 2010-2011 tariffs. All 165 procedures (100%) were coded correctly as verified by Trust Informatics. This compares favourably with the 14.4% coding inaccuracy rate for EBUS-TBNA in a previous U.K. prospective cohort study [odds ratio 201.1 (1.1-357.5), p = 0.006]. Projected income loss was GBP 40,000 per year in the previous study, compared to a GBP 492,195 income here with no coding-attributable loss in revenue. Greater physician engagement with coders prevents coding errors and financial losses which can be significant especially in interventional specialties. The intervention can be as cheap, quick and simple as a prospective email to the coding team with cross-checks by Trust Informatics and against a procedural database. We suggest that all specialties should engage more with their coders using such a simple intervention to prevent revenue losses. Copyright © 2013 S. Karger AG, Basel.

  10. Field trials results of guided wave tomography

    International Nuclear Information System (INIS)

    Volker, Arno; Zon, Tim van; Leden, Edwin van der

    2015-01-01

    Corrosion is one of the industries major issues regarding the integrity of assets. Guided wave travel time tomography is a method capable of providing an absolute wall thickness map. This method is currently making the transition from the laboratory to the field. For this purpose a dedicated data acquisition system and special purpose EMAT sensor rings have been developed. The system can be deployed for permanent monitoring and inspections. Field trials have been conducted on various pipes with different diameters, containing either liquid or gas. The main focus has been on pipe supports. The results demonstrate the successful operation of the technology in the field. Expected corrosion damage was clearly visible on the produced results enabling asset owner to make calculated decisions on the pipelines safety, maintenance and operations

  11. Field trials results of guided wave tomography

    Science.gov (United States)

    Volker, Arno; van Zon, Tim; van der Leden, Edwin

    2015-03-01

    Corrosion is one of the industries major issues regarding the integrity of assets. Guided wave travel time tomography is a method capable of providing an absolute wall thickness map. This method is currently making the transition from the laboratory to the field. For this purpose a dedicated data acquisition system and special purpose EMAT sensor rings have been developed. The system can be deployed for permanent monitoring and inspections. Field trials have been conducted on various pipes with different diameters, containing either liquid or gas. The main focus has been on pipe supports. The results demonstrate the successful operation of the technology in the field. Expected corrosion damage was clearly visible on the produced results enabling asset owner to make calculated decisions on the pipelines safety, maintenance and operations.

  12. Computerized tomography-guided neurolytic splanchnic nerve block

    International Nuclear Information System (INIS)

    Henriquet, Franco; De Martini, Giuseppe; Roy, Maria Teresa; Pretrolesi, Fabio; Martinoli, Carlo; Cariati, Maurizio; Fiorentini, Franco.

    1997-01-01

    Computerized tomography-guided neurolytic splanchnic nerve block is a technique for relieving abdominal cancer pain; the goal is the alcoholic neurolytic interruption of the sensitive structures in retroperitoneal space. Computerized tomography yields accurate anatomical detailing and the course for needle placement and alcohol spread. January, 1993, to July, 1996, twenty-one bilateral splanchnic nerve blocks were performed through the posterior access. Forty-eight hours after alcoholism. 14 patients (66%) had complete pain regression; 52% of the patients needed no analgesics for 6 to 54 days and only 9 patients (42%) needed another low opioid therapy. Complications included hypotension and diarrhea in all cases. One had a cardiac arrest and diet 8 days after the procedure. There were no other complications. The whole procedure usually lasted 60 min (range: 45 to 90 min). Splanchnic nerve neurolysis is a useful treatment in the patients with severe chronic abdominal pain. It is used as a second line treatment when large lesions change celia anatomy and complicate the percutaneous block of the celiac plexus. Endosulfan, Malathion and Methyl parathion, on the metabolic rate of the estuarine clam, Villorita cyprinoides var. cochinensis, have been investigated. The animals exposed to the lower sublethal concentrations of Endosulfan, Malthion and Methyl parathion consumed oxygen at the rate of 1.60, 1.98 and 2.09 ml. 0 2 g - 1 h -1 respectively, while at the higher concentrations of the pesticides, consumption of oxygen by the animal dropped to nearly half the control value. When compared to Malathion and Methyl parathion. Endosulfan induced animals recorded a greater reduction in her percentage deviation (from control) of oxygen consumption, possibly due to hypoxia induced by the pollutants

  13. Ultrasound Guided Needle Aspiration versus Surgical Drainage in the management of breast abscesses: a Ugandan experience

    Directory of Open Access Journals (Sweden)

    Chandika Alphonce B

    2012-01-01

    Full Text Available Abstract Background Despite breast abscess becoming less common in developed countries, it has remained one of the leading causes of morbidity in women in developing countries. A randomized controlled trial was conducted at Mulago hospital complex in Kampala Uganda to establish whether ultrasound guided needle aspiration is a feasible alternative treatment option for breast abscesses. Results A total of 65 females with breast abscess were analyzed, of these 33 patients were randomized into the ultrasound guided needle aspiration and 32 patients in the Incision and drainage arm. The mean age was 23.12, most of them were lactating (66.2%, primipararous (44.6% with peripheral abscesses (73.8% located in the upper lateral quadrant (56%.The mean breast size was 3.49 cm. The two groups were comparably in demographic characteristic and breast abscess size. Survival analysis showed no difference in breast abscess healing rate between the two groups (Log rank 0.24 df 1 and P = 0.63. Incision and drainage was found to be more costly than ultrasound guided aspiration (cost effective ratio of 2.85. Conclusion Ultrasound guided needle aspiration is therefore a feasible and cost effective treatment option for both lactating and non lactating breast abscesses with a diameter up to 5 cm by ultrasound in an immune competent patient

  14. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

    International Nuclear Information System (INIS)

    Tantawy, Wahid H.; El-Gemeie, Emad H.; Ibrahim, Ahmed S.; Mohamed, Mona A.

    2012-01-01

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening

  15. Extrapleural paravertebral CT guided fine needle biopsy of subcarinal lymph nodes

    Energy Technology Data Exchange (ETDEWEB)

    Tantawy, Wahid H., E-mail: tantawyw@yahoo.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); El-Gemeie, Emad H. [Pathology Department, National Cancer Institute, Fom El Khalige Faculty of Medicine, Cairo University (Egypt); Ibrahim, Ahmed S., E-mail: asibrahima@gmail.com [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt); Mohamed, Mona A. [Radiology Department, Faculty of Medicine, Ain Shams University, Egypt Abbassyia square, Cairo (Egypt)

    2012-10-15

    Purpose: To report our experience in CT guided extrapleural paravertebral subcarinal lymph biopsy using a thin 25 gauge (25 G) thin needle without the need of injection of saline to widen the mediastinum. Materials and methods: Biopsy was performed using a 25 G needle which was advanced lateral to the vertebral body between the endothoracic fascia and the parietal pleura to gain access to subcarinal lymph nodes. One hundred and forty one patients were included in the study (74 females, 57 males). No artificial widening of the mediastinum using saline injection was required. The study was performed in the presence of a cytopathologist; sensitivity and specificity rates were calculated. Complications were documented for each case especially for pneumothorax and haemorrhage. Results: Cytopathological diagnosis was reached in all cases. All re-aspirations were done in the same session to reach a primary diagnosis at the time of the biopsy. Imunophenotyping study was done in 94 cases to confirm the primary diagnosis and to classify the malignant lesions. No pneumothorax was encountered. Small haematomas were noted in 5 cases (3.5%). Cytopathology showed a sensitivity of 97.2% and specificity of 100%. By adding immunophenotyping a 100% sensitivity and specificity was achieved. Conclusion: Fine needle aspiration cytology (FNAC) using a 25 gauge needle for subcarinal lymph nodes via a percutaneous extrapleural paravertebral CT guided approach is a safe, minimally invasive, and tolerable procedure yielding a high sensitivity and specificity rates without the need of artificial widening.

  16. Ultrasound-guided fine needle aspiration in the diagnosis of peripheral nerve sheath tumors in 4 dogs

    Science.gov (United States)

    da Costa, Ronaldo C.; Parent, Joane M.; Dobson, Howard; Ruotsalo, Kristiina; Holmberg, David; Duque, M. Carolina; Poma, Roberto

    2008-01-01

    Ultrasound-guided fine needle aspiration was used in establishing the diagnosis in 4 cases of malignant peripheral nerve sheath tumor. Sonographic and cytologic characteristics are discussed. Because of its availability and ease of use, axillary ultrasonography with fine needle aspiration can be an initial diagnostic step for suspected brachial plexus tumors. PMID:18320983

  17. Predicting factors for conversion from fluoroscopy guided Percutaneous transthoracic needle biopsy to cone-beam CT guided Percutaneous transthoracic needle biopsy

    International Nuclear Information System (INIS)

    Lee, Kang Ji; Han, Young Min; Jin, Gong Yong; Song, Ji Soo

    2015-01-01

    To evaluate the predicting factors for conversion from fluoroscopy guided percutaneous transthoracic needle biopsy (PTNB) to cone-beam CT guided PTNB. From January 2011 to December 2012, we retrospectively identified 38 patients who underwent cone-beam CT guided PTNB with solid pulmonary lesions, and 76 patients who underwent fluoroscopy guided PTNB were matched to the patients who underwent cone-beam CT guided PTNB for age, sex, and lesion location. We evaluated predicting factors such as, long-axis diameter, short-axis diameter, anterior-posterior diameter, and CT attenuation value of the solid pulmonary lesion affecting conversion from fluoroscopy guided PTNB to cone-beam CT guided PTNB. Pearson χ 2 test, Fisher exact test, and independent t test were used in statistical analyses; in addition, we also used receiver operating characteristics curve to find the proper cut-off values affecting the conversion to cone-beam CT guided PTNB. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent fluoroscopy guided PTNB were 2.70 ± 1.57 cm, 3.40 ± 1.92 cm, 3.06 ± 1.81 cm, and 35.67 ± 15.70 Hounsfield unit (HU), respectively. Short-axis, long-axis, anterior-posterior diameter and CT attenuation value of the solid pulmonary lesion in patients who underwent cone-beam CT guided PTNB were 1.60 ± 1.30 cm, 2.20 ± 1.45 cm, 1.91 ± 1.99 cm, and 18.32 ± 23.11 HU, respectively. Short-axis, long-axis, anterior-posterior diameter, and CT attenuation value showed a significantly different mean value between the 2 groups (p = 0.001, p < 0.001, p = 0.003, p < 0.001, respectively). Odd ratios of CT attenuation value and short-axis diameter of the solid pulmonary lesion were 0.952 and 0.618, respectively. Proper cut-off values affecting the conversion to cone-beam CT guided PTNB were 1.65 cm (sensitivity 68.4%, specificity 71.1%) in short-axis diameter and 29.50 HU (sensitivity 65.8%, specificity 65.8%) in

  18. Usefulness of CT-guided trans-bronchial needle aspiration biopsy for mediastinal lymph nodes

    International Nuclear Information System (INIS)

    Cui Bing; Rong Fu

    2001-01-01

    Objective: To determine the nature of enlarged mediastinal lymph nodes, the study of CT-guided trans-bronchial needle aspiration biopsy (CT-TBNA) was conducted. Methods: According to classification and locating standard of mediastinal lymph nodes, CT-TBNA was performed in 158 mediastinal lymph nodes of 73 patients, including 54 primary lung cancer with enlarged mediastinal lymph nodes, 5 malignant lymphoma, 3 mediastinal abscess and 11 mediastinal inflammatory adenopathy. Results: CT confirmed that the needles were inside all 158 lymph nodes. Adequate aspirates for histologic and/or cytologic diagnosis were obtained in 136 of 158(86%) lymph node biopsies. No serious complications occurred. Conclusion: Locating standard of CT-guided TBNA was reliable. Puncture was safe and cost-effective. CT-TBNA was important for ascertaining the nature of mediastinal adenopathy and staging of neoplasms

  19. Scan-guided fine needle aspiration biopsy in malignant hepatic disease

    International Nuclear Information System (INIS)

    Johansen, P.; Svendsen, K.N.

    1978-01-01

    The method of scan-guided fine needle aspiration biopsy of the liver is described, and the diagnostic value of this combined method in the diagnosis of malignant hepatic disease is evaluated in 83 confirmed cases, showing a specificity of 100% and a sensitivity of 94%. The combined method is compared to liver scanning alone and to Menghini biopsy. Different methods for the diagnosis of malignant hepatic disease are discussed, and it is concluded that scan-guided fine needle aspiration biopsy has a diagnostic value only obtainable otherwise by a combination of liver scanning and biopsy during laparoscopy. Cytologic features in the two most common tumor types in this study, i.e., metastatic colonic adenocarcinoma and hepatocarcinoma, are presented along with a brief discussion of the specificity of the cytologic diagnosis of hepatocarcinoma

  20. CT-guided procedures: evaluation of a phantom system to teach accurate needle placement

    International Nuclear Information System (INIS)

    Dimmick, S.; Jones, M.; Challen, J.; Iedema, J.; Wattuhewa, U.; Coucher, J.

    2007-01-01

    Aim: To evaluate the use of a phantom system to help teach the basic techniques of accurate CT-guided needle placement, thereby avoiding the risks associated with teaching on patients. Materials and Methods: Gelatine phantoms with five, 1.9 cm embedded spherical wooden targets were constructed. Four trainee operators performed 15 simulated biopsy procedures on the targets (series one) and repeated identical procedures 2 weeks later (series two). Statistical analysis of accuracy of needle placement and subject confidence were performed. Results: Significant sequential improvement in axial plane angular error was noted with the average error decreasing by 0.33 degrees after every five procedures performed (95% CI: -0.58 to -0.08, p = 0.01). Operator confidence indicated significant improvement both within each series and from series one to series two (95% CI: 0.08 to 1.17, p = 0.025 and 95% CI: 0.00 to 0.58, p = 0.05) respectively. However, variability in operator performance made statistically significant improvement in other variables unproven. Conclusion: Despite the study comprising a relatively small number of participants and procedures, it clearly demonstrated the effectiveness of teaching operators to perform CT-guided procedures using a phantom system. Needle placement accuracy significantly improved, with a reduction in axial angular error, and improved operator confidence without the risks associated with training on patients. Three of the operators in this study had never performed a CT-guided procedure previously, and their proficiency, after a relatively short but intense period of training, was impressive. The use of phantoms should be considered routinely for basic training of CT-guided needle placement

  1. Clinical Value of CT-Guided Needle Biopsy for Retroperitoneal Lesions

    International Nuclear Information System (INIS)

    Tomozawa, Yuki; Inaba, Yoshitaka; Yamaura, Hidekazu; Sato, Yozo; Kato, Mina; Kanamoto, Takaaki; Sakane, Makoto

    2011-01-01

    The purpose of this study was to investigate retrospectively the clinical procedural performance of CT-guided needle biopsy for retroperitoneal lesions. CT-guided needle biopsy was performed in 74 consecutive patients (M:F = 44:30; mean age, 59.7 years) with retroperitoneal lesions between April 1998 and June 2009. The target lesion ranged from 1.5 to 12.5 cm in size. The biopsy access path ranged from 3.5 to 11.5 cm in depth. A biopsy specimen was obtained using an 18-gauge core needle under a CT or CT-fluoroscopy guidance and with the patient under local anesthesia. The histopathological diagnoses from the biopsies were obtained. The diagnostic confirmation of the subtype of lymphoma was evaluated. Satisfactory biopsy samples were obtained in 73 (99%) of 74 patients and a pathological diagnosis was made in 70 (95%) of 74 patients. Sixty three lesions were malignant (45 lymphomas, nine primary tumors, nine lymph node metastases) and seven were benign. The subtype of lymphoma was specified in 43 (96%) of 45 patients who were diagnosed with lymphoma. Analysis of the value of CT-guided biopsy in this series indicated 63 true positives, zero false positive, six true negatives and five false negatives. This test had a sensitivity of 93%, a specificity of 100% and an accuracy of 93%. No major complications were seen and minor complications were noted in seven patients (five with local hematomas, two with transient pain at the puncture site). CT-guided needle biopsy for retroperitoneal lesions is highly practical and useful, and particularly for determining the subtypes in patients with lymphoma.

  2. About the diagnostic accuracy rate of fluoroscopy-guided fine needle puncture

    International Nuclear Information System (INIS)

    Wernecke, K.; Teske, H.J.

    1983-01-01

    Percutaneous fine-needle biopsies guided by X-ray were performed in 100 patients utilizing the Nordenstroem canule. All cases have now been clinically controlled for at least 14 and up to 30 months. The follow up allowed further conclusions due to the dignity of histologically negative biopsies. Positive results on malignant lesions were obtained in 74% of cases. Our experience revealed that negative aspiration biopsies should be considered false negative until they could be confirmed by further investigations. (orig.) [de

  3. Two-dimensional mapping of needle visibility with linear and curved array for ultrasound-guided interventional procedure

    Science.gov (United States)

    Susanti, Hesty; Suprijanto, Kurniadi, Deddy

    2018-02-01

    Needle visibility in ultrasound-guided technique has been a crucial factor for successful interventional procedure. It has been affected by several factors, i.e. puncture depth, insertion angle, needle size and material, and imaging technology. The influences of those factors made the needle not always well visible. 20 G needles of 15 cm length (Nano Line, facet) were inserted into water bath with variation of insertion angles and depths. Ultrasound measurements are performed with BK-Medical Flex Focus 800 using 12 MHz linear array and 5 MHz curved array in Ultrasound Guided Regional Anesthesia mode. We propose 3 criteria to evaluate needle visibility, i.e. maximum intensity, mean intensity, and the ratio between minimum and maximum intensity. Those criteria were then depicted into representative maps for practical purpose. The best criterion candidate for representing the needle visibility was criterion 1. Generally, the appearance pattern of the needle from this criterion was relatively consistent, i.e. for linear array, it was relatively poor visibility in the middle part of the shaft, while for curved array, it is relatively better visible toward the end of the shaft. With further investigations, for example with the use of tissue-mimicking phantom, the representative maps can be built for future practical purpose, i.e. as a tool for clinicians to ensure better needle placement in clinical application. It will help them to avoid the "dead" area where the needle is not well visible, so it can reduce the risks of vital structures traversing and the number of required insertion, resulting in less patient morbidity. Those simple criteria and representative maps can be utilized to evaluate general visibility patterns of the needle in vast range of needle types and sizes in different insertion media. This information is also important as an early investigation for future research of needle visibility improvement, i.e. the development of beamforming strategies and

  4. The diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions

    International Nuclear Information System (INIS)

    Wang Hui; Zhang Fuchen; Ji Hongjian; Chen Liping

    2009-01-01

    Objective: To evaluate the diagnostic significance of CT-guided percutaneous transthoracic cutting needle biopsy for pulmonary lesions. Methods: The clinical data of CT-guided transthoracic cutting needle biopsy in 436 patients performed in past 10 years were retrospectively analyzed. Of 436 cases with pulmonary lesions, primary lung cancer was confirmed in 341, pulmonary metastasis in 62, non-malignant lesions in 33. The diagnostic accuracy and sensitivity were statistically analyzed. The occurrence of complications was discussed. Results: The diagnostic accuracy rate and sensitivity rate in primary lung cancer group were 94.7% and 94.1% respectively, in pulmonary metastasis group were 58.2% and 51.6% respectively and in non-malignant lesions group were 57.6% and 57.6% respectively. The successful rate of biopsy was 97.9%. The occurrence of complications was 15.6%. Conclusion: CT-guided percutaneous transthoracic cutting needle biopsy is a safe and valuable diagnostic technique with high diagnostic accuracy and less complications. It is very helpful in confirming the diagnosis in the patients with suspected primary pulmonary cancer, although the technical procedures need to be further improved for metastatic and non-malignant lung lesions. (authors)

  5. Ultrasound-guided core needle biopsy in diagnosis of abdominal and pelvic neoplasm in pediatric patients.

    Science.gov (United States)

    Wang, Hailing; Li, Fangxuan; Liu, Juntian; Zhang, Sheng

    2014-01-01

    Ultrasound-guided core needle biopsy of abdominal and pelvic masses in adults has gained tremendous popularity. However, the application of the same treatment in children is not as popular because of apprehensions regarding inadequate tissues for the biopsy and accidental puncture of vital organs. Data of the application of ultrasound-guided core needle biopsy in 105 pediatric patients with clinically or ultrasound-diagnosed abdominopelvic masses were reviewed. Diagnostic procedures were conducted in our institution from May 2011 to May 2013. The biopsies were conducted on 86 malignant lesions and 19 benign lesions. 86 malignant tumors comprised neuroblastomas (30 cases), hepatoblastomas (15 cases), nephroblastomas (11 cases), and primitive neuroectodermal tumors/malignant small round cells (6 cases). Among malignant tumor cases, only a pelvic primitive neuroectodermal tumor did not receive a pathological diagnosis. Therefore, the biopsy accuracy was 98.8 % in malignant tumor. However, the biopsies for one neuroblastomas and one malignant small round cell tumor were inadequate for cytogenetic analysis. Therefore, 96.5 % of the malignant tumor patients received complete diagnosis via biopsy. 19 benign tumors comprised mature teratoma (10 cases), hemangioendothelioma (3 cases), paraganglioma (2 cases), and infection (2 cases). The diagnostic accuracy for benign neoplasm was 100 %. Five patients experienced postoperative complications, including pain (2 patients), bleeding from the biopsy site (2 patients), and wound infection (1 patient). Ultrasound-guided core needle biopsy is an efficient, minimally invasive, accurate, and safe diagnostic method that can be applied in the management of abdominal or pelvic mass of pediatric patients.

  6. The effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety.

    Science.gov (United States)

    Hızlı, Fatih; Özcan, Osman; Selvi, İsmail; Eraslan, Pınar; Köşüş, Aydın; Baş, Okan; Yıkılmaz, Taha Numan; Güven, Oğuz; Başar, Halil

    2015-11-01

    Several studies evaluating the tolerance of transrectal ultrasound (TRUS)-guided needle biopsies showed that moderate-to-severe pain was associated with the procedure. Additionally, prebiopsy anxiety or rebiopsy as a result of a prior biopsy procedure is mentioned as factors predisposing to higher pain intensity. Thus, in this study, we investigated the effects of hypnotherapy during transrectal ultrasound-guided prostate needle biopsy for pain and anxiety. Sixty-four patients presenting for TRUS-guided prostate needle biopsy were randomly assigned to receive either 10-min presurgery hypnosis session (n = 32, mean age 63.5 ± 6.1, p = 0.289) or a presurgery control session (n = 32, mean age 61.8 ± 6.8, p = 0.289). The hypnosis session involved suggestions for increased relaxation and decreased anxiety. Presurgery pain and anxiety were measured using visual analog scales (VAS), Beck Anxiety Inventory (BAI), and Hamilton Anxiety Scale (HAS), respectively. In our statistics, p < 0.05 was considered statistically significant. Postintervention, and before surgery, patients in the hypnosis group had significantly lower mean values for presurgery VAS [mean 1 (0-8); p = 0.011], BAI (6.0 vs 2.0; p < 0.001), and HAS (11.0 vs 6.0; p < 0.001). The study results indicate that a brief presurgery hypnosis intervention can be an effective means of controlling presurgical anxiety, and therefore pain, in patients awaiting diagnostic prostate cancer surgery.

  7. Molecular imaging needles: dual-modality optical coherence tomography and fluorescence imaging of labeled antibodies deep in tissue

    Science.gov (United States)

    Scolaro, Loretta; Lorenser, Dirk; Madore, Wendy-Julie; Kirk, Rodney W.; Kramer, Anne S.; Yeoh, George C.; Godbout, Nicolas; Sampson, David D.; Boudoux, Caroline; McLaughlin, Robert A.

    2015-01-01

    Molecular imaging using optical techniques provides insight into disease at the cellular level. In this paper, we report on a novel dual-modality probe capable of performing molecular imaging by combining simultaneous three-dimensional optical coherence tomography (OCT) and two-dimensional fluorescence imaging in a hypodermic needle. The probe, referred to as a molecular imaging (MI) needle, may be inserted tens of millimeters into tissue. The MI needle utilizes double-clad fiber to carry both imaging modalities, and is interfaced to a 1310-nm OCT system and a fluorescence imaging subsystem using an asymmetrical double-clad fiber coupler customized to achieve high fluorescence collection efficiency. We present, to the best of our knowledge, the first dual-modality OCT and fluorescence needle probe with sufficient sensitivity to image fluorescently labeled antibodies. Such probes enable high-resolution molecular imaging deep within tissue. PMID:26137379

  8. Microscopic findings in EUS-guided fine needle (SharkCore) biopsies with type 1 and type 2 autoimmune pancreatitis

    DEFF Research Database (Denmark)

    Detlefsen, Sönke; Joergensen, Maiken Thyregod; Mortensen, Michael Bau

    2017-01-01

    The International Consensus Diagnostic Criteria (ICDC) for the diagnosis of autoimmune pancreatitis (AIP) include the histological criterion that is based on either pancreatic core needle biopsies (CNBs) or surgical specimens. However, CNBs are difficult to obtain by endoscopic ultrasound (EUS......). EUS fine-needle aspiration (EUS-FNA) cytology is usually not sufficient for the diagnosis of AIP, but may sometimes contain tissue microfragments. Another approach is EUS-guided histological fine-needle biopsy (EUS-FNB), using needles such as the SharkCore or ProCore needle. Published data regarding...... EUS-guided SharkCore FNB for the diagnosis of AIP are lacking. We aimed to describe our histological findings in one type 1 and two type 2 AIP patients who underwent EUS SharkCore FNB. The EUS-FNBs of two patients fulfilled the histological level 2 ICDC for type 1 AIP or type 2 AIP. The EUS-FNB of one...

  9. CT-guided transthoracic core needle biopsy for small pulmonary lesions: diagnostic performance and adequacy for molecular testing.

    Science.gov (United States)

    Tian, Panwen; Wang, Ye; Li, Lei; Zhou, Yongzhao; Luo, Wenxin; Li, Weimin

    2017-02-01

    Computed tomography (CT)-guided transthoracic needle biopsy is a well-established, minimally invasive diagnostic tool for pulmonary lesions. Few large studies have been conducted on the diagnostic performance and adequacy for molecular testing of transthoracic core needle biopsy (TCNB) for small pulmonary lesions. This study included CT-guided TCNB with 18-gauge cutting needles in 560 consecutive patients with small (≤3 cm) pulmonary lesions from January 2012 to January 2015. There were 323 males and 237 females, aged 51.8±12.7 years. The size of the pulmonary lesions was 1.8±0.6 cm. The sensitivity, specificity, accuracy and complications of the biopsies were investigated. The risk factors of diagnostic failure were assessed using univariate and multivariate analyses. The sample's adequacy for molecular testing of non-small cell lung cancer (NSCLC) was analyzed. The overall sensitivity, specificity, and accuracy for diagnosis of malignancy were 92.0% (311/338), 98.6% (219/222), and 94.6% (530/560), respectively. The incidence of bleeding complications was 22.9% (128/560), and the incidence of pneumothorax was 10.4% (58/560). Logistic multivariate regression analysis showed that the independent risk factors for diagnostic failure were a lesion size ≤1 cm [odds ratio (OR), 3.95; P=0.007], lower lobe lesions (OR, 2.83; P=0.001), and pneumothorax (OR, 1.98; P=0.004). Genetic analysis was successfully performed on 95.45% (168/176) of specimens diagnosed as NSCLC. At least 96.8% of samples with two or more passes from a lesion were sufficient for molecular testing. The diagnostic yield of small pulmonary lesions by CT-guided TCNB is high, and the procedure is relatively safe. A lesion size ≤1 cm, lower lobe lesions, and pneumothorax are independent risk factors for biopsy diagnostic failure. TCNB specimens could provide adequate tissues for molecular testing.

  10. Fiber Bragg gratings-based sensing for real-time needle tracking during MR-guided brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Borot de Battisti, Maxence, E-mail: M.E.P.Borot@umcutrecht.nl; Maenhout, Metha; Lagendijk, Jan J. W.; Vulpen, Marco van; Moerland, Marinus A. [Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX (Netherlands); Denis de Senneville, Baudouin [Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands and IMB, UMR 5251 CNRS/University of Bordeaux, Talence 33400 (France); Hautvast, Gilion; Binnekamp, Dirk [Philips Group Innovation Biomedical Systems, Eindhoven 5656 AE (Netherlands)

    2016-10-15

    Purpose: The development of MR-guided high dose rate (HDR) brachytherapy is under investigation due to the excellent tumor and organs at risk visualization of MRI. However, MR-based localization of needles (including catheters or tubes) has inherently a low update rate and the required image interpretation can be hampered by signal voids arising from blood vessels or calcifications limiting the precision of the needle guidance and reconstruction. In this paper, a new needle tracking prototype is investigated using fiber Bragg gratings (FBG)-based sensing: this prototype involves a MR-compatible stylet composed of three optic fibers with nine sets of embedded FBG sensors each. This stylet can be inserted into brachytherapy needles and allows a fast measurement of the needle deflection. This study aims to assess the potential of FBG-based sensing for real-time needle (including catheter or tube) tracking during MR-guided intervention. Methods: First, the MR compatibility of FBG-based sensing and its accuracy was evaluated. Different known needle deflections were measured using FBG-based sensing during simultaneous MR-imaging. Then, a needle tracking procedure using FBG-based sensing was proposed. This procedure involved a MR-based calibration of the FBG-based system performed prior to the interventional procedure. The needle tracking system was assessed in an experiment with a moving phantom during MR imaging. The FBG-based system was quantified by comparing the gold-standard shapes, the shape manually segmented on MRI and the FBG-based measurements. Results: The evaluation of the MR compatibility of FBG-based sensing and its accuracy shows that the needle deflection could be measured with an accuracy of 0.27 mm on average. Besides, the FBG-based measurements were comparable to the uncertainty of MR-based measurements estimated at half the voxel size in the MR image. Finally, the mean(standard deviation) Euclidean distance between MR- and FBG-based needle position

  11. Helical-Tip Needle for Transthoracic Percutaneous Image-Guided Biopsy of Lung Tumors: Results of a Pilot Prospective Comparative Study with a Standard Tru-Cut Needle

    Energy Technology Data Exchange (ETDEWEB)

    Veltri, Andrea, E-mail: andrea.veltri@unito.it; Busso, Marco; Sardo, Diego; Angelino, Valeria; Priola, Adriano M. [University of Torino, Department of Radiology, San Luigi Gonzaga Hospital (Italy); Novello, Silvia [University of Torino, Department of Oncology, San Luigi Gonzaga Hospital (Italy); Barba, Matteo [University of Torino, Department of Radiology, San Luigi Gonzaga Hospital (Italy); Gatti, Gaia; Righi, Luisella [University of Torino, Department of Pathology, San Luigi Gonzaga Hospital (Italy)

    2017-06-15

    PurposeTo prospectively evaluate feasibility and diagnostic performance of the 14-gauge helical-tip (Spirotome™, Cook{sup ®} Medical, Bloomington, USA) needle in transthoracic needle biopsy (TTNB) of lung lesions, compared to a conventional 18-gauge Tru-Cut needle.Materials and MethodsStudy was institutional review board approved, with informed consent obtained. Data from synchronous Spirotome and Tru-Cut image-guided TTNB of 20 consecutive patients with malignant peripheral lung tumors larger than 3 cm were enrolled for pathologic characterization and mutational analysis. Samples obtained with Spirotome and Tru-Cut needle were compared for fragmentation, length, weight, morphologic and immunohistochemistry typifying, tumor cellularity (TC) and DNA concentration.ResultsThe technical success rate for TTNB with Spirotome was 100%, and no major complications occurred. Less fragmentation (mean 2 vs. 3 fragments, P = .418), greater weight (mean 13 vs. 8.5 mg, P = .027) and lower length (mean 10.2 vs. 12.6 mm, P = .174) were observed with Spirotome compared to Tru-Cut needle. Accuracy of Spirotome and Tru-Cut needle in defining cancer histotype was similar (90%). Absolute and relative TC (mean 42 vs. 38, 124 vs. 108/10HPF), and DNA concentration (mean 49.6 vs. 39.0 ng/μl) were higher with Spirotome compared to Tru-Cut needle, with no statistical significance (P = .787 and P = .140, respectively).Conclusions Percutaneous 14-gauge Spirotome TTNB of selected lesions is feasible and accurate. It provides adequate samples for diagnosis, comparable to 18-gauge Tru-Cut needle, with a higher amount of tumor tissue (weight, TC, DNA concentration) even in shorter samples.

  12. Carbon fibre and nitinol needles for MRI-guided interventions: First in vitro and in vivo application

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Christoph, E-mail: Christoph.thomas@med.uni-tuebingen.de [Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Wojtczyk, Hanne [Section of Experimental Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Rempp, Hansjoerg; Clasen, Stephan; Horger, Marius [Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Lassberg, Christoph von [Department of Sports Medicine, University of Tuebingen, Silcherstrasse 5, 72076 Tuebingen (Germany); Fritz, Jan [Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 (United States); Claussen, Claus D. [Department of Diagnostic and Interventional Radiology, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen (Germany); Pereira, Philippe L. [Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078 Heilbronn (Germany)

    2011-09-15

    Objective: To assess the artefact properties of a MR-compatible carbon fibre needle with a nitinol mandrin in vitro and to report first clinical experiences. Materials and methods: In vitro, the carbon fibre/nitinol needle was imaged at different angles against the main magnetic field (1.5 T open bore magnet). A gradient echo MR fluoroscopy sequence (GRE: TR 9.3 ms, TE 3.12 ms, bandwidth 200 Hz/pixel, flip-angle 12{sup o}) and a fast turbo spin echo sequence (FSE: TR 412 ms, TE 9.7 ms, bandwidth 200 Hz/pixel, flip-angle 150{sup o}) were used. Artefact width, needle intensity contrast and needle tip location errors were assessed. In vivo, lumbar periradicular corticosteroid injections and one sclerotherapy were performed with carbon fibre needles (10 procedures) and with titanium alloy needles (2 procedures). The artefact sizes and contrasts were measured. Results: In vitro, artefact diameters of the carbon fibre needle ranged from 3.3 to 4.6 mm, contrasts from 0.11 to 0.52, with larger artefact contrasts and widths with the GRE sequence. Needle tip location errors of -2.1 to -2.8 mm were observed. Decreasing angles to the main field lead to smaller artefacts. In vivo, the carbon fibre/nitinol needle produced smaller artefacts (mean width FSE/GRE: 2.8 mm/4.6 mm) with lower contrast (0.30-0.42) than the titanium alloy needle (mean width FSE/GRE: 4.1 mm/7.5 mm, contrast 0.60-0.73). Conclusions: The carbon fibre/nitinol needle is useful for performing MR-guided interventions at 1.5 T, producing more subtle artefacts than a titanium alloy needle, but with an incomplete depiction and thus inaccurate localization of the needle tip.

  13. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

    International Nuclear Information System (INIS)

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvao Vieira; Matushita Junior, Joao Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens

    2014-01-01

    Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paraesthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. (author)

  14. Computed tomography-guided percutaneous biopsy of bone lesions: rate of diagnostic success and complications

    Energy Technology Data Exchange (ETDEWEB)

    Maciel, Macello Jose Sampaio; Tyng, Chiang Jeng; Barbosa, Paula Nicole Vieira Pinto; Bitencourt, Almir Galvao Vieira; Matushita Junior, Joao Paulo Kawaoka; Zurstrassen, Charles Edouard; Chung, Wu Tu; Chojniak, Rubens, E-mail: macellomaciel@me.com [A.C.Camargo Cancer Center, Sao Paulo, SP (Brazil)

    2014-09-15

    Objective: To determine the rates of diagnostic success and complications of computed tomography (CT)-guided percutaneous biopsy of bone lesions suspected for malignancy. Materials and Methods: Retrospective study including 186 cases of CT-guided percutaneous biopsies of bone lesions in the period from January, 2010 to December, 2012. All the specimens were obtained with 8-10 gauge needles. The following data were collected: demographics, previous history of malignancy, data related to the lesion, to the procedure, and to histological results. Results: Most patients were women (57%), and the mean age was 53.0 ± 16.4 years. In 139 cases (74.6%), there was diagnostic suspicion of metastasis and the most common primary tumors were breast (32.1%) and prostate (11.8%). The bones most commonly involved were spine (36.0%), hip (32.8%) and long bones (18.3%). Complications occurred in only three cases (1.6%) including bone fracture, paraesthesia with functional impairment, and needle breakage requiring surgical removal. The specimens collected from 183 lesions (98.4%) were considered appropriate for diagnosis. Malignant results were more frequently found in patients who had a suspected secondary lesion and history of known malignancy (p < 0.001), and in patients who underwent PET/CT-guided procedures (p = 0.011). Conclusion: CT-guided percutaneous biopsy is a safe and effective procedure for the diagnosis of suspicious bone lesions. (author)

  15. Histopathologic quality of prostate core biopsy specimens: comparison of an MR-compatible biopsy needle and a ferromagnetic biopsy needle used for ultrasound-guided prostate biopsy

    International Nuclear Information System (INIS)

    Franiel, T.; Hamm, B.; Beyersdorff, D.; Fritzsche, F.; Staack, A.; Rost, J.

    2006-01-01

    Purpose: The histopathologic quality of core biopsy specimens obtained via MRI-guided prostate biopsy using a 16G MR-compatible needle was compared to that of biopsies obtained via ultrasound-guided biopsy using a conventional 18G stainless steel biopsy needle. Material and Methods: A retrospective analysis was performed for a total of 247 transrectal prostate biopsy specimens obtained from 32 patients. A total of 117 tissue cores were obtained from 15 patients (PSA of 10.8 ng/ml, age 64 years) who underwent an MRI-guided prostate biopsy using a 16G (1.7 mm) MR-compatible biopsy needle made of titanium alloy. The remaining 130 tissue cores were obtained from 17 patients (PSA of 6.7 ng/ml, age 68 years) who underwent a transrectal ultrasound-guided prostate biopsy using an 18G (1.3 mm) ferromagnetic stainless steel biopsy needle. The length and width of the histologic sections prepared from the tissue cores were measured to calculate the area. The histopathologic quality of the specimens was assessed microscopically using tissue fragmentation, the presence of crush artifacts, and the overall assessability as criteria. Each of these features was assigned a score from 0 to 3. All 3 features contributed equally to the overall score which ranged from 0 (no tissue) to 9 (optimal quality). Results: The overall quality scores assigned to the biopsies obtained with a 16G MR-compatible needle and an 18G ferromagnetic needle can be considered to be equivalent to a mean difference between patient related median scores of the specimens of -0.05 (95% confidence interval [-0.46; 0.36]) and a given equivalence limit of 1. The MRI biopsies showed more tissue fragmentation (p=0.001) but fewer crush artifacts (p=0.022) while the assessability did not differ significantly between the two needle types (p=0.064). There was also no significant difference in the calculated areas of the tissue cores (p=0.236). According to the different calibers of the biopsy needles, the lengths (p=0

  16. Diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy in cavitary pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping, E-mail: yipingzhuang2010@sina.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Wang, Hai-Yan, E-mail: mycherishgirl@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Jin, E-mail: yari_zj@hotmail.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Feng, Yong, E-mail: fengyong119@sohu.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China); Zhang, Lei, E-mail: motozl163@163.com [Department of Radiology, Jiangsu Cancer Institute and Hospital, No. 42 Baiziting Road, Nanjing 210009, Jiangsu (China)

    2013-01-15

    Objective: CT-guided transthoracic biopsy is a well-established method in the cytologic or histologic diagnosis of pulmonary lesions. The knowledge of its diagnostic performance and complications for cavitary pulmonary lesions is limited. The purpose of this study was to determine the diagnostic accuracy and safety of CT-guided fine needle aspiration biopsy (FNAB) in cavitary pulmonary lesions. Materials and methods: 102 consecutive patients with pulmonary cavitary lesions received CT-guided FNAB with use of an 18-gauge (n = 35) or 20-gauge (n = 67) Chiba for histology diagnosis. The sensitivity, specificity, and diagnostic accuracy of FNAB were calculated as compared with the final diagnosis. Complications associated with FNAB were observed. The diagnostic accuracy and complications were compared between patients with different lesion sizes and different cavity wall thickness. Results: The overall sensitivity, specificity, and accuracy of FNAB were 96.3%, 98.0%, and 96.1%, respectively. The sensitivity, specificity, and diagnosis accuracy in different lesion size (<2 cm vs ≥2 cm), or different cavity wall thickness (<5 mm vs ≥5 mm) were not different (P > 0.05; 0.235). More nondiagnostic sample was found in wall thickness <5 mm lesions (P = 0.017). Associated complications included pneumothorax in 9 (8.8%) patients and alveolar hemorrhage in 14 patients (13.7%) and hemoptysis in 1 patient (1%). No different rate of complications was found with regard to lesion size, wall thickness, length of the needle path and needle size (P > 0.05). Conclusion: CT-guided FNAB can be effectively ad safely used for patients with pulmonary cavitary lesions.

  17. Comparison of needles size in pediatric renal biopsy with sono-guided percutaneous-automated gun technique

    International Nuclear Information System (INIS)

    Kim, Jong Chul; Park, Jin Yong

    1997-01-01

    To compare the efficacy of a 20-gauge and an 18-gauge needle in sono-guided percutaneous automated gun biopsy for establishing the specific diagnosis of renal parenchymal disease in pediatric kidneys. In 60 pediatric patients with renal parenchymal diseases, percutaneous sono-guided gun biopsy was performed by an experienced radiologist. In two groups of 30 patients, regardless of their age, two needle passes were performed, using alternately an 18-gauge or a 20-gauge biopsy needle. The core of renal tissue thus obtained was examined with light, immunofluorescent or electron microscopy by the renal pathologist. The mean number of intact glomeruli of whole tissue core per biopsy, as seen on the light microscopy, and post-bioptic complications were compared between the two different needle size groups. The number (mean±1 standard deviation) of glomeruli obtained per biopsy was 17±8 in the 18-gauge needle group, and 14±5 in the 20-gauge group. Between two groups, there was no major post-bioptic complication requiring specific treatment, nor a statistically significant difference in the frequency of minor complications. Even though more glomeruli were obtained with an 18-gauge needle, the number obtained with a 20-gauge needle also permitted adequate pathologic examination. Both an 18-gauge and a 20-gauge needle may thus be suitable for renal biopsy in pediatric patients

  18. Diagnostic efficacy of ultrasound-guided core-needle biopsy of peripheral lymph nodes in sarcoidosis.

    Science.gov (United States)

    Boussouar, S; Medjhoul, A; Bernaudin, J F; Tayebjee, O; Soussan, M; Uzunhan, Y; Nunes, H; Kambouchner, M; Martin, A; Valeyre, D; Brillet, P Y

    2015-09-14

    Core-needle biopsy guided by ultrasound can be performed for investigating peripheral lymph node (PLN). The aim of this study was to determine the efficacy of this technique in sarcoidosis. Retrospective review of files of all patients in the database of the radiology department of Avicenne university hospital who underwent PLN biopsies guided by ultrasound from January 2008 to June 2011 (n=292). Cases with either granulomas at histology with the procedure or with a final diagnosis of sarcoidosis were included in the study. The histological specimens were adequate in 282 out of 292 cases (96%) showing non-caseating granulomas in 22 cases (n=20 patients with a final diagnosis of sarcoidosis and n=2 patients with tuberculosis). After reviewing clinical files of the 282 patient, 22 were confirmed to have sarcoidosis, at initial presentation (n=19) or later during flare-up or relapse (n=3) with only 2 patients having no granuloma on PLN biopsy. PLN were palpable in 18 cases and only detected by (18F)FDG-PET/CT showing increased PLN uptake in 4 cases. The sensitivity and specificity of adequate biopsy were 91 and 99% and the positive and negative predictive values were 91 and 99%, respectively. Core-needle biopsy guided by ultrasound has a high efficacy for evidencing granulomas in sarcoidosis patients with PLN involvement either clinically palpable or in the presence of (18F)FDG-PET/CT uptake.

  19. Compressed sensing electron tomography of needle-shaped biological specimens – Potential for improved reconstruction fidelity with reduced dose

    Energy Technology Data Exchange (ETDEWEB)

    Saghi, Zineb, E-mail: saghizineb@gmail.com [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Divitini, Giorgio [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Winter, Benjamin [Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg, Cauerstraße 6, 91058 Erlangen (Germany); Leary, Rowan [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Spiecker, Erdmann [Center for Nanoanalysis and Electron Microscopy (CENEM), Friedrich-Alexander-Universität Erlangen-Nürnberg, Cauerstraße 6, 91058 Erlangen (Germany); Ducati, Caterina [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom); Midgley, Paul A., E-mail: pam33@cam.ac.uk [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, Cambridge CB3 0FS (United Kingdom)

    2016-01-15

    Electron tomography is an invaluable method for 3D cellular imaging. The technique is, however, limited by the specimen geometry, with a loss of resolution due to a restricted tilt range, an increase in specimen thickness with tilt, and a resultant need for subjective and time-consuming manual segmentation. Here we show that 3D reconstructions of needle-shaped biological samples exhibit isotropic resolution, facilitating improved automated segmentation and feature detection. By using scanning transmission electron tomography, with small probe convergence angles, high spatial resolution is maintained over large depths of field and across the tilt range. Moreover, the application of compressed sensing methods to the needle data demonstrates how high fidelity reconstructions may be achieved with far fewer images (and thus greatly reduced dose) than needed by conventional methods. These findings open the door to high fidelity electron tomography over critically relevant length-scales, filling an important gap between existing 3D cellular imaging techniques. - Highlights: • On-axis electron tomography of a needle-shaped biological sample is presented. • A reconstruction with isotropic resolution is achieved. • Compressed sensing methods are compared to conventional reconstruction algorithms. • High fidelity reconstructions are achieved with greatly undersampled datasets.

  20. Compressed sensing electron tomography of needle-shaped biological specimens – Potential for improved reconstruction fidelity with reduced dose

    International Nuclear Information System (INIS)

    Saghi, Zineb; Divitini, Giorgio; Winter, Benjamin; Leary, Rowan; Spiecker, Erdmann; Ducati, Caterina; Midgley, Paul A.

    2016-01-01

    Electron tomography is an invaluable method for 3D cellular imaging. The technique is, however, limited by the specimen geometry, with a loss of resolution due to a restricted tilt range, an increase in specimen thickness with tilt, and a resultant need for subjective and time-consuming manual segmentation. Here we show that 3D reconstructions of needle-shaped biological samples exhibit isotropic resolution, facilitating improved automated segmentation and feature detection. By using scanning transmission electron tomography, with small probe convergence angles, high spatial resolution is maintained over large depths of field and across the tilt range. Moreover, the application of compressed sensing methods to the needle data demonstrates how high fidelity reconstructions may be achieved with far fewer images (and thus greatly reduced dose) than needed by conventional methods. These findings open the door to high fidelity electron tomography over critically relevant length-scales, filling an important gap between existing 3D cellular imaging techniques. - Highlights: • On-axis electron tomography of a needle-shaped biological sample is presented. • A reconstruction with isotropic resolution is achieved. • Compressed sensing methods are compared to conventional reconstruction algorithms. • High fidelity reconstructions are achieved with greatly undersampled datasets.

  1. Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions

    Energy Technology Data Exchange (ETDEWEB)

    Lima, Cristiano Dias de; Nunes, Rodolfo Acatauassu; Saito, Eduardo Haruo; Higa, Claudio; Cardona, Zanier Jose Fernando; Santos, Denise Barbosa dos, E-mail: cristianodiaslima@gmail.co [Hospital Universitario Pedro Ernesto (HUPE/UERJ), Rio de Janeiro, RJ (Brazil). Dept. Cirurgia Toracica

    2011-03-15

    Objective: to analyze the cytological findings of CT-guided percutaneous fine-needle aspiration biopsies of the lung, to demonstrate the diagnostic feasibility of the method in the investigation of pulmonary lesions, and to determine the complications of the procedure, evaluating its safety. Methods: a retrospective analysis of 89 patients with various types of pulmonary lesions who underwent 97 procedures over a period of five years. The patients were divided into groups regarding the indication for the procedure: suspicion of primary lung cancer (stages IIIB or IV); suspicion of lung cancer (stages I, II, or IIIA) and clinical contraindications for surgery; suspicion of pulmonary metastasis from other organs; and pulmonary lesions with benign radiological aspect. All of the procedures were performed with 25-gauge needles and were guided by spiral CT. The final diagnosis was confirmed by surgical biopsy and clinical/oncological follow-up. For the analysis of complications, the total number of procedures was considered. Results: the main indication for the procedure was suspicion of advanced stage primary lung cancer. The accuracy of the method for malignant lesions was 91.5%. The lesion was confirmed as cancer in 73% of the patients. The major complication was pneumothorax (27.8%), which required chest tube drainage in 12.4% of the procedures. Conclusions: the principal indication for CT-guided fine-needle biopsy was suspicion of primary lung cancer in patients who were not surgical candidates. The procedure has high diagnostic feasibility for malignant pulmonary diseases. The most prevalent complication was pneumothorax. However, in most cases, chest tube drainage was unnecessary. No deaths were related to the procedure. (author)

  2. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.

    Science.gov (United States)

    Sanchez, Leon D; Straszewski, Shannon; Saghir, Amina; Khan, Atif; Horn, Erin; Fischer, Christopher; Khosa, Faisal; Camacho, Marc A

    2011-10-01

    Recent research describes failed needle decompression in the anterior position. It has been hypothesized that a lateral approach may be more successful. The aim of this study was to identify the optimal site for needle decompression. A retrospective study was conducted of emergency department (ED) patients who underwent computed tomography (CT) of the chest as part of their evaluation for blunt trauma. A convenience sample of 159 patients was formed by reviewing consecutive scans of eligible patients. Six measurements from the skin surface to the pleural surface were made for each patient: anterior second intercostal space, lateral fourth intercostal space, and lateral fifth intercostal space on the left and right sides. The distance from skin to pleura at the anterior second intercostal space averaged 46.3 mm on the right and 45.2 mm on the left. The distance at the midaxillary line in the fourth intercostal space was 63.7 mm on the right and 62.1 mm on the left. In the fifth intercostal space the distance was 53.8 mm on the right and 52.9 mm on the left. The distance of the anterior approach was statistically less when compared to both intercostal spaces (p < 0.01). With commonly available angiocatheters, the lateral approach is less likely to be successful than the anterior approach. The anterior approach may fail in many patients as well. Longer angiocatheters may increase the chances of decompression, but would also carry a higher risk of damage to surrounding vital structures. © 2011 by the Society for Academic Emergency Medicine.

  3. Endoscopic ultrasound-guided fine-needle tissue acquisition - A review and update of literature

    Directory of Open Access Journals (Sweden)

    Benjamin Tharian

    2015-01-01

    Full Text Available Ever since the first endoscopic ultrasound-guided fine needle aspiration (FNA was done in 1992, the procedure has evolved to become an indispensable tool for tissue acquisition in patients with gastrointestinal tumors and periluminal lesions. With the growing evidence of neoadjuvant therapy and research into intratumoral therapy, the need to obtain tissue diagnosis for tumors is quite apparent. This review provides an overall perspective to the endosonographer on various issues that are a key for best practices in FNA, in addition to being an update for practicing experienced endosonographers.

  4. Application of B-ultrasonic guided fine needle aspiration cytology in diagnosis of tuberculous lymphadenitis

    International Nuclear Information System (INIS)

    Yu Qi; Yang Jianghui; Li Ning

    2011-01-01

    To explore the value of B-ultrasonic guided fine needle aspiration cytology(FNAC) in the diagnosis of tuberculous lymphadenitis (TB). The patients were carried out FNAC under B-ultrasonic guidance to distinguish the tuberculosis lymphadenitis. With the FNAC diagnosis of lymphoglandulae and reactive hyperplasia lesions of 80 cases, 41 cases were confirmed by histopathology. With FNAC diagnosed tuberculosis 36 cases, granulomatous lymphadenitis 2 cases and reactive hyperplasia 3 cases. FANC is one of efficient method to diagnosis the tuberculous lymphadenitis. This method has some limitations, but it could be overcome by biopsy or polymerase chain reaction. (authors)

  5. Image guided versus palpation guided core needle biopsy of palpable breast masses: a prospective study

    Directory of Open Access Journals (Sweden)

    Smriti Hari

    2016-01-01

    Interpretation & conclusions: Our results showed that in palpable breast masses, image guided biopsy was superior to palpation guided biopsy in terms of sensitivity, false negative rate and repeat biopsy rates.

  6. Percutaneous CT-Guided Core Needle Biopsy Versus Fine Needle Aspiration in Diagnosing Pneumonia and Mimics of Pneumonia

    International Nuclear Information System (INIS)

    Thanos, Loukas; Galani, Panagiota; Mylona, Sophia; Pomoni, Maria; Mpatakis, Nikolaos

    2004-01-01

    The purpose of this study was to determine the diagnostic value of percutaneous core needle biopsy (CNB) relative to fine needle aspiration (FNA) in patients with pneumonia and pneumonia mimics. In this prospective study we present our experience with 48 thoracic FNAs and CNBs carried out on 48 patients with pneumonia and pneumonia mimics. Samples were obtained from all patients using both CNB (with an automated 18-G core biopsy needle and a gun) and FNA (with a 22-G needle). A specific diagnosis was made in 10/48 cases (20.83%) by FNA and in 42/48 (87.5%) by CNB. The main complications encountered were pneumothorax (n = 4) and hemoptysis (n = 2), yielding a total complication rate of 12.5%. We concluded that CNB using an automated biopsy gun results in a higher diagnostic accuracy for pneumonia and pneumonia mimic biopsies than FNA. Complications should be considered and proper patient observation should follow the procedure

  7. Comparison of 22G reverse-beveled versus standard needle for endoscopic ultrasound-guided sampling of solid pancreatic lesions

    Science.gov (United States)

    Alatawi, Abdullah; Beuvon, Frédéric; Grabar, Sophie; Leblanc, Sarah; Chaussade, Stanislas; Terris, Benoit; Barret, Maximilien

    2015-01-01

    Objectives Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) using standard needles has a high diagnostic value in the evaluation of solid pancreatic masses. Fenestrated needles have been developed to improve the quality of EUS-guided tissue sampling by providing core biopsies (FNB). Methods Patients with solid pancreatic masses of >2 cm were prospectively included in our study and randomized to receive EUS sampling, using either a standard 22G FNA or a 22G Procore® FNB needle. The main study endpoint was the number of needle passes required to obtain a diagnosis in more than 90% of cases. Results We included 100 patients (male = 63, female = 37; mean age = 68.4 years) in our study. We found that 88% of the lesions were malignant, with a mean size of 32 mm. A sample adequate for diagnosis was obtained in more than 90% of cases after the second needle pass in the FNB group, versus the third needle pass in the FNA group. Slide cellularity and presence of tissue microfragments were significantly higher in the FNB group. Sensitivity for the diagnosis of malignancy was 88.4% versus 97.8% for the EUS-FNA and EUS-FNB group, respectively, while specificity for both techniques was 100%. No complications were recorded. Conclusions Although the accuracy of both needle types for proving malignancy was similar, a lower number of passes was required with the FNB needles to achieve the same contributive sample rate as with the FNA needles. FNB also improved the histopathological quality of specimens, suggesting an overall superiority of FNB sampling. PMID:26279842

  8. Ultrasound-guided, minimally invasive, percutaneous needle puncture treatment for tennis elbow.

    Science.gov (United States)

    Zhu, Jiaan; Hu, Bing; Xing, Chunyan; Li, Jia

    2008-10-01

    This report evaluates the efficacy of percutaneous needle puncture under sonographic guidance in treating lateral epicondylitis (tennis-elbow). Ultrasound-guided percutaneous needle puncture was performed on 76 patients who presented with persistent elbow pain. Under a local anesthetic and sonographic guidance, a needle was advanced into the calcification foci and the calcifications were mechanically fragmented. This was followed by a local injection of 25 mg prednisone acetate and 1% lidocaine. If no calcification was found then multiple punctures were performed followed by local injection of 25 mg prednisone acetate and 1% lidocaine. A visual analog scale (VAS) was used to evaluate the degree of pain pre-and posttreatment at 1 week to 24 weeks. Elbow function improvement and degree of self-satisfaction were also evaluated. Of the 76 patients, 55% were rated with excellent treatment outcome, 32% good, 11% average, and 3% poor. From 3 weeks posttreatment, VAS scores were significantly reduced compared with the pretreatment score (Ptennis elbow. Sonography can be used to accurately identify the puncture location and monitor changes.

  9. Image-guided core-needle biopsy of peripheral lymph nodes allows the diagnosis of lymphomas

    International Nuclear Information System (INIS)

    Kerviler, Eric de; Bazelaire, Cedric de; Mathieu, Olivier; Frija, Jacques; Mounier, Nicolas; Gisselbrecht, Christian; Brethon, Benoit; Briere, Josette; Marolleau, Jean-Pierre; Brice, Pauline

    2007-01-01

    It is commonly admitted that the diagnosis of lymphomas can be assessed by the image-guided needle biopsy (IGNB) of deep lymph nodes. However, when peripheral lymph nodes are present, surgical dissection remains the standard strategy. The aim of this study was to evaluate the diagnostic yield of IGNB of peripheral lymph nodes in patients with suspected lymphomas. The records of 180 multisampling IGNBs of peripheral lymph nodes in 180 patients were reviewed. One hundred and twenty-three IGNBs were observed at first diagnosis and 57 at progression using large-cutting core-biopsy needles ranging between 18 G and 14 G in size. Immunohistochemistry studies were performed in all cases and at least one biopsy was systematically frozen. A diagnosis of lymphoma with sufficient information such that a therapeutic decision could be made was obtained in 146 of the 152 patients with lymphoproliferative disorders (96%). IGNB was equally effective in making the correct diagnosis of lymphoma at the time of original diagnosis than at relapse. The results did not depend on the biopsy site, lymph nodes size, or needle type. We recommend that IGNB may be performed as an initial procedure for the diagnosis of lymphomas either in the presence of peripheral or deep lymph nodes, as it avoids surgery. (orig.)

  10. A serious game for learning ultrasound-guided needle placement skills.

    Science.gov (United States)

    Chan, Wing-Yin; Qin, Jing; Chui, Yim-Pan; Heng, Pheng-Ann

    2012-11-01

    Ultrasound-guided needle placement is a key step in a lot of radiological intervention procedures such as biopsy, local anesthesia and fluid drainage. To help training future intervention radiologists, we develop a serious game to teach the skills involved. We introduce novel techniques for realistic simulation and integrate game elements for active and effective learning. This game is designed in the context of needle placement training based on the some essential characteristics of serious games. Training scenarios are interactively generated via a block-based construction scheme. A novel example-based texture synthesis technique is proposed to simulate corresponding ultrasound images. Game levels are defined based on the difficulties of the generated scenarios. Interactive recommendation of desirable insertion paths is provided during the training as an adaptation mechanism. We also develop a fast physics-based approach to reproduce the shadowing effect of needles in ultrasound images. Game elements such as time-attack tasks, hints and performance evaluation tools are also integrated in our system. Extensive experiments are performed to validate its feasibility for training.

  11. Pancreatic metastases from ocular malignant melanoma: the use of endoscopic ultrasound-guided fine-needle aspiration to establish a definitive cytologic diagnosis: a case report

    Directory of Open Access Journals (Sweden)

    Diogo Turiani Hourneaux De Moura

    2016-12-01

    Full Text Available Abstract Background When encountering solid pancreatic lesions, nonpancreatic primary metastases are rare and differentiating a metastasis from a primary neoplastic lesion is challenging. The clinical presentation and radiologic features can be similar and the possibility of a pancreatic metastasis should be considered when the patient refers to a history of a different primary cancer. Endoscopic ultrasound offers a key anatomical advantage in accessing the pancreas and endoscopic ultrasound-guided fine-needle aspiration has become the gold standard method for diagnosing pancreatic lesions. Case presentation A 58-year-old white Hispanic woman with a history of uveal malignant melanoma, presented with abdominal pain and jaundice. On admission, laboratory tests were performed (her total bilirubin was 6.37 mg/dL with a direct fraction of 5.30 mg/dL. Cross-sectional, abdominal computed tomography with contrast, showed a low-attenuating lesion localized in the pancreatic head (measuring 4 × 3 cm and a thinner section of the distal bile duct suspicious for compression. Our patient was scheduled for an endoscopic ultrasound-guided fine-needle aspiration to establish a diagnosis. Endoscopic ultrasound showed a solid, hypoechoic, well-defined lesion with regular contours (measuring 3.17 × 2.61 cm, localized between the head and neck of the pancreas. Endoscopic ultrasound-guided fine-needle aspiration was performed with a 22G needle and cytology confirmed the diagnosis of metastatic melanoma. Our patient subsequently underwent right orbital exenteration, followed by duodenopancreatectomy without complications. At the moment our patient is receiving adjuvant chemotherapy at an outside oncology clinic. Conclusions To the best of our knowledge, this is a very rare presentation of an ocular malignant melanoma with an isolated pancreatic metastasis causing symptomatic biliary obstruction. Endoscopic ultrasound-guided fine-needle aspiration has

  12. Needle localization using a moving stylet/catheter in ultrasound-guided regional anesthesia: a feasibility study

    Science.gov (United States)

    Beigi, Parmida; Rohling, Robert

    2014-03-01

    Despite the wide range and long history of ultrasound guided needle insertions, an unresolved issue in many cases is clear needle visibility. A well-known ad hoc technique to detect the needle is to move the stylet and look for changes in the needle appearance. We present a new method to automatically locate a moving stylet/catheter within a stationary cannula using motion detection. We then use this information to detect the needle trajectory and the tip. The differences between the current frame and the previous frame are detected and localized, to minimize the influence of tissue global motions. A polynomial fit based on the detected needle axis determines the estimated stylet shaft trajectory, and the extent of the differences along the needle axis represents the tip. Over a few periodic movements of the stylet including its full insertion into the cannula to the tip, a combination of polynomial fits determines the needle trajectory and the last detected point represents the needle tip. Experiments are conducted in water bath and bovine muscle tissue for several stylet/catheter materials. Results show that a plastic stylet has the best needle shaft and tip localization accuracy in the water bath with RMSE = 0:16 mm and RMSE = 0:51 mm, respectively. In the bovine tissue, the needle tip was best localized with the plastic catheter with RMSE = 0:33 mm. The stylet tip localization was most accurate with the steel stylet, with RMSE = 2:81 mm and the shaft was best localized with the plastic catheter, with RMSE = 0:32 mm.

  13. Computed tomography-guided percutaneous biopsy of pancreatic masses using pneumodissection; Biopsia percutanea de massas pancreaticas guiada por tomografia computadorizada com pneumodisseccao

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang Jeng; Bitencourt, Almir Galvao Vieira; Almeida, Maria Fernanda Arruda; Barbosa, Paula Nicole Vieira; Martins, Eduardo Bruno Lobato; Junior, Joao Paulo Kawaoka Matushita; Chojniak, Rubens, E-mail: chiangjengtyng@gmail.com [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Imagem; Coimbra, Felipe Jose Fernandez [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Cirurgia Abdominal

    2013-05-15

    Objective: to describe the technique of computed tomography-guided percutaneous biopsy of pancreatic tumors with pneumodissection. Materials and methods: in the period from June 2011 to May 2012, seven computed tomography guided percutaneous biopsies of pancreatic tumors utilizing pneumodissection were performed in the authors' institution. All the procedures were performed with an automatic biopsy gun and coaxial system with Tru-core needles. The biopsy specimens were histologically assessed. Results: in all the cases the pancreatic mass could not be directly approached by computed tomography without passing through major organs and structures. The injection of air allowed the displacement of adjacent structures and creation of a safe coaxial needle pathway toward the lesion. Biopsy was successfully performed in all the cases, yielding appropriate specimens for pathological analysis. Conclusion: Pneumodissection is a safe, inexpensive and technically easy approach to perform percutaneous biopsy in selected cases where direct access to the pancreatic tumor is not feasible. (author)

  14. Automated Real-Time Needle-Guide Tracking for Fast 3-T MR-guided Transrectal Prostate Biopsy: A Feasibility Study

    NARCIS (Netherlands)

    Zamecnik, P.; Schouten, M.G.; Krafft, A.J.; Maier, F.; Schlemmer, H.-P.; Barentsz, J.O.; Bock, M. de; Futterer, J.J.

    2014-01-01

    Purpose To assess the feasibility of automatic needle-guide tracking by using a real-time phase-only cross correlation (POCC) algorithm-based sequence for transrectal 3-T in-bore magnetic resonance (MR)-guided prostate biopsies. Materials and Methods This study was approved by the ethics review

  15. Mediastinal abscess after endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.

    Science.gov (United States)

    Leong, Steven C; Marshall, Henry M; Bint, Michael; Yang, Ian A; Bowman, Rayleen V; Fong, Kwun M

    2013-10-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique that allows lung cancer nodal staging and biopsy of parabronchial and paratracheal tissue. Its simplicity, high diagnostic yield, ability to diagnose both benign and malignant conditions, and exceedingly low complication rate has resulted in rapid widespread adoption by surgeons and physicians. EBUS-TBNA-related complications, however, do occur and need to be considered when assessing the risk-benefit profile of performing the procedure, and if the patient represents with unexpected symptoms after the procedure. We describe a 64-year-old woman who presented with a mediastinal abscess 5 days after EBUS-TBNA. This case demonstrates the importance of considering EBUS-TBNA-related complications to guide relevant imaging decisions and antibiotic choices. We review the published literature regarding infective complications of EBUS-TBNA and propose possible pathophysiologies. These complications are likely to increase in frequency as the technique is more widely adopted.

  16. Radiographic-guided fine-needle aspiration of nonpalpable breast lesions

    International Nuclear Information System (INIS)

    Helvie, M.A.; Baker, D.E.; Adler, D.D.; Andersson, I.; Naylor, B.; Buckwalter, K.

    1989-01-01

    The authors have performed radiographically guided fine-needle aspirations (FNA) on 215 nonpalpable mammographically detected breast lesions, using a coordinate grid localization system. Aspirates were classified into five cytologic groups. With the most stringent cytologic criteria, the sensitivity was 98% and the specificity 95% for the detection of carcinoma. However, according to these strict cytologic criteria, only 46% of aspirates contained representative material. Forty-two of 74 lesions undergoing biopsy proved malignant. Sixteen percent of patients did not compete adequate mammographic follow-up. High sensitivity and specificity can be achieved with radiographically guided FNA. However, management decisions ultimately require integration of mammographic findings with cytologic results. Close cooperation between mammographer, surgeon, cytopathologist, and patients is mandatory for successful operation

  17. Integration and evaluation of a needle-positioning robot with volumetric microcomputed tomography image guidance for small animal stereotactic interventions

    International Nuclear Information System (INIS)

    Waspe, Adam C.; McErlain, David D.; Pitelka, Vasek; Holdsworth, David W.; Lacefield, James C.; Fenster, Aaron

    2010-01-01

    Purpose: Preclinical research protocols often require insertion of needles to specific targets within small animal brains. To target biologically relevant locations in rodent brains more effectively, a robotic device has been developed that is capable of positioning a needle along oblique trajectories through a single burr hole in the skull under volumetric microcomputed tomography (micro-CT) guidance. Methods: An x-ray compatible stereotactic frame secures the head throughout the procedure using a bite bar, nose clamp, and ear bars. CT-to-robot registration enables structures identified in the image to be mapped to physical coordinates in the brain. Registration is accomplished by injecting a barium sulfate contrast agent as the robot withdraws the needle from predefined points in a phantom. Registration accuracy is affected by the robot-positioning error and is assessed by measuring the surface registration error for the fiducial and target needle tracks (FRE and TRE). This system was demonstrated in situ by injecting 200 μm tungsten beads into rat brains along oblique trajectories through a single burr hole on the top of the skull under micro-CT image guidance. Postintervention micro-CT images of each skull were registered with preintervention high-field magnetic resonance images of the brain to infer the anatomical locations of the beads. Results: Registration using four fiducial needle tracks and one target track produced a FRE and a TRE of 96 and 210 μm, respectively. Evaluation with tissue-mimicking gelatin phantoms showed that locations could be targeted with a mean error of 154±113 μm. Conclusions: The integration of a robotic needle-positioning device with volumetric micro-CT image guidance should increase the accuracy and reduce the invasiveness of stereotactic needle interventions in small animals.

  18. Integration and evaluation of a needle-positioning robot with volumetric microcomputed tomography image guidance for small animal stereotactic interventions

    Energy Technology Data Exchange (ETDEWEB)

    Waspe, Adam C.; McErlain, David D.; Pitelka, Vasek; Holdsworth, David W.; Lacefield, James C.; Fenster, Aaron [Biomedical Engineering Graduate Program and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Department of Medical Biophysics and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario N6A 5C1 (Canada); Biomedical Engineering Graduate Program, Department of Medical Biophysics, Department of Medical Imaging, Department of Surgery, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Graduate Program, Department of Electrical and Computer Engineering, Department of Medical Biophysics, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Graduate Program, Department of Medical Biophysics, Department of Medical Imaging, and Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada)

    2010-04-15

    Purpose: Preclinical research protocols often require insertion of needles to specific targets within small animal brains. To target biologically relevant locations in rodent brains more effectively, a robotic device has been developed that is capable of positioning a needle along oblique trajectories through a single burr hole in the skull under volumetric microcomputed tomography (micro-CT) guidance. Methods: An x-ray compatible stereotactic frame secures the head throughout the procedure using a bite bar, nose clamp, and ear bars. CT-to-robot registration enables structures identified in the image to be mapped to physical coordinates in the brain. Registration is accomplished by injecting a barium sulfate contrast agent as the robot withdraws the needle from predefined points in a phantom. Registration accuracy is affected by the robot-positioning error and is assessed by measuring the surface registration error for the fiducial and target needle tracks (FRE and TRE). This system was demonstrated in situ by injecting 200 {mu}m tungsten beads into rat brains along oblique trajectories through a single burr hole on the top of the skull under micro-CT image guidance. Postintervention micro-CT images of each skull were registered with preintervention high-field magnetic resonance images of the brain to infer the anatomical locations of the beads. Results: Registration using four fiducial needle tracks and one target track produced a FRE and a TRE of 96 and 210 {mu}m, respectively. Evaluation with tissue-mimicking gelatin phantoms showed that locations could be targeted with a mean error of 154{+-}113 {mu}m. Conclusions: The integration of a robotic needle-positioning device with volumetric micro-CT image guidance should increase the accuracy and reduce the invasiveness of stereotactic needle interventions in small animals.

  19. Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration

    Science.gov (United States)

    Konge, Lars; Nayahangan, Leizl Joy; Clementsen, Paul Frost

    2017-01-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible. PMID:28840013

  20. Imaging-guided percutaneous needle biopsy for infectious spondylitis: Factors affecting culture positivity

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Si Yoon; Kwon, Jong Won [Dept. of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2015-11-15

    To evaluate the variable factors affecting the results of percutaneous needle biopsies for infectious spondylitis. In all, 249 patients who underwent both MRI and percutaneous needle biopsies due to a suspicion of infectious spondylitis were evaluated with respect to the following factors: the usage of antibiotics before the procedure, the location of the biopsy, the guiding equipment used, the experience level of the operators, and the number of biopsies performed. The positivity of culture in cases of treated with antibiotics (16.3%) before the biopsy was lower than in the untreated cases (30.5%) (p = 0.004). Biopsies performed at the abscess (43.5%) and with fluoroscopic guidance (27.8%) showed higher culture positivity as well. The experience level of the operators and the number of biopsies had no effect on culture positivity. The usage of antibiotics before the biopsy, the biopsy's location, and the guiding equipment used affect the culture positivity, while the experience levels of the operators and the number of biopsies do not have an effect.

  1. The diagnostic value of ultrasound-guided fine-needle aspiration biopsy in breast masses

    International Nuclear Information System (INIS)

    Lee, Nam Hee; Lim, Hyun Yang; Park, Noh Kyong; Tae, Seok; Shin, Kyung Ja; Lee, Sang Chun

    1993-01-01

    Real-time ultrasound-guided fine-needle aspiration biopsy in 137 solid breast masses was performed. Sonographic findings were categorized into three groups and aspirates were categorized into three cytologic groups. The cytologic results was reported benign masses (cytologic group 1) in 71 cases (52%). malignant masses (cytologic group 2 and 3) in 44 cases (32%) and insufficient specimens in 22 case (16%). Insufficient specimens were treated as benign masses. Excisional biopsy in 44 malignant masses and 3 benign masses according to cytologic results, clinical findings and follow up study was performed. The result was reported 41 malignant masses and 6 benign masses. Based on cytologic criteria, sensitivity for detection of malignancy was 93% and specificity was 94%. In conclusion, the high specificity provided by ultrasound-guided fine-needle aspiration biopsy could markedly reduce unnecessary surgical excisions for benign masses and it should be routinely performed, since it can give physical and emotional benefits to patients and lead to earlier and cost effective diagnosis of breast cancer

  2. The diagnostic value of ultrasound-guided fine-needle aspiration biopsy in breast masses

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Nam Hee; Lim, Hyun Yang; Park, Noh Kyong; Tae, Seok; Shin, Kyung Ja; Lee, Sang Chun [Seoul Red Cross Hospital, Seoul (Korea, Republic of)

    1993-05-15

    Real-time ultrasound-guided fine-needle aspiration biopsy in 137 solid breast masses was performed. Sonographic findings were categorized into three groups and aspirates were categorized into three cytologic groups. The cytologic results was reported benign masses (cytologic group 1) in 71 cases (52%). malignant masses (cytologic group 2 and 3) in 44 cases (32%) and insufficient specimens in 22 case (16%). Insufficient specimens were treated as benign masses. Excisional biopsy in 44 malignant masses and 3 benign masses according to cytologic results, clinical findings and follow up study was performed. The result was reported 41 malignant masses and 6 benign masses. Based on cytologic criteria, sensitivity for detection of malignancy was 93% and specificity was 94%. In conclusion, the high specificity provided by ultrasound-guided fine-needle aspiration biopsy could markedly reduce unnecessary surgical excisions for benign masses and it should be routinely performed, since it can give physical and emotional benefits to patients and lead to earlier and cost effective diagnosis of breast cancer.

  3. The accuracy of frozen section analysis in ultrasound- guided core needle biopsy of breast lesions

    International Nuclear Information System (INIS)

    Brunner, Andreas H; Sagmeister, Thomas; Kremer, Jolanta; Riss, Paul; Brustmann, Hermann

    2009-01-01

    Limited data are available to evaluate the accuracy of frozen section analysis and ultrasound- guided core needle biopsy of the breast. In a retrospective analysis data of 120 consecutive handheldultrasound- guided 14- gauge automated core needle biopsies (CNB) in 109 consecutive patients with breast lesions between 2006 and 2007 were evaluated. In our outpatient clinic120 CNB were performed. In 59/120 (49.2%) cases we compared histological diagnosis on frozen sections with those on paraffin sections of CNB and finally with the result of open biopsy. Of the cases 42/59 (71.2%) were proved to be malignant and 17/59 (28.8%) to be benign in the definitive histology. 2/59 (3.3%) biopsies had a false negative frozen section result. No false positive results of the intraoperative frozen section analysis were obtained, resulting in a sensitivity, specificity and positive predicting value (PPV) and negative predicting value (NPV) of 95%, 100%, 100% and 90%, respectively. Histological and morphobiological parameters did not show up relevance for correct frozen section analysis. In cases of malignancy time between diagnosis and definitive treatment could not be reduced due to frozen section analysis. The frozen section analysis of suspect breast lesions performed by CNB displays good sensitivity/specificity characteristics. Immediate investigations of CNB is an accurate diagnostic tool and an important step in reducing psychological strain by minimizing the period of uncertainty in patients with breast tumor

  4. Imaging-guided percutaneous needle biopsy for infectious spondylitis: Factors affecting culture positivity

    International Nuclear Information System (INIS)

    Sung, Si Yoon; Kwon, Jong Won

    2015-01-01

    To evaluate the variable factors affecting the results of percutaneous needle biopsies for infectious spondylitis. In all, 249 patients who underwent both MRI and percutaneous needle biopsies due to a suspicion of infectious spondylitis were evaluated with respect to the following factors: the usage of antibiotics before the procedure, the location of the biopsy, the guiding equipment used, the experience level of the operators, and the number of biopsies performed. The positivity of culture in cases of treated with antibiotics (16.3%) before the biopsy was lower than in the untreated cases (30.5%) (p = 0.004). Biopsies performed at the abscess (43.5%) and with fluoroscopic guidance (27.8%) showed higher culture positivity as well. The experience level of the operators and the number of biopsies had no effect on culture positivity. The usage of antibiotics before the biopsy, the biopsy's location, and the guiding equipment used affect the culture positivity, while the experience levels of the operators and the number of biopsies do not have an effect

  5. Yield and Safety Profile of Ultrasound Guided Fine Needle Aspiration Cytology (FNAC) of Lymph Nodes

    International Nuclear Information System (INIS)

    Sattar, A.; Wahab, S.; Javed, A.; Shamim, S. H.

    2016-01-01

    Objective: To determine the re-biopsy rate, positive yield and safety profile of ultrasound guided fine needle aspiration cytology (FNAC) in cervical lymph nodes in terms of its complications and repeat procedures. Study Design: An analytical study. Place and Duration of Study: Department of Vascular and Interventional Radiology, Dow University Hospital, Dow University of Health Sciences, Karachi, from June to December 2013. Methodology: Eighty neck swellings, which were found to be lymph nodes on ultrasound, underwent ultrasound guided FNAC, from outpatients. Lymph nodes which were included in the study were those that were not easily palpable, located near major blood vessels, where patient refused of direct palpation and wanted image guided FNAC, those directly sent by physician for image guided FNAC and where blind biopsy remained inconclusive. Patients who refused on explanation or did not give consent were excluded. Complications and repeat biopsy were noted. Result: This study consisted of 80 cases, of which 51 cases (63.75 percentage) were female and 29 cases (36.25 percentage) were male. Repeat biopsy was required in 1 case (1.6 percentage). There were no procedure-related complications. A total of 44 cases (55 percentage) revealed evidence suggesting or confirming the existence of tuberculosis. Rest of the others showed other benign lesions, reactive lymphadenopathy and malignancy. Conclusion: Ultrasound guided FNAC is a safe procedure with low re-biopsy rate that aids diagnosis. The predominant cause of cervical lymphadenopathy in this study was tuberculous lymphadenitis. (author)

  6. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.

  7. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    International Nuclear Information System (INIS)

    Min, Lingfeng; Xu, Xingxiang; Song, Yong; Issahar, Ben-Dov; Wu, Jingtao; Zhang, Le; Huang, Qian; Chen, Mingxiang

    2013-01-01

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study

  8. Does obesity preclude lumbar puncture with a standard spinal needle? The use of computed tomography to measure the skin to lumbar subarachnoid space distance in the general hospital population.

    LENUS (Irish Health Repository)

    Halpenny, Darragh

    2013-06-05

    OBJECTIVES: Failed lumbar puncture (LP) is a common indication for referral for radiologically guided LP. This study aims to evaluate what percentage of the hospital population would fail an LP using a standard 9-cm needle because of obesity and a skin to subarachnoid space distance greater than 9 cm. METHODS: Images of 402 consecutive patients undergoing computed tomography of the abdomen and pelvis were reviewed. Skin to subarachnoid space distance was calculated using sagittal images. A survey was conducted among junior hospital doctors to assess their experience of performing lumbar puncture in obese patients. RESULTS: Four hundred patients were included. Fifty-five patients (13.8 %) had a skin to subarachnoid space distance greater than 9 cm. Intra-abdominal fat, subcutaneous fat and abdominal girth correlated with distance between the skin and subarachnoid space. Among junior doctors, 68.3 % (n = 41) reported LP failure on an obese patient; 78.4 % (n = 47) were unaware of the existence of a longer needle and 13.3 % (n = 8) had experience using a longer needle. CONCLUSIONS: A significant proportion of the hospital population will fail LP with a standard length spinal needle. Selecting a longer needle may be sufficient to successfully complete LP in obese patients. KEY POINTS : • Lumbar puncture failure commonly leads to referral for an image-guided procedure • Standard lumbar puncture may fail in 13.8 % of patients due to obesity • 78.4 % of trainee doctors are unaware of the existence of longer spinal-needles • Using longer spinal needles may allow successful LP in obese patients.

  9. Fluoroscopically Guided Extraforaminal Cervical Nerve Root Blocks: Analysis of Epidural Flow of the Injectate with Respect to Needle Tip Position

    Science.gov (United States)

    Shipley, Kyle; Riew, K. Daniel; Gilula, Louis A.

    2013-01-01

    Study Design Retrospective evaluation of consecutively performed fluoroscopically guided cervical nerve root blocks. Objective To describe the incidence of injectate central epidural flow with respect to needle tip position during fluoroscopically guided extraforaminal cervical nerve root blocks (ECNRBs). Methods Between February 19, 2003 and June 11, 2003, 132 consecutive fluoroscopically guided ECNRBs performed with contrast media in the final injected material (injectate) were reviewed on 95 patients with average of 1.3 injections per patient. Fluoroscopic spot images documenting the procedure were obtained as part of standard quality assurance. An independent observer not directly involved in the procedures retrospectively reviewed the images, and the data were placed into a database. Image review was performed to determine optimal needle tip positioning for injectate epidural flow. Results Central epidural injectate flow was obtained in only 28.9% of injections with the needle tip lateral to midline of the lateral mass (zone 2). 83.8% of injectate went into epidural space when the needle tip was medial to midline of the lateral mass (zone 3). 100% of injectate flowed epidurally when the needle tip was medial to or at the medial cortex of the lateral mass (zone 4). There was no statistically significant difference with regards to central epidural flow and the needle tip position on lateral view. Conclusion To ensure central epidural flow with ECNRBs one must be prepared to pass the needle tip medial to midplane of the lateral mass or to medial cortex of the lateral mass. Approximately 16% of ECNRBs with needle tip medial to midline of the lateral mass did not flow into epidural space. One cannot claim a nerve block is an epidural block unless epidural flow of injectate is observed. PMID:24494176

  10. How accurate are measurements of skin-lesion depths on prebiopsy supine chest computed tomography for transthoracic needle biopsies?

    International Nuclear Information System (INIS)

    Cheung, Joo Yeon; Kim, Yookyung; Shim, Sung Shine; Lee, Jin Hwa; Chang, Jung Hyun; Ryu, Yon Ju; Lee, Rena J.

    2012-01-01

    Aim: To evaluate the accuracy of depth measurements on supine chest computed tomography (CT) for transthoracic needle biopsy (TNB). Materials and methods: We measured skin-lesion depths from the skin surface to nodules on both prebiopsy supine CT scans and CT scans obtained during cone beam CT-guided TNB in the supine (n = 29) or prone (n = 40) position in 69 patients, and analyzed the differences between the two measurements, based on patient position for the biopsy and lesion location. Results: Skin-lesion depths measured on prebiopsy supine CT scans were significantly larger than those measured on CT scans obtained during TNB in the prone position (p < 0.001; mean difference ± standard deviation (SD), 6.2 ± 5.7 mm; range, 0–18 mm), but the differences showed marginal significance in the supine position (p = 0.051; 3.5 ± 3.9 mm; 0–13 mm). Additionally, the differences were significantly larger for the upper (mean ± SD, 7.8 ± 5.7 mm) and middle (10.1 ± 6.5 mm) lung zones than for the lower lung zones (3.1 ± 3.3 mm) in the prone position (p = 0.011), and were larger for the upper lung zone (4.6 ± 5.0 mm) than for the middle (2.4 ± 2.0 mm) and lower (2.3 ± 2.3 mm) lung zones in the supine position (p = 0.004). Conclusions: Skin-lesion depths measured on prebiopsy supine chest CT scans were inaccurate for TNB in the prone position, particularly for nodules in the upper and middle lung zones.

  11. Needle-tissue interactive mechanism and steering control in image-guided robot-assisted minimally invasive surgery: a review.

    Science.gov (United States)

    Li, Pan; Yang, Zhiyong; Jiang, Shan

    2018-06-01

    Image-guided robot-assisted minimally invasive surgery is an important medicine procedure used for biopsy or local target therapy. In order to reach the target region not accessible using traditional techniques, long and thin flexible needles are inserted into the soft tissue which has large deformation and nonlinear characteristics. However, the detection results and therapeutic effect are directly influenced by the targeting accuracy of needle steering. For this reason, the needle-tissue interactive mechanism, path planning, and steering control are investigated in this review by searching literatures in the last 10 years, which results in a comprehensive overview of the existing techniques with the main accomplishments, limitations, and recommendations. Through comprehensive analyses, surgical simulation for insertion into multi-layer inhomogeneous tissue is verified as a primary and propositional aspect to be explored, which accurately predicts the nonlinear needle deflection and tissue deformation. Investigation of the path planning of flexible needles is recommended to an anatomical or a deformable environment which has characteristics of the tissue deformation. Nonholonomic modeling combined with duty-cycled spinning for needle steering, which tracks the tip position in real time and compensates for the deviation error, is recommended as a future research focus in the steering control in anatomical and deformable environments. Graphical abstract a Insertion force when the needle is inserted into soft tissue. b Needle deflection model when the needle is inserted into soft tissue [68]. c Path planning in anatomical environments [92]. d Duty-cycled spinning incorporated in nonholonomic needle steering [64].

  12. Ultrasonography-Guided Fine Needle Aspiration Cytology of Cervical Lymphadenopathy: Comparative Study of the Cytological Adequacy Using of 21- and 23- Gauge Needles

    International Nuclear Information System (INIS)

    Beak, Jin Wook; KIm, Dong Wook; Kim, Bo Mi

    2011-01-01

    To assess the difference in the cytological adequacy of ultrasonography (US)-guided fine needle aspiration cytology (US-FNAC) for cervical lymphadenopathy using 21 and 23 gauge needles. US-FNACs were separately performed on two cervical lymph nodes and in each patient using 21 gauge (group A) and 23 gauge (group B) needles, respectively. We used 4 grade classifications for the cytological analysis of each slide and compared the cytological adequacy of US-FNAC for cervical lymphadenopathy in the two groups. We performed US-FNACs on 58 cervical lymph nodes from 29 patients, with a cytological adequacy of 69.0%. The number of adequate cytological results was 19 (65.5%) in group A and 21 (72.4%) in group B, and the diagnostic adequacy did not differ significantly between the two groups (Mann-Whitney test, p = 0.574). There was no statistically significant difference in the cytological adequacy of US-FNAC for cervical lymphadenopathy according using of 21 and 23 gauge needles.

  13. Computed tomographic fluoroscopy-guided transthoracic needle biopsy for diagnosis of pulmonary nodules

    International Nuclear Information System (INIS)

    Hirose, Takashi; Mori, Kiyoshi; Machida, Suguru; Tominaga, Keigo; Yokoi, Kohei; Adachi, Mitsuru

    2000-01-01

    The purpose of this study was to evaluate the usefulness of computed tomographic (CT) fluoroscopy-guided transthoracic needle biopsy (TTNB) with an 18-gauge automatic biopsy gun for the diagnosis of pulmonary nodules. Between March 1996 and January 1998, 50 patients in whom pulmonary lesions could not be diagnosed cytopathologically with fiberoptic bronchoscopy or were not clearly visualized with fluoroscopy underwent CT fluoroscopy-guided TTNB. Final pathological diagnoses were 23 lung carcinomas, five pulmonary metastases and 22 benign lesions. Sufficient tissue for analysis was obtained from 48 of the 50 lesions (96%). The overall diagnostic yield of CT fluoroscopy-guided TTNB was 90%. The sensitivity, specificity and accuracy for malignancy were 89%, 100% and 94%, respectively. In 20 of the 22 cases (91%) of benign lesions, histological analysis yielded correct and specific diagnoses. Complications occurred in 22 of the 50 cases (44%). The most common complication was pneumothorax, which occurred in 21 of the 50 cases (42%). Chest tube insertion was required in 6 (12%). Although CT fluoroscopy could not decrease the complication rate, CT fluoroscopy-guided TTNB with an automatic biopsy gun appears to be a promising technique for diagnosing pulmonary lesions, particularly benign lesions. (author)

  14. Ultrasound-Guided Fine-Needle Aspiration Biopsy of Multiple Thyroid Nodules

    International Nuclear Information System (INIS)

    Kim, Ji Dae; Bae, Il Hun; Lee, Seung Young; Han, Gi Seok; Cha, Sang Hun; Kim, Sung Jin; Park, Kil Sun; Koong, Sung Soo; Lee, Ok Jun

    2006-01-01

    To standardize the number of nodules which necessitates ultrasound-guided, fine-needle, aspiration biopsy in patients who have multiple thyroid nodules with the same sonographic characteristics as each other. From February, 2002 to March, 2004, among patients whose diagnosis was confirmed by ultrasound-guided, fine-needle, aspiration biopsy, 545 nodules of 203 patients were found in sonography with more than two thyroid nodules. Each thyroid gland nodule was classified on a score from 0 to 2 points on the basis of the following 5 characteristics: internal content, margin, echogenicity, shape and calcification in sonography. When the score of all characteristics was the same, by deciding on nodules with the same sonographic characteristics and with the score of at least one characteristic being different, we divided the nodules with different sonographic characteristics in a patient. By methods such as given in the preceding descriptions, patients with multiple thyroid nodules were separated into two groups: one in which all nodules had the same sonographic characteristics and another in which nodules have at least one different sonographic characteristic. Then, each pathologic result was searched for the same case and different case in each patient group. Among the 203 patients who were diagnosed with multiple thyroid nodules in ultrasonography, 79 patients (38.9%) had nodules with the same ultrasonographic characteristics and 124 patients (61.1%) had nodules with at least one different ultrasonographic characteristic. All 79 patient's nodules with the same ultrasonographic characteristics in each patient showed the same pathologic result in all cases (100.0%) and there was no case showing a different pathologic result. Otherwise, among the 124 patient's nodules with different ultrasonographic characteristics, each patient showed the same pathologic result in 111 (89.5%) and different pathologic result in 13 (10.5%). In patients who have multiple thyroid nodules

  15. Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study.

    Science.gov (United States)

    Overduin, Christiaan G; Heidkamp, Jan; Rothgang, Eva; Barentsz, Jelle O; de Lange, Frank; Fütterer, Jurgen J

    2018-05-22

    To assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy. Twenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded. Needle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min. Use of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction. • Performing MR-guided prostate biopsy using an in-room tablet device is feasible. • CSRs could be sampled after a single alignment step in 19/20 patients. • The mean procedure time for biopsy with the tablet device was 23.7 min.

  16. Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil*,**

    Science.gov (United States)

    Figueiredo, Viviane Rossi; Cardoso, Paulo Francisco Guerreiro; Jacomelli, Márcia; Demarzo, Sérgio Eduardo; Palomino, Addy Lidvina Mejia; Rodrigues, Ascédio José; Terra, Ricardo Mingarini; Pego-Fernandes, Paulo Manoel; Carvalho, Carlos Roberto Ribeiro

    2015-01-01

    Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients. PMID:25750671

  17. Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil,

    Directory of Open Access Journals (Sweden)

    Viviane Rossi Figueiredo

    2015-02-01

    Full Text Available Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67% and squamous cell carcinoma (in 24%. For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.

  18. Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil.

    Science.gov (United States)

    Figueiredo, Viviane Rossi; Cardoso, Paulo Francisco Guerreiro; Jacomelli, Márcia; Demarzo, Sérgio Eduardo; Palomino, Addy Lidvina Mejia; Rodrigues, Ascédio José; Terra, Ricardo Mingarini; Pego-Fernandes, Paulo Manoel; Carvalho, Carlos Roberto Ribeiro

    2015-01-01

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.

  19. Fluoroscopy-Guided Percutaneous Lung Biopsy: A Valuable Alternative to Computed Tomography

    International Nuclear Information System (INIS)

    Kurban, L.A.; Gomersall, L.; Weir, J.; Wade, P.

    2008-01-01

    Background: Computed tomography (CT) fluoroscopy nowadays is the most preferred method of guidance to perform percutaneous lung biopsy of pulmonary masses. Conventional fluoroscopy is an increasingly forgotten technique that still can be used to perform lung biopsies, with many advantages. Purpose: To compare the accuracy, safety, and effective dose (ED) of conventional fluoroscopy-guided needle lung biopsy (FNLB) with CT-guided needle lung biopsy procedures (CTNLB) reported in the literature. Material and Methods: 100 consecutive patients who underwent FNLB were reviewed retrospectively. Using the final histological diagnoses and the clinical and radiological course of the disease as references, the accuracy and sensitivity of FNLB were calculated. The complication rates of FNLB were assessed. Using computer software (XDOSE), the ED was calculated. The accuracy, complication rates, and the ED of FNLB were compared with CTNLB reported in the literature. Results: The overall accuracy rate and sensitivity of FNLB were both 87%, which are comparable to the range of accuracies reported in the literature for CTNLB (74-97%). The complication rates of FNLB were also comparable to the complication rates reported for CTNLB. The commonest complication was pneumothorax, at a rate of 25%. The ED of FNLB was small, significantly lower than reported in the literature for CT-guided procedures. The mean ED of FNLB was 0.029 mSv, which is approximately equivalent to one chest X-ray. Conclusion: Conventional fluoroscopy is an accurate, safe, and low-dose alternative modality to CT to obtain an image-guided histological diagnosis of pulmonary lesions

  20. Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

    Science.gov (United States)

    Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

    2017-12-01

    To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (ptechnical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  1. CT-guided core needle biopsy of pleural lesions: Evaluating diagnostic yield and associated complications

    International Nuclear Information System (INIS)

    Niu, Xiang Ke; Bhetuwal, Anup; Yang, Han Feng

    2015-01-01

    The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

  2. CT-guided core needle biopsy of pleural lesions: Evaluating diagnostic yield and associated complications

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    Niu, Xiang Ke [Dept. of Radiology, Affiliated Hospital of Chengdu University, Chengdu (China); Bhetuwal, Anup; Yang, Han Feng [Dept. of Radiology, Sichuan Key Laboratory of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong (China)

    2015-02-15

    The purpose of this study was to retrospectively evaluate the diagnostic accuracy and complications of CT-guided core needle biopsy (CT-guided CNB) of pleural lesion and the possible effects of influencing factors. From September 2007 to June 2013, 88 consecutive patients (60 men and 28 women; mean [+/- standard deviation] age, 51.1 +/- 14.4 years; range, 19-78 years) underwent CT-guided CNB, which was performed by two experienced chest radiologists in our medical center. Out of 88 cases, 56 (63%) were diagnosed as malignant, 28 (31%) as benign and 4 (5%) as indeterminate for CNB of pleural lesions. The final diagnosis was confirmed by either histopathological diagnosis or clinical follow-up. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and complication rates were statistically evaluated. Influencing factors (patient age, sex, lesion size, pleural-puncture angle, patient position, pleural effusion, and number of pleural punctures) were assessed for their effect on accuracy of CT-guided CNB using univariate and subsequent multivariate analysis. Diagnostic accuracy, sensitivity, specificity, PPV, and NPV were 89.2%, 86.1%, 100%, 100%, and 67.8%, respectively. The influencing factors had no significant effect in altering diagnostic accuracy. As far as complications were concerned, occurrence of pneumothorax was observed in 14 (16%) out of 88 patients. Multivariate analysis revealed lesion size/pleural thickening as a significant risk factor (odds ratio [OR]: 8.744, p = 0.005) for occurrence of pneumothorax. Moreover, presence of pleural effusion was noted as a significant protective factor (OR: 0.171, p = 0.037) for pneumothorax. CT-guided CNB of pleural lesion is a safe procedure with high diagnostic yield and low risk of significant complications.

  3. Fiber Bragg gratings-based sensing for real-time needle tracking during MR-guided brachytherapy

    NARCIS (Netherlands)

    Borot, Maxence; Denis de Senneville, Baudouin; Maenhout, Metha; Lagendijk, JJW; van Vulpen, Marco; Hautvast, Gilion; Binnekamp, Dirk; Moerland, Rien

    2016-01-01

    PURPOSE: The development of MR-guided high dose rate (HDR) brachytherapy is under investigation due to the excellent tumor and organs at risk visualization of MRI. However, MR-based localization of needles (including catheters or tubes) has inherently a low update rate and the required image

  4. CT-Guided Percutaneous Fine-Needle Aspiration Biopsy of the Inferior Vena Cava Wall: A Posterior Coaxial Approach

    International Nuclear Information System (INIS)

    Kos, Sebastian; Bilecen, Deniz; Baumhoer, Daniel; Guillaume, Nicolas; Jacob, Augustinus L.

    2010-01-01

    A 72-year-old man was referred to our department with an incidentally diagnosed bronchogenic carcinoma of the right upper lobe. Positron emission tomography (PET) combined with computed tomography (PET-CT) revealed an unexpected hot spot in the ventral wall of the infrarenal segment of the inferior vena cava (IVC). Diagnostic biopsy of this lesion was performed under CT guidance with semiautomated 20G fine-needle aspiration (FNA) through a 19G coaxial needle. Cytology revealed few carcinoma cells, which led to the remarkable diagnosis of a distant metastasis to the IVC wall. Both the immediate postinterventional CT control and the further surveillance period of the patient were unremarkable; in particular, no signs of bleeding complications were detected. We conclude that coaxial FNA of an IVC wall lesion is technically feasible and may even help diagnose distant metastasis.

  5. Diagnostic Yield of CT-Guided Percutaneous Transthoracic Needle Biopsy for Diagnosis of Anterior Mediastinal Masses.

    Science.gov (United States)

    Petranovic, Milena; Gilman, Matthew D; Muniappan, Ashok; Hasserjian, Robert P; Digumarthy, Subba R; Muse, Victorine V; Sharma, Amita; Shepard, Jo-Anne O; Wu, Carol C

    2015-10-01

    The purpose of this study was to evaluate the diagnostic yield and accuracy of CT-guided percutaneous biopsy of anterior mediastinal masses and assess prebiopsy characteristics that may help to select patients with the highest diagnostic yield. Retrospective review of all CT-guided percutaneous biopsies of the anterior mediastinum conducted at our institution from January 2003 through December 2012 was performed to collect data regarding patient demographics, imaging characteristics of biopsied masses, presence of complications, and subsequent surgical intervention or medical treatment (or both). Cytology, core biopsy pathology, and surgical pathology results were recorded. A per-patient analysis was performed using two-tailed t test, Fisher's exact test, and Pearson chi-square test. The study cohort included 52 patients (32 men, 20 women; mean age, 49 years) with mean diameter of mediastinal mass of 6.9 cm. Diagnostic yield of CT-guided percutaneous biopsy was 77% (40/52), highest for thymic neoplasms (100% [11/11]). Non-diagnostic results were seen in 12 of 52 patients (23%), primarily in patients with lymphoma (75% [9/12]). Fine-needle aspiration yielded the correct diagnosis in 31 of 52 patients (60%), and core biopsy had a diagnostic rate of 77% (36/47). None of the core biopsies were discordant with surgical pathology. There was no statistically significant difference between the diagnostic and the nondiagnostic groups in patient age, lesion size, and presence of necrosis. The complication rate was 3.8% (2/52), all small self-resolving pneumothoraces. CT-guided percutaneous biopsy is a safe diagnostic procedure with high diagnostic yield (77%) for anterior mediastinal lesions, highest for thymic neoplasms (100%), and can potentially obviate more invasive procedures.

  6. Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice

    NARCIS (Netherlands)

    Scholten, H.J.; Pourtaherian, A.; Mihajlovic, N.; Korsten, H.; Bouwman, R.A.

    2017-01-01

    Ultrasound guidance is becoming standard practice for needle-based interventions in anaesthetic practice, such as vascular access and peripheral nerve blocks. However, difficulties in aligning the needle and the transducer can lead to incorrect identification of the needle tip, possibly damaging

  7. Analysis of a Steerable Needle for Fine Needle Aspiration and Biopsy: Efficiency and Radiation Dose Compared With a Conventional Straight Needle.

    Science.gov (United States)

    Rutigliano, Sandra; Abraham, John A; Kenneally, Barry E; Zoga, Adam C; Nevalainen, Mika; Roedl, Johannes B

    Percutaneous computed tomography (CT)-guided needle biopsy has proven to be an efficacious method for sampling of many soft tissue lesions, especially deep-seated masses in the abdomen and pelvis. This study sought to test the potential for a novel steerable needle to improve localization and to reduce procedure duration and radiation dose compared with a conventional straight needle. A fresh, raw meat sample (lean bovine flank) was imbedded with cylindrical radiopaque and radiolucent obstacles designed to simulate vessels (radiolucent objects) and bones (radiopaque objects) on CT. A pit-containing olive (partially radiopaque) was imbedded beyond the obstacles to represent the target. Two sites on the surface of the meat were selected and marked to determine initial needle placement. Two radiologists with different levels of experience proceeded to position a straight needle and the steerable needle from each skin site to the target using CT guidance as efficiently as possible, avoiding the obstacles. The total positioning time, the number of CT scans required for positioning, and the number of repositioning events (partial withdrawal followed by advancement) were tracked for the straight and steerable needles. For the straight needle, total time to reach the target was 499 to 667 seconds (mean, 592 seconds); for the steerable needle, total time to reach the target was 281 to 343 seconds (mean, 309 seconds), on average, 48% lower. The number of CT scans needed for needle positioning averaged 6.25 for the straight needle and 3.5 for the steerable needle, which is 44% lower. Repositioning events (withdrawing and readvancing the needle) ranged from 3 to 10 for the straight needle (mean, 6.5) and 0 for the steerable needle. Using an in vitro model embedded with obstacles, the steerable needle performed better than a straight needle with regard to procedure time, needle repositioning events, and CT scans required for placement.

  8. CT-guided biopsy with cutting-edge needle for the diagnosis of malignant lymphoma: Experience of 267 biopsies

    International Nuclear Information System (INIS)

    Agid, R.; Sklair-Levy, M.; Bloom, A.I.; Lieberman, S.; Polliack, A.; Ben-Yehuda, D.; Sherman, Y.; Libson, E.

    2003-01-01

    AIM: We performed a retrospective study of 267 core needle aspiration biopsies in order to estimate the accuracy of CT-guided aspiration core needle biopsies for the diagnosis and subsequent treatment of malignant lymphoma. MATERIALS AND METHODS: Between 1989 and 1999, 267 CT-guided core needle biopsies were performed in 241 patients with either primary or recurrent malignant lymphoma. Patients age ranged from 4--88 years. One hundred and sixty-six (62.2%) nodal and 101 (37.8%) extranodal aspiration biopsies were performed using either 18 G or 20 G Turner needles. Statistical method used was Chi-square analysis. RESULTS: An accurate histological diagnosis was made in 199 (82.5%) patients, the remaining 42 (17.4%) patients had non-diagnostic CT biopsies. Thirty-seven of them were diagnosed by a surgical biopsy, four by bone marrow biopsy and in one patient by paracentesis. One hundred and seventy-nine patients had non-Hodgkin's lymphoma (NHL) and 62 had Hodgkin's disease (HD); 23 (9.54%) patients underwent repeated CT biopsy which was diagnostic in 17 (73.9%) and non-diagnostic in six (26%). CONCLUSION: CT-guided aspiration core biopsies were sufficient to establish a diagnosis in lymphoproliferative disorders in 82.5% of cases. In the light of this experience we suggest that imaging-guided core needle biopsy be used as the first step in the work up of many patients with lymphoma Agid,R. et al. (2003). Clinical Radiology58, 143-147

  9. Diagnostic accuracy of percutaneous cytodiagnosis of hepatic masses, by ultrasound guided fine needle aspiration cytology

    International Nuclear Information System (INIS)

    Asghar, F.; Riaz, S.

    2010-01-01

    Objective: To evaluate the diagnostic accuracy, usefulness and limitations of ultrasound guided FNAC of hepatic masses. Design: Cross - sectional analytical (comparative study). Place and Duration: Department of histopathology, Sheikh Zayed Hospital, Lahore. Study period 1 year. Material and Methods: A total of 32 patients with solitary or multiple hepatic masses underwent FNAC from March 1999 to March 2000. Adequate aspirates were obtained in all these cases. Smears were stained with May-Grunwald Giemsa, Haematoxylin and Eosin and Papanicolaou stain. Needle biopsies from the same cases were also obtained and processed. These were stained with routine Haematoxylin and Eosin staining. The blood clots obtained during FNAC were fixed in 10% neu-tral buffered formalin. The histopathology of these blood clots was used for cases whose needle core biopsy was not available. The screened FNAC smears were divided into 3 categories i.e., benign (group - I), malignant (group - II), non-neoplastic / inflammatory lesions (including cysts and abscesses) (group - III). Results: Out of 32 cases, 6 were categorized as benign, 18 as malignant, and 8 as non-neoplastic inflammatory lesions. Three false negative diagnoses, including 1 for malignant tumour and 2 for benign tumours was obtained. There was 1 false positive diagnosis for malignancy. FNAC - histological correlation showed a 94.2% sensitivity and 92.3% diagnostic accuracy for malignant tumours, while benign tumours posed maximum diagnostic problems, giving a 66.67% sensitivity and 85.7% diagnostic accuracy. FNAC picked up correctly all the non-neoplastic lesions giving a 100% sensitivity and diagnostic accuracy. Conclusion: Majority of the malignant tumours can be categorized on FNAC, with a high degree of accuracy, while benign tumours should be subjected to biopsy, as there is a relatively greater possibility of false negative diagnosis. (author)

  10. Endobronchial ultrasound elastography: a new method in endobronchial ultrasound-guided transbronchial needle aspiration.

    Science.gov (United States)

    Jiang, Jun-Hong; Turner, J Francis; Huang, Jian-An

    2015-12-01

    TBNA through the flexible bronchoscope is a 37-year-old technology that utilizes a TBNA needle to puncture the bronchial wall and obtain specimens of peribronchial and mediastinal lesions through the flexible bronchoscope for the diagnosis of benign and malignant diseases in the mediastinum and lung. Since 2002, the Olympus Company developed the first generation ultrasound equipment for use in the airway, initially utilizing an ultrasound probe introduced through the working channel followed by incoroporation of a fixed linear ultrasound array at the distal tip of the bronchoscope. This new bronchoscope equipped with a convex type ultrasound probe on the tip was subsequently introduced into clinical practice. The convex probe (CP)-EBUS allows real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of mediastinal and hilar lymph nodes. EBUS-TBNA is a minimally invasive procedure performed under local anesthesia that has been shown to have a high sensitivity and diagnostic yield for lymph node staging of lung cancer. In 10 years of EBUS development, the Olympus Company developed the second generation EBUS bronchoscope (BF-UC260FW) with the ultrasound image processor (EU-M1), and in 2013 introduced a new ultrasound image processor (EU-M2) into clinical practice. FUJI company has also developed a curvilinear array endobronchial ultrasound bronchoscope (EB-530 US) that makes it easier for the operator to master the operation of the ultrasonic bronchoscope. Also, the new thin convex probe endobronchial ultrasound bronchoscope (TCP-EBUS) is able to visualize one to three bifurcations distal to the current CP-EBUS. The emergence of EBUS-TBNA has also been accompanied by innovation in EBUS instruments. EBUS elastography is, then, a new technique for describing the compliance of structures during EBUS, which may be of use in the determination of metastasis to the mediastinal and hilar lymph nodes. This article describes these new EBUS

  11. Usefulness of CT-guided automatic needle biopsy of solitary pulmonary nodule smaller than 15 mm

    International Nuclear Information System (INIS)

    Jin, Gong Yong; Lim, Yeong Su

    2004-01-01

    To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications

  12. Diagnostic Accuracy of MRI-guided Percutaneous Transthoracic Needle Biopsy of Solitary Pulmonary Nodules

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Shangang, E-mail: 1198685580@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Li, Chengli, E-mail: chenglilichina@yeah.net [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Yu, Xuejuan, E-mail: yuxuejuan2011@126.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China); Liu, Ming, E-mail: mingliuyxs@163.com [Shandong University, Department of Interventional MRI, Shandong Medical Imaging Research Institute (China); Fan, Tingyong, E-mail: FTY681105@sohu.com; Chen, Dong, E-mail: 857984870@qq.com; Zhang, Pinliang, E-mail: zhangpinliang@163.com; Ren, Ruimei, E-mail: liusg708@qq.com [University of Jinan-Shandong Academy of Medical Science, Department of Radiation Oncology, Shandong Cancer Hospital and Institute, School of Medicine and Life Sciences (China)

    2015-04-15

    ObjectiveThe purpose of our study was to evaluate the diagnostic accuracy of MRI-guided percutaneous transthoracic needle biopsy (PTNB) of solitary pulmonary nodules (SPNs).MethodsRetrospective review of 69 patients who underwent MR-guided PTNB of SPNs was performed. Each case was reviewed for complications. The final diagnosis was established by surgical pathology of the nodule or clinical and imaging follow-up. Pneumothorax rate and diagnostic accuracy were compared between two groups according to nodule diameter (≤2 vs. >2 cm) using χ{sup 2} chest and Fisher’s exact test, respectively.ResultsThe success rate of single puncture was 95.6 %. Twelve (17.4 %) patients had pneumothorax, with 1 (1.4 %) requiring chest tube insertion. Mild hemoptysis occurred in 7 (7.2 %) patients. All of the sample material was sufficient for histological diagnostic evaluation. Pathological analysis of biopsy specimens showed 46 malignant, 22 benign, and 1 nondiagnostic nodule. The final diagnoses were 49 malignant nodules and 20 benign nodules basing on postoperative histopathology and clinical follow-up data. One nondiagnostic sample was excluded from calculating diagnostic performance. A sensitivity, specificity, accuracy, positive predictive value, and negative predictive value in diagnosing SPNs were 95.8, 100, 97.0, 100, and 90.9 %, respectively. Pneumothorax rate, diagnostic sensitivity, and accuracy were not significantly different between the two groups (P > 0.05).ConclusionsMRI-guided PTNB is safe, feasible, and high accurate diagnostic technique for pathologic diagnosis of pulmonary nodules.

  13. Ultrasound-guided fine-needle aspiration biopsy of the thyroid.

    Science.gov (United States)

    Tambouret, R; Szyfelbein, W M; Pitman, M B

    1999-10-25

    We reviewed the Massachusetts General Hospital experience with ultrasound-guided fine-needle aspiration biopsies (FNABs) of the thyroid to determine the indications, rate of unsatisfactory smears, correlation with excisional biopsy results, and verification of efficient use of personnel time. All radiologically guided FNABs of the thyroid from January 1993 through June 1997 were reviewed. As a measure of efficient use of technologist time, a sample of times spent by the technologist during the procedure for 20 cases in 1993 and 1997 was compared with that of an equal number of random nonthyroid image guided FNABs. Two hundred-ninety FNABs were identified in 251 patients, representing 12% of all thyroid FNABs and 11% of all radiologically guided FNABs. Indications in the 251 patients included multiple nodules (78), solitary nodules (61), complex nodules (39), prior failed FNAB (39), thyroid bed abnormalities post-thyroidectomy (21), difficult access (7), and investigation of recurrent tumor in residual thyroid lobe (6). Available records indicated 118 lesions were palpable and 45 were nonpalpable; the physical examination characteristics of the remainder (88) were not stated. Diagnoses included 44 unsatisfactory cases (15%), 103 macrofollicular lesions, 20 microfollicular lesions, 26 mixed macro/microfollicular lesions, 5 oxyphilic lesions, 1 trabecular pattern, 15 nonspecific follicular cell pattern, 9 follicular cell atypia, 30 cysts, 11 thyroiditis, 23 malignant tumors, and 3 other (1 parathyroid, 2 lymph node). Eighty-nine FNABs from 76 patients had subsequent surgical biopsy. Excisional biopsies in 14 unsatisfactory FNABs were benign. In the remaining 75 FNABs from 67 patients, 18 malignancies on FNAB were correctly diagnosed, but 3 other papillary carcinomas were only qualified as atypical follicular cells on cytology. No false-positive cases occurred. Of 15 macrofollicular lesions on cytology, 10 were adenomas on excision, only 2 of which were microfollicular

  14. Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses

    International Nuclear Information System (INIS)

    Kang, Yun Dan; Kim, You Me

    2016-01-01

    The purpose of this study was to compare needle aspiration and vacuum-assisted biopsy in the ultrasound-guided treatment of lactational breast abscesses. Between January 2005 and December 2014, a total of 74 patients presented with lactational breast abscesses. Thirty of these patients underwent treatment with antibioticsalone, while the remaining 44 lactating women with breast abscesses were treated with needle aspiration (n=25) or vacuum-assisted biopsy (n=19). Age, duration of lactation, abscess diameter, pus culture results, the number of interventions, the healing time, and the cure rate were reviewed and compared between these two groups. The Student's t test and the chi-square test were used to compare the variables. No significant difference was found in the cure rate between the needle aspiration group (22/25, 88%) and the vacuum-assisted biopsy group (18/19, 94.7%) (P=0.441). However, the mean healing time was significantly shorter in the vacuum-assisted biopsy group (6.7 days) than in the needle aspiration group (9.0 days) (P=0.001). Vacuum-assisted biopsy is a viable option for the management of lactational breast abscesses and was found to lead to a shorter healing time than needle aspiration. However, further study is necessary to establish the clinical efficacy of vacuum-assisted biopsy in the management of lactational breast abscesses

  15. Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yun Dan; Kim, You Me [Dankook University College of Medicine, Cheonan (Korea, Republic of)

    2016-03-15

    The purpose of this study was to compare needle aspiration and vacuum-assisted biopsy in the ultrasound-guided treatment of lactational breast abscesses. Between January 2005 and December 2014, a total of 74 patients presented with lactational breast abscesses. Thirty of these patients underwent treatment with antibioticsalone, while the remaining 44 lactating women with breast abscesses were treated with needle aspiration (n=25) or vacuum-assisted biopsy (n=19). Age, duration of lactation, abscess diameter, pus culture results, the number of interventions, the healing time, and the cure rate were reviewed and compared between these two groups. The Student's t test and the chi-square test were used to compare the variables. No significant difference was found in the cure rate between the needle aspiration group (22/25, 88%) and the vacuum-assisted biopsy group (18/19, 94.7%) (P=0.441). However, the mean healing time was significantly shorter in the vacuum-assisted biopsy group (6.7 days) than in the needle aspiration group (9.0 days) (P=0.001). Vacuum-assisted biopsy is a viable option for the management of lactational breast abscesses and was found to lead to a shorter healing time than needle aspiration. However, further study is necessary to establish the clinical efficacy of vacuum-assisted biopsy in the management of lactational breast abscesses.

  16. CT-guided needle biopsy of lung lesions: A survey of severe complication based on 9783 biopsies in Japan

    International Nuclear Information System (INIS)

    Tomiyama, Noriyuki; Yasuhara, Yoshifumi; Nakajima, Yasuo; Adachi, Shuji; Arai, Yasuaki; Kusumoto, Masahiko; Eguchi, Kenji; Kuriyama, Keiko; Sakai, Fumikazu; Noguchi, Masayuki; Murata, Kiyoshi; Murayama, Sadayuki; Mochizuki, Teruhito; Mori, Kiyoshi; Yamada, Kozo

    2006-01-01

    Purpose: The aim of our study was to update the rate of severe complications following CT-guided needle biopsy in Japan via a mailed survey. Materials and methods: Postal questionnaires regarding CT-guided needle biopsy were sent out to multiple hospitals in Japan. The questions regarded: the total number and duration of CT-guided lung biopsies performed at each hospital, and the complication rates and numbers of pneumothorax, hemothorax, air embolism, tumor seeding, tension pneumothorax and other rare complications. Each severe complication was followed with additional questions. Results: Data from 9783 biopsies was collected from 124 centers. Pneumothorax was the most common complication, and occurred in 2412 (35%) of 6881 cases. A total of 39 (35%) hospitals reported 74 (0.75%) cases with severe complications. There were six cases (0.061%) with air embolism, six cases (0.061%) with tumor seeding at the site of the biopsy route, 10 cases (0.10%) with tension pneumothorax, six cases (0.061%) with severe pulmonary hemorrhage or hemoptysis, nine cases (0.092%) with hemothorax, and 27 cases (0.26%) with others, including heart arrest, shock, and respiratory arrest. From a total of 62 patients with severe complications, 54 patients (0.55%) recovered without sequela, however one patient (0.01%) recovered with hemiplegia due to cerebral infarction, and the remaining seven patients (0.07%) died. Conclusions: This is the first national study documenting severe complications with respect to CT-guided needle biopsy in Japan. The complication rate in Japan is comparable to internationally published figures. We believe this data will improve both clinicians as well as patients understanding of the risk versus benefit of CT-guided needle biopsy, resulting better decisions

  17. Feasibility Study of Needle Placement in Percutaneous Vertebroplasty: Cone-Beam Computed Tomography Guidance Versus Conventional Fluoroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Braak, Sicco J., E-mail: sjbraak@gmail.com [St. Antonius Hospital, Department of Radiology (Netherlands); Zuurmond, Kirsten, E-mail: kirsten.zuurmond@philips.com; Aerts, Hans C. J., E-mail: hans.cj.aerts@philips.com [Philips Medical, Department of Clinical Development (Netherlands); Leersum, Marc van, E-mail: m.van.leersum@antoniusziekenhuis.nl; Overtoom, Timotheus T. Th., E-mail: overtm@knoware.nl; Heesewijk, Johannes P. M. van, E-mail: j.heesewijk@antoniusziekenhuis.nl; Strijen, Marco J. L. van, E-mail: m.van.strijen@antoniusziekenhuis.nl [St. Antonius Hospital, Department of Radiology (Netherlands)

    2013-08-01

    ObjectiveTo investigate the accuracy, procedure time, fluoroscopy time, and dose area product (DAP) of needle placement during percutaneous vertebroplasty (PVP) using cone-beam computed tomography (CBCT) guidance versus fluoroscopy.Materials and MethodsOn 4 spine phantoms with 11 vertebrae (Th7-L5), 4 interventional radiologists (2 experienced with CBCT guidance and two inexperienced) punctured all vertebrae in a bipedicular fashion. Each side was randomization to either CBCT guidance or fluoroscopy. CBCT guidance is a sophisticated needle guidance technique using CBCT, navigation software, and real-time fluoroscopy. The placement of the needle had to be to a specific target point. After the procedure, CBCT was performed to determine the accuracy, procedure time, fluoroscopy time, and DAP. Analysis of the difference between methods and experience level was performed.ResultsMean accuracy using CBCT guidance (2.61 mm) was significantly better compared with fluoroscopy (5.86 mm) (p < 0.0001). Procedure time was in favor of fluoroscopy (7.39 vs. 10.13 min; p = 0.001). Fluoroscopy time during CBCT guidance was lower, but this difference is not significant (71.3 vs. 95.8 s; p = 0.056). DAP values for CBCT guidance and fluoroscopy were 514 and 174 mGy cm{sup 2}, respectively (p < 0.0001). There was a significant difference in favor of experienced CBCT guidance users regarding accuracy for both methods, procedure time of CBCT guidance, and added DAP values for fluoroscopy.ConclusionCBCT guidance allows users to perform PVP more accurately at the cost of higher patient dose and longer procedure time. Because procedural complications (e.g., cement leakage) are related to the accuracy of the needle placement, improvements in accuracy are clinically relevant. Training in CBCT guidance is essential to achieve greater accuracy and decrease procedure time/dose values.

  18. Motion compensation for MRI-compatible patient-mounted needle guide device: estimation of targeting accuracy in MRI-guided kidney cryoablations

    Science.gov (United States)

    Tokuda, Junichi; Chauvin, Laurent; Ninni, Brian; Kato, Takahisa; King, Franklin; Tuncali, Kemal; Hata, Nobuhiko

    2018-04-01

    Patient-mounted needle guide devices for percutaneous ablation are vulnerable to patient motion. The objective of this study is to develop and evaluate a software system for an MRI-compatible patient-mounted needle guide device that can adaptively compensate for displacement of the device due to patient motion using a novel image-based automatic device-to-image registration technique. We have developed a software system for an MRI-compatible patient-mounted needle guide device for percutaneous ablation. It features fully-automated image-based device-to-image registration to track the device position, and a device controller to adjust the needle trajectory to compensate for the displacement of the device. We performed: (a) a phantom study using a clinical MR scanner to evaluate registration performance; (b) simulations using intraoperative time-series MR data acquired in 20 clinical cases of MRI-guided renal cryoablations to assess its impact on motion compensation; and (c) a pilot clinical study in three patients to test its feasibility during the clinical procedure. FRE, TRE, and success rate of device-to-image registration were mm, mm, and 98.3% for the phantom images. The simulation study showed that the motion compensation reduced the targeting error for needle placement from 8.2 mm to 5.4 mm (p  <  0.0005) in patients under general anesthesia (GA), and from 14.4 mm to 10.0 mm () in patients under monitored anesthesia care (MAC). The pilot study showed that the software registered the device successfully in a clinical setting. Our simulation study demonstrated that the software system could significantly improve targeting accuracy in patients treated under both MAC and GA. Intraprocedural image-based device-to-image registration was feasible.

  19. Precision of MR-guided needle placement. Experimental results; Praezision der Lokalisierbarkeit einer Punktionsnadel in der MRT. Experimentelle Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Langen, H.J. [Roentgenabteilung der Missionsaerztlichen Klinik Wuerzburg (Germany); Stuetzer, H. [Inst. fuer Medizinische Statistik, Informatik und Epidemiologie der Univ. zu Koeln (Germany); Kugel, H.; Krug, B.; Hesselmann, V.; Schulte, O.; Walter, C.; Landwehr, P. [Inst. und Poliklinik fuer Radiologische Diagnostik der Univ. zu Koeln (Germany)

    2000-11-01

    To estimate the accuracy of the determination of tip position of MR compatible biopsy needles based on signal voids and artifacts in MR guided biopsies. Method: In a nylon grid phantom an MR compatible 18G needle (E-Z-EM) was measured in a 1.0 T imager using TSE- and FFE-sequences of 20 s and 40 s duration in 34 different orientations of needle versus B{sub 0}, frequency and slice selection gradient. 4 radiologists with no experience in the evaluation of signal void artifacts estimated the needle tip positions from needle tip artifacts. The readers determined the needle tip before and after a 15 minute training session based on high resolution images with explanation of size and shape of specific artifacts of biopsy needles in 12 different orthogonal or parallel orientations to B{sub 0} and frequency encoding gradient that are possible if the needle lies parallel to the slice, i.e. orthogonal to the slice selection gradient. The values obtained before and after the training session were compared to the real position of the needle tip. Results: Mean distance of actual needle tip and tip position as determined from images was 1.8{+-}2.3 mm in TSE- versus 2.5{+-}1.2 mm in FFE-images, with the needle length overestimated. After a 15 minute training session the positioning error decreased significantly to 0.2{+-}1.8 mm for TSE-sequences and to 1.0{+-}1.8 mm for FFE-sequences. A higher accuracy of tip localization was obtained with TSE sequences. Conclusion: In MR guided biopsies using FFE- and TSE-sequences the needle position can be more accurately determined if the reader is familiar with the 12 orthogonal or parallel positions of the needle with respect to B{sub 0} and frequency encoding gradient and the corresponding artifacts. (orig.) [German] Abschaetzung der Praezision, mit der die Spitze einer MR-kompatiblen Biopsienadel anhand ihrer Artefakte bestimmt werden kann. Methode: Experimentell wurde eine MR-kompatible 18 G Biopsienadel (E-Z-EM) in einem 1,0 Tesla MR

  20. Imaging-guided and nonimaging-guided fine needle aspiration of liver lesions: experience with 406 patients.

    Science.gov (United States)

    Edoute, Y; Tibon-Fisher, O; Ben-Haim, S A; Malberger, E

    1991-12-01

    The aim of the present study was to determine the diagnostic accuracy of different modes of fine needle aspiration (FNA) of liver lesions. A total of 492 FNAs were performed on 406 patients in order to confirm or to rule out focal or multifocal neoplastic disease: 29% under ultrasound (US) guidance, 3% with computed tomographic (CT) guidance, 67% preoperatively, and 1% intraoperatively without imaging guidance. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 387 patients, of whom 264 had malignant liver disease and 123 had benign liver disease. Of 321 aspirations performed in patients with malignant liver disease, the cytologic findings suggested malignancy in 225 (70.1%), suspected malignancy in 25 (7.8%), and did not reveal malignancy in 71 aspirations (22.1%). Among the 123 patients with benign liver disease, the cytologic findings were reported as benign in all but two patients, who had false-positive cytologic findings. The overall sensitivity, specificity, positive, and negative predictive values for cytologic findings were 85.6, 98.4, 99.1, and 76.1%, respectively. The overall diagnostic accuracy was 89.7%. In one patient, fatal intraperitoneal bleeding due to chronic intravascular coagulation complicated the FNA procedure. We conclude that imaging-guided FNA as well as nonguided FNA for cytologic diagnosis of liver lesions are highly accurate and only rarely may be associated with a fatal complication.

  1. Risks and benefits in treatment of mediastinal abscess by endobronchial ultrasound-guided transbronchial needle aspiration.

    Science.gov (United States)

    Tian, Lei; Krimsky, William S; Wu, Qingchen; Sun, Jiayuan

    2017-07-01

    Mediastinal abscess is a fatal condition, treatment of mediastinal abscess is with antibiotics and sometimes surgery for debridement and drainage. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe assessment and candidate treatment method of mediastinal lesions. This study aimed to HYPERLINK "javascript:void(0);" discuss risks and benefits in treatment of mediastinal abscess by EBUS-TBNA. We noticed a 56-year-old man with developed bilateral pneumonia and sepsis after puncture of mediastinal abscess by EBUS-TBNA. The patient was successfully treated with a combination of systemic anti-infection treatment and intracavitary administration of antibiotics, antifungal and repeated drainage and lavage via EBUS-TBNA, in 1 year follow-up without recurrence. This study indicated infection spread risk of mediastinal abscess after EBUS-TBNA, and mediastinal abscess was successfully cured by combination of systemic anti-infection and local intervention through EBUS-TBNA. EBUS-TBNA is a potential effective minimally invasive treatment for mediastinal abscess, and it is necessary to be aware of clinical complications after puncture of mediastinal infectious lesions by EBUS-TBNA. © 2015 John Wiley & Sons Ltd.

  2. Paraffin-gel tissue-mimicking material for ultrasound-guided needle biopsy phantom.

    Science.gov (United States)

    Vieira, Sílvio L; Pavan, Theo Z; Junior, Jorge E; Carneiro, Antonio A O

    2013-12-01

    Paraffin-gel waxes have been investigated as new soft tissue-mimicking materials for ultrasound-guided breast biopsy training. Breast phantoms were produced with a broad range of acoustical properties. The speed of sound for the phantoms ranged from 1425.4 ± 0.6 to 1480.3 ± 1.7 m/s at room temperature. The attenuation coefficients were easily controlled between 0.32 ± 0.27 dB/cm and 2.04 ± 0.65 dB/cm at 7.5 MHz, depending on the amount of carnauba wax added to the base material. The materials do not suffer dehydration and provide adequate needle penetration, with a Young's storage modulus varying between 14.7 ± 0.2 kPa and 34.9 ± 0.3 kPa. The phantom background material possesses long-term stability and can be employed in a supine position without changes in geometry. These results indicate that paraffin-gel waxes may be promising materials for training radiologists in ultrasound biopsy procedures. Copyright © 2013 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  3. Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (ebus-tbna) for Diagnosis of Mediastinal and Hilar Masses

    International Nuclear Information System (INIS)

    Fatima, M.; Jamal, S.; Khan, M.A.; Ansari, J.K.; Ullah, M.U.

    2016-01-01

    Objective: To determine the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA). Study Design: Across-sectional validation study. Place and Duration of Study: Department of Histopathology, Army Medical College, in collaboration with Department of Pulmonology, Military Hospital Rawalpindi, from March 2014 to March 2015. Methodology: Cases of EBUS-TBNAcomprised of both TBNAs and cell block/biopsy of the same patients. Diagnosis was made on the TBNAslides and cell block/biopsy material. Taking biopsy/cell block as the gold standard, the data was analysed to calculate the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of EBUSTBNA. Result: The sensitivity of EBUS-TBNAwas found to be 96.5 percent; whereas, specificity and positive predictive values were 100 percent. The negative predictive value was calculated at 50 percent. Diagnostic accuracy of the procedure was found to be 96.67 percent. Conclusion: EBUS-TBNA is a sensitive and a specific test and is accurate in diagnosing mediastinal and hilar pathologies. (author)

  4. INITIAL EXPERIENCE WITH ENDOSCOPIC ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION OF RENAL MASSES: indications, applications and limitations

    Directory of Open Access Journals (Sweden)

    Renata Nobre MOURA

    2014-12-01

    Full Text Available Context Tissue sampling of renal masses is traditionally performed via the percutaneous approach or laparoscopicaly. The utility of endoscopic ultrasound to biopsy renal lesions it remains unclear and few cases have been reported. Objectives To evaluate the feasibility and outcome of endoscopic ultrasound fine needle aspiration of renal tumors. Methods Consecutive subjects undergoing attempted endoscopic ultrasound fine needle aspiration of a kidney mass after evaluation with computerized tomography or magnetic resonance. Results Ten procedures were performed in nine male patients (median age 54.7 years on the right (n = 4 and left kidney (n = 4 and bilaterally (n = 1. Kidney masses (median diameter 55 mm ; range 13-160 mm were located in the upper pole (n = 3, the lower pole (n = 2 and the mesorenal region (n = 3. In two cases, the mass involved more than one kidney region. Surgical resection confirmed renal cell carcinoma in six patients in whom pre-operative endoscopic ultrasound fine needle aspiration demonstrated renal cell carcinoma. No complications were reported. Conclusions Endoscopic ultrasound fine needle aspiration appears as a safe and feasible procedure with good results and minimal morbidity.

  5. Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

    Science.gov (United States)

    Wahidi, Momen M; Herth, Felix; Yasufuku, Kazuhiro; Shepherd, Ray Wesley; Yarmus, Lonny; Chawla, Mohit; Lamb, Carla; Casey, Kenneth R; Patel, Sheena; Silvestri, Gerard A; Feller-Kopman, David J

    2016-03-01

    Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights

  6. Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses

    OpenAIRE

    Kang, Yun-Dan; Kim, You Me

    2015-01-01

    Purpose: The purpose of this study was to compare needle aspiration and vacuum-assistedbiopsy in the ultrasound-guided treatment of lactational breast abscesses. Methods: Between January 2005 and December 2014, a total of 74 patients presented withlactational breast abscesses. Thirty of these patients underwent treatment with antibioticsalone, while the remaining 44 lactating women with breast abscesses were treated withneedle aspiration (n=25) or vacuum-assisted biopsy (n=19). Age, duration ...

  7. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...

  8. Oblique needle segmentation and tracking for 3D TRUS guided prostate brachytherapy

    International Nuclear Information System (INIS)

    Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron

    2005-01-01

    An algorithm was developed in order to segment and track brachytherapy needles inserted along oblique trajectories. Three-dimensional (3D) transrectal ultrasound (TRUS) images of the rigid rod simulating the needle inserted into the tissue-mimicking agar and chicken breast phantoms were obtained to test the accuracy of the algorithm under ideal conditions. Because the robot possesses high positioning and angulation accuracies, we used the robot as a ''gold standard,'' and compared the results of algorithm segmentation to the values measured by the robot. Our testing results showed that the accuracy of the needle segmentation algorithm depends on the needle insertion distance into the 3D TRUS image and the angulations with respect to the TRUS transducer, e.g., at a 10 deg. insertion anglulation in agar phantoms, the error of the algorithm in determining the needle tip position was less than 1 mm when the insertion distance was greater than 15 mm. Near real-time needle tracking was achieved by scanning a small volume containing the needle. Our tests also showed that, the segmentation time was less than 60 ms, and the scanning time was less than 1.2 s, when the insertion distance into the 3D TRUS image was less than 55 mm. In our needle tracking tests in chicken breast phantoms, the errors in determining the needle orientation were less than 2 deg. in robot yaw and 0.7 deg. in robot pitch orientations, for up to 20 deg. needle insertion angles with the TRUS transducer in the horizontal plane when the needle insertion distance was greater than 15 mm

  9. Recent developments in guided wave travel time tomography

    Energy Technology Data Exchange (ETDEWEB)

    Zon, Tim van; Volker, Arno [TNO, Stieltjesweg 1, P.O. box 155 2600 AD Delft (Netherlands)

    2014-02-18

    The concept of predictive maintenance using permanent sensors that monitor the integrity of an installation is an interesting addition to the current method of periodic inspections. Guided wave tomography had been developed to create a map of the wall thickness using the travel times of guided waves. It can be used for both monitoring and for inspection of pipe-segments that are difficult to access, for instance at the location of pipe-supports. An important outcome of the tomography is the minimum remaining wall thickness, as this is critical in the scheduling of a replacement of the pipe-segment. In order to improve the sizing accuracy we have improved the tomography scheme. A number of major improvements have been realized allowing to extend the application envelope to pipes with a larger wall thickness and to larger distances between the transducer rings. Simulation results indicate that the sizing accuracy has improved and that is now possible to have a spacing of 8 meter between the source-ring and the receiver-ring. Additionally a reduction of the number of sensors required might be possible as well.

  10. The reliability of ultrasound-guided core needle biopsy in the evaluation of non-palpable solid breast lesions using 18-gauge needles

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Sung Chul; Kim, Young Sook [Chosun University College of Medicine, Gwangju (Korea, Republic of); Sneige, Nour [The University of Texas M.D. Andreson Carcer Canter, Houston (United States)

    2003-04-01

    Ultrasound-guided core needle biopsy (US CNB) is increasingly used in the histologic evaluation of non-palpable solid breast lesions. We retrospectively investigated the diagnostic accuracy of this technique, using an 18-gauge needle in 422 non-palpable breast lesions. 583 female patients with an average age 56 (range, 22-90) years underwent 590 US CNBs. Between January 1994 and December 1999, using 18-gauge needles, an average of four cores per lesion was obtained. Three hundred and eighty-five lesions were subsequently surgically excised; for 14 of these, the pathologic diagnosis was breast carcinoma metastasis, while 23 with benign diagnoses were clinically followed up for {>=}2.5 years and were considered for analysis. Of the 422 lesions, 340 (80.6%) were malignant [308 invasive, 24 ductal carcinoma in situ (DCIS), 7 DCIS with undetermined invasion and 1 DCIS vs. lobular carcinoma in situ], 67 (15.9%) were benign [30 fibroadenoma (FA) and 37 other diagnoses], and five (1.2%) were fibroepithelial lesions. The remaining ten samples (2,4%) included six cases of atypical ductal hyperplasia (ADH), two of atypical hyperplasia (AH), and two of lobular neoplasia. The sensitivity, specificity, positive predictive value, and negative predictive value of CNBs were 99%, 100%, 100%, and 96%, respectively. Two cases of invasive carcinoma were missed at CNB; there was no false-positive diagnosis. Five of six ADHs and one of two AHs were found to be carcinomas (3 DCIS and 3 infiltrating duct carcinomas). Sixteen of 24 (66.7%) cases of DCIS were found at excision to be invasion carcinomas. Of 31 FAs, two (6.5%) were found to be low-grade phyllodes tumor (PT). The five fibroepithelial lesions were shown at excision to be either PT (n=4) or FA (n=1). US CNB using an 18-gauge needle is a safe and reliable means of diagnosing breast carcinoma. Because of the high prevalence of ductal carcinoma is these lesions; findings of ADH/AH at US CNB indicate that surgical excision is needed

  11. Relationship of pancreatic mass size and diagnostic yield of endoscopic ultrasound-guided fine needle aspiration.

    Science.gov (United States)

    Siddiqui, Ali A; Brown, Lauren J; Hong, Shih-Kuang S; Draganova-Tacheva, Rossitza A; Korenblit, Jason; Loren, David E; Kowalski, Thomas E; Solomides, Charalambos

    2011-11-01

    Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is central to discerning the diagnosis of solid pancreatic tumors through tissue acquisition. Test performance is affected by a number of factors including location of mass within the pancreas, presence of onsite cytology technologist, and number of passes with the needle. The influence of tumor size has not been well studied. The objective of the current study was to determine whether the size of mass affects the diagnostic accuracy for solid pancreatic lesions aspirated under EUS guidance. Data were collected retrospectively on all patients with solid pancreatic masses undergoing EUS-FNA from June 2003 to August 2010. The cytology samples were reported as positive, suspicious for malignancy, atypical, negative, or nondiagnostic. The gold standard for a cytological diagnosis was histological confirmation or clinical follow-up of more than 6 months with repeat imaging. Patients were divided into five groups based upon lesion size as follows: (a) less than 1 cm, (b) 1-2 cm, (c) 2-3 cm, (d) 3-4 cm, and (e) greater than 4 cm. Performance characteristics of EUS-FNA including sensitivity, specificity, and accuracy were compared for each group. Accuracy was defined as the ratio of the sum of true-positive and true-negative values divided by the number of lesions. We identified 583 patients with solid pancreatic lesions in which EUS-FNA was performed and adequate cellularity was obtained (47% men, mean age 65 ± 1.4 (SE) years). Overall, 486 (83%) of lesions were pancreatic adenocarcinoma, 18 (3%) were neuroendocrine tumors, 12 (2%) were lymphomas, and 67 (12%) were benign lesions. The median size of the mass was 3 cm (range, 0.5-7 cm). A mean of 4.9 passes (range, 1-9 passes) was needed to obtain adequate samples from lesions. The overall yield of obtaining adequate samples for diagnosis was 85%. When stratified by size, the EUS-FNA sensitivity for lesions with size 4 cm was 40, 75.9, 86.9, 93

  12. Computed tomography-guided percutaneous catheter drainage of primary and secondary iliopsoas abscesses

    International Nuclear Information System (INIS)

    Cantasdemir, M.; Kara, B.; Cebi, D.; Selcuk, N.D.; Numan, F.

    2003-01-01

    AIM: To report our experience with computed tomography (CT)-guided percutaneous catheter drainage (PCD) of iliopsoas abscesses. MATERIALS AND METHODS: Twenty-two iliopsoas abscesses in 21 patients (11 women, 10 men) aged between 18 and 66 years (mean 36 years) were treated with PCD. Abdominal CT demonstrated the iliopsoas abscesses, which were definitively determined by Gram staining and aspirate cultures. Twenty of the 22 iliopsoas abscesses were primary and two were secondary. All PCD procedures were performed under local anaesthesia using a single-step trocar technique (n=19) or Seldinger technique (n=3). RESULTS: PCD was an effective treatment in 21 out of the 22 iliopsoas abscesses. Recurrence was seen in three abscesses as minimal residual collections. Two of them resolved spontaneously with anti-tuberculous regimen. One required percutaneous needle aspiration. The procedure failed in a diabetic patient with a secondary abscess, who died due to sepsis. The length of time that catheters remained in place ranged from 21 to 75 days (mean 59.7 days). Complications included catheter dislocation in four abscesses, which required removal of dislocated catheters and indwelling new ones. CONCLUSION: CT-guided PCD is a safe and effective front-line treatment of iliopsoas abscesses. Surgery should be reserved for failure of PCD and presence of contraindications to PCD

  13. Ultrasound-Guided Fine-Needle Aspiration Biopsy of Thyroid Nodules: is it Necessary to Use Local Anesthesia for the Application of One Needle Puncture?

    International Nuclear Information System (INIS)

    Kim, Dong Wook; Rho, Myung Ho; Kim, Ki Nam

    2009-01-01

    This study was designed to evaluate the difference in the degree of patient pain for an ultrasound-guided fine-needle aspiration biopsy (USFNAB) of a thyroid nodule with one needle puncture with and without local anesthesia. A total of 50 patients participated in the study. We examined prospective patients who would undergo US-FNABs of two thyroid nodules (larger than 10 mm maximum diameter), which were located in separate thyroid lobes. For one of these thyroid nodules, US-FNAB was performed following the administration of local anesthesia; for the other nodule, no anesthesia was administered. The application of anesthesia was alternatively administered between patients (either prior to the first US-FNAB procedure or prior to the second procedure). For all patients, the degree of pain during and after each US-guided FNAB was evaluated according to a 4-category verbal rating scale (VRS), an 11-point numeric rating scale (NRS) and a 100-mm visual analogue scale (VAS). The mean maximum diameters of thyroid nodules examined by US-FNAB with the use of local anesthesia and with no local anesthesia were 13.6 mm and 13.0 mm, respectively. There was no significant difference in nodule size (p > 0.05) between two groups. For the VRS, there were 27 patients with a higher pain score when local anesthesia was used and four patients with a higher pain score when no local anesthesia was administered. Nineteen patients had equivalent pain score for both treatments. This finding was statistically significant (p < 0.001). For the NRS, there were 33 patients with a higher pain score when local anesthesia was used and 10 patients with a higher pain score when no local anesthesia was administered. Seven patients had an equivalent pain score for each treatment. This finding was statistically significant (p < 0.001). For the VAS, there were 35 patients with a higher pain score when local anesthesia was used and 11 patients with a higher pain score where no local anesthesia was

  14. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    Energy Technology Data Exchange (ETDEWEB)

    Cornelis, F.; Takaki, H. [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States); Laskhmanan, M. [Perfint Healthcare Inc (India); Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G., E-mail: srimaths@mskcc.org [Memorial Sloan-Kettering Cancer Center, Interventional Radiology Service, Department of Radiology (United States)

    2015-10-15

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy.

  15. Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver

    International Nuclear Information System (INIS)

    Cornelis, F.; Takaki, H.; Laskhmanan, M.; Durack, J. C.; Erinjeri, J. P.; Getrajdman, G. I.; Maybody, M.; Sofocleous, C. T.; Solomon, S. B.; Srimathveeravalli, G.

    2015-01-01

    PurposeTo compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.Materials and MethodsManual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal–Wallis test.ResultsPaired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).ConclusionsCT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy

  16. Comparison of needle aspiration and vacuum-assisted biopsy in the ultrasound-guided drainage of lactational breast abscesses

    Directory of Open Access Journals (Sweden)

    Yun-Dan Kang

    2016-04-01

    Full Text Available Purpose: The purpose of this study was to compare needle aspiration and vacuum-assistedbiopsy in the ultrasound-guided treatment of lactational breast abscesses. Methods: Between January 2005 and December 2014, a total of 74 patients presented withlactational breast abscesses. Thirty of these patients underwent treatment with antibioticsalone, while the remaining 44 lactating women with breast abscesses were treated withneedle aspiration (n=25 or vacuum-assisted biopsy (n=19. Age, duration of lactation, abscess diameter, pus culture results, the number of interventions, the healing time, and the cure rate were reviewed and compared between these two groups. The Student’s t test and the chi-square test were used to compare the variables. Results: No significant difference was found in the cure rate between the needle aspirationgroup (22/25, 88% and the vacuum-assisted biopsy group (18/19, 94.7% (P=0.441. However, the mean healing time was significantly shorter in the vacuum-assisted biopsy group (6.7 days than in the needle aspiration group (9.0 days (P=0.001. Conclusion: Vacuum-assisted biopsy is a viable option for the management of lactational breast abscesses and was found to lead to a shorter healing time than needle aspiration. However, further study is necessary to establish the clinical efficacy of vacuum-assisted biopsy in the management of lactational breast abscesses.

  17. Ultrasound guided fine needle aspiration cytology versus core biopsy in the preoperative assessment of non-palpable breast lesions

    International Nuclear Information System (INIS)

    Ahmed, M.E.; Ahmad, I.

    2010-01-01

    Background: Breast screening is a method of detecting breast cancer at a very early stage. Most of the lesions detected by screening are not malignant. Objective of this study was to compare ultrasound guided fine needle aspiration cytology and core biopsy in the preoperative assessment of non-palpable breast lesions. Methods: The study was conducted prospectively at Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan from March 2004 to February 2005. All the patients underwent fine needle aspiration cytology and core biopsy. Later on, all of them had excision biopsy/ mastectomy. Prospectively 80 patients were studied; information was collected on a specifically designed form according to inclusion criteria. The patient age, sex, medical record number and side of lesion were recorded. Clinical history of duration of lump was also taken. Informed consent was obtained. Results: The age of patients were ranges from 20-71 years, with mean of 44.31+- 11.002 and the maximum number of patients 28 (35.3%) was between the ages 50 - 59 years. The sensitivity of FNAC was 92.85%, while the specificity of was 90% and the accuracy rate was 92.1%. The sensitivity of core biopsy was 94.64%, specificity 91.30% and accuracy rate was 94.87%. Conclusion: Fine Needle Aspiration has been found to be an extremely useful method for the diagnosis of lumps of breast. The accuracy and the sensitivity of diagnosis on fine needle aspiration cytology were high. (author)

  18. Development of a guidance guide for dosimetry in computed tomography

    International Nuclear Information System (INIS)

    Fontes, Ladyjane Pereira

    2016-01-01

    Due to frequent questions from users of ionization chambers pencil type calibrated in the Instrument Calibration Laboratory of the Institute of Energy and Nuclear Research (LCI - IPEN), on how to properly apply the factors indicated in their calibration certificates, a guide was prepared guidance for dosimetry in computed tomography. The guide includes guidance prior knowledge of half value layer (HVL), as it is necessary to know the effective beam energy for application quality for correction factor (kq). The evaluation of HVL in TC scanners becomes a difficult task due to system geometry and therefore a survey was conducted of existing methodologies for the determination of HVL in clinical beams Computed Tomography, taking into account technical, practical and economic factors. In this work it was decided to test a Tandem System consists of absorbing covers made in the workshop of IPEN, based on preliminary studies due to low cost and good response. The Tandem system consists of five cylindrical absorbing layers of 1mm, 3mm, 5mm, 7mm and 10mm aluminum and 3 cylindrical absorbing covers 15mm, 25mm and acrylic 35mm (PMMA) coupled to the ionization chamber of commercial pencil type widely used in quality control tests in dosimetry in clinical beams Computed tomography. Through Tandem curves it was possible to assess HVL values and from the standard curve pencil-type ionization chamber, Kq find the appropriate beam. The elaborate Guide provides information on how to build the calibration curve on the basis of CSR, to find the Kq and information for construction Tandem curve, to find values close to CSR. (author)

  19. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch

    International Nuclear Information System (INIS)

    De Oliveira e Britto Villalobos, Maria Isabel; Leite, Thaisa Cristina Gomes Ferreira; Barra, Samila Goncalves; Da Cunha Werneche, Daniela Teresa Pinto; Manzi, Flavio Ricardo; E Alves Cardoso, Claudia Assuncao

    2017-01-01

    Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring

  20. Radiographic and computed tomography monitoring of a fractured needle fragment in the mandibular branch

    Energy Technology Data Exchange (ETDEWEB)

    De Oliveira e Britto Villalobos, Maria Isabel; Leite, Thaisa Cristina Gomes Ferreira; Barra, Samila Goncalves; Da Cunha Werneche, Daniela Teresa Pinto; Manzi, Flavio Ricardo; E Alves Cardoso, Claudia Assuncao [Dept. of Dentistry, Pontificial Catholic University of Minas Gerais, Belo Horizonte (Brazil)

    2017-03-15

    Some complications can arise with the usage of local anesthesia for dental procedures, including the fracture of needles in the patient. This is a rare incident, usually caused by the patient's sudden movements during anesthetic block. Its complications are not common, but can include pain, trismus, inflammation in the region, difficulty in swallowing, and migration of the object, which is the least common but has the ability to cause more serious damage to the patient. This report describes a case in which, after the fracture of the anesthetic needle used during alveolar nerve block for exodontia of the left mandibular third molar, the fragment moved significantly in the first 2 months, before stabilizing after the third month of radiographic monitoring.

  1. Detection of suspicious malignant cervical lymph nodes of unknown origin: diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy with nodal size and central necrosis correlate

    International Nuclear Information System (INIS)

    Lo, C.-P.; Chen, C.-Y.; Chin, S-.C.; Lee, K.-W.; Hsueh, C.-J.; Juan, C.-J.; Kao, H.-W.; Huang, G.-S.

    2007-01-01

    To assess the role of ultrasound-guided fine-needle aspiration biopsy (US-guided FNAB) in the diagnostic workup of suspicious malignant cervical lymph nodes in patients with palpable neck masses and without known primary cancer. The diagnostic accuracy of imaging morphologic criteria, including sizes and central necrosis for assessing suspicious malignant nodes, were also examined. This is a retrospective study of 426 patients with palpable neck masses from an outpatient department evaluated with computed tomography, magnetic resonance imaging, or US. US-guided FNABs were performed in 102 patients with suspicious malignant cervical lymph nodes at a single institution. Cytologically positive lymph nodes (n = 12) were further validated with excisional biopsy. Negative lymph nodes (n = 90) were either excised (n = 10) or followed up by imaging studies for at least one year (n = 80). The diagnostic accuracy of the FNABs along with the imaging findings of nodal sizes and presence of central necrosis, which were classified by a consensus of 2 radiologists, were assessed. Twelve malignant nodes were detected with US-guided FNAB with one false-positive and one false-negative result. The overall sensitivity, specificity, and accuracy for FNAB were 91.7%, 98.9%, and 98.0%. respectively. The sensitivity, specificity, and accuracy were 66.7%, 30.0%, and 34.3% for size criterion and 75.0%, 83.3%, and 82.3% for central necrosis criterion. The size of cervical lymph node does not appear to be an important imaging criterion for assessing suspicious malignant lymph nodes, compared with the criterion of central necrosis. US-guided FNAB is highly specific and sensitive in the diagnostic workup of suspicious malignant cervical lymph nodes in patients without known primary cancers. (author)

  2. Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla.

    Science.gov (United States)

    Wang, Wei; Gong, Biao; Jiang, Wei-Song; Liu, Lei; Bielike, Kouken; Xv, Bin; Wu, Yun-Lin

    2015-05-21

    To determine the efficacy and safety of meticulous cannulation by needle-knife. Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed. Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301). The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

  3. Sonographic features and ultrasonography-guided fine-needle aspiration of metastases to the thyroid gland

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Jung Hyun; Kim, Eun Kyung; Kwak, Jin Young; Moon, Hee Jung; Kim, Ga Ram [Dept. of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-03-15

    To evaluate the characteristic ultrasonographic (US) features of metastatic carcinoma to the thyroid, and how accurate US features and ultrasonography-guided fine-needle aspiration (US-FNA) are for the diagnosis of thyroid metastases. Twenty-three thyroid lesions in 23 patients (mean age, 66.7 years; range, 46 to 85 years) that had been diagnosed as thyroid metastases were included. The composition, echogenicity, margin, shape, presence of calcifications, underlying parenchymal echotexture, and vascularity were analyzed in US images of the thyroid metastases. Final US assessments were categorized into probably benign and suspicious malignancy. The presence of suspicious metastatic cervical lymph nodes was noted. The medical records, US-FNA cytology, and pathology reports of these patients were retrospectively reviewed. Of the 23 thyroid lesions, the general US appearance was mass-forming in 21 (91.3%) and non-mass-forming in 2 (8.7%). All 23 lesions showed a solid tumor composition. Common US features among the 21 mass-forming thyroid metastases were hypoechogenicity (81.0%), non-circumscribed margins (90.5%), no calcifications (76.2%), and parallel shape (81.0%). Suspicious cervical lymph nodes were present in 18 patients (78.3%). Of the 23 lesions, 21 (91.3%) were classified as suspicious malignancy, and 2 (8.7%) as probably benign. US-FNA showed diagnostic results specific for metastases in 21 of the 22 patients (95.5%) who had undergone US-FNA. Common US features in thyroid metastasis were hypoechogenicity, non-circumscribed margins, no calcifications, parallel shape, and the presence of suspicious cervical lymph nodes. US-FNA can be effectively used in the diagnosis of thyroid metastasis, preventing unnecessary surgery.

  4. Lean Six Sigma Applied to Ultrasound Guided Needle Biopsy in the Head and Neck.

    Science.gov (United States)

    Matt, Bruce H; Woodward-Hagg, Heather K; Wade, Christopher L; Butler, Penny D; Kokoska, Mimi S

    2014-07-01

    (1) Confirm the positive value stream of office-based ultrasound using Lean Six Sigma; (2) demonstrate how ultrasound reduces time to diagnosis, costs, patient inconvenience and travel, exposure to ionizing radiation, intravenous contrast, and laboratory tests. Case series with historical controls using chart review. Tertiary Veterans Administration Hospital (university-affiliated). Patients with a consult request or decision for ultrasound guided fine needle aspiration (USFNA) from 2006 to 2012. Process evaluation using Lean Six Sigma methodologies; years study conducted: 2006-2012; outcome measurements: type of diagnostic tests and imaging studies including CT scans with associated radiation exposure, time to preliminary and final cytopathologic diagnosis, episodes of patient travel. Value stream mapping prior to and after implementing office-based ultrasound confirmed the time from consult request or decision for USFNA to completion of the USFNA was reduced from a range of 0 to 286 days requiring a maximum 17 steps to a range of 0 to 48 days, necessitating only a maximum of 9 steps. Office-based USFNA for evaluation of head and neck lesions reduced costs, time to diagnosis, risks and inconvenience to patients, radiation exposure, unnecessary laboratory, and patient complaints while increasing staff satisfaction. In addition, office-based ultrasound also changed the clinical management of specific patients. Lean Six Sigma reduces waste and optimizes quality and accuracy in manufacturing. This is the first known application of Lean Six Sigma to office-based USFNA in the evaluation of head and neck lesions. The literature supports the value of office-based ultrasound to patients and health care systems. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  5. An electrical impedance tomography (EIT) multi-electrode needle-probe device for local assessment of heterogeneous tissue impeditivity.

    Science.gov (United States)

    Meroni, Davide; Maglioli, Camilla Carpano; Bovio, Dario; Greco, Francesco G; Aliverti, Andrea

    2017-07-01

    Electrical Impedance Tomography (EIT) is an image reconstruction technique applied in medicine for the electrical imaging of living tissues. In literature there is the evidence that a large resistivity variation related to the differences of the human tissues exists. As a result of this interest for the electrical characterization of the biological samples, recently the attention is also focused on the identification and characterization of the human tissue, by studying the homogeneity of its structure. An 8 electrodes needle-probe device has been developed with the intent of identifying the structural inhomogeneities under the surface layers. Ex-vivo impeditivity measurements, by placing the needle-probe in 5 different patterns of fat and lean porcine tissue, were performed, and impeditivity maps were obtained by EIDORS open source software for image reconstruction in electrical impedance. The values composing the maps have been analyzed, pointing out a good tissue discrimination, and the conformity with the real images. We conclude that this device is able to perform impeditivity maps matching to reality for position and orientation. In all the five patterns presented is possible to identify and replicate correctly the heterogeneous tissue under test. This new procedure can be helpful to the medical staff to completely characterize the biological sample, in different unclear situations.

  6. En bloc excision of nonpalpable breast lesions using the advanced breast biopsy instrumentation system: an alternative to needle guided surgery?

    International Nuclear Information System (INIS)

    Lifrange, E.; Colin, C.; Dondelinger, R.F.; Fridman, V.

    2001-01-01

    This study was prospectively conducted to evaluate the clinical potential of the advanced breast biopsy instrumentation (ABBI) system as an alternative to needle localization and open surgery in the management of nonpalpable breast lesions (NPBL). One hundred and eighty-six consecutive patients were referred for management of NPBL. Thirty-six underwent an ABBI procedure, offered as a first step before possible surgery for lesions which would in any case have required complete excision. The 18 patients with a malignant ABBI biopsy underwent re-excision of the biopsy site and axillary dissection was carried out in cases of infiltrating carcinoma. The other 150 patients underwent image-guided needle biopsy. Following these procedures, 60/150 (40 %) patients underwent needle-guided surgery. Finally, 96/186 (51 %) patients required complete excision. A total of 43 benign lesions and 53 carcinomas were confirmed. Thirty-six out of 96 (38 %) excisions were obtained with the ABBI system; 17/43 (40 %) benign lesions and 11/53 (21 %) carcinomas were completely removed with the ABBI system. Out of 9 malignant specimens with a pathological size less than 10 mm, 5/9 (55 %) had tumor-free margins and in 8/9 (89 %) no residual disease was found at re-excision. The preliminary results of this study suggest that, in selected cases, en bloc excision using the ABBI procedure could be an alternative to conventional surgery. (orig.)

  7. Guide for the realization of core needle biopsy through stereotaxy in the diagnosis of suspicious breast lesions of malignity

    International Nuclear Information System (INIS)

    Jimenez Zuniga, Jorge Luis

    2012-01-01

    Guides have been made for the realization of breast biopsies through stereotaxy in the management of breast lesions. The type of injuries that have been detected in mammography services, most have corresponded to nonpalpable lesions, that should be clarified through the take samples for an histological study with the purpose of categorize them. A bibliographic review was realized of the findings most frequent in the breast pathology. Also, before a nonpalpable breast lesion that requires a diagnosis biopsy, should be assessed the method of suitable guide for to access the same. The interventionist procedures of the breast have been developed in last years and have been guided by stereotaxy, in order to preoperative localization of these lesions or for obtaining valid cytologic-histologic material to reach a diagnosis, as it has often been difficult to differentiate, just for the image, between benign and malignant lesions. Thus, has emerged the necessity to guide the needle tip objectifying the lesion through mammography. A localization system based on triangulation is applied. The location of the lesion is calculated in the three axes of space (X, Y and Z) with a minimum error. The stereotactic devices have created to guide needles to injuries from a unique projection. This has allowed that breast and lesion are subject on a site while have taken samples several times. The complete mammography study that include the projections craniocaudal (CC) and mediolateral oblique (MLO) are analyzed to find out exactly on which quadrant has found the injury. Sometimes, the injury only has observed in a unique projection which is used for locating. The two main devices that have been used to perform stereotactic biopsy are automatic gun of biopsy and vacuum-assisted directional biopsy. Automatic gun of biopsy has used a long needle tru-cut type, with calibers between 18 and 14, although it is preferred 14-gauge needles. Multiple samples obtained from this needle have

  8. CT-guided percutaneous injection of the fibrin glue by 'double needle' technique for the treatment of sacral cysts

    International Nuclear Information System (INIS)

    Wang Ganggang; Chen Long; Yang Chao; Ni Caifang

    2013-01-01

    Objective: To analyze the efficacy and safety of CT-guided percutaneous injection of the fibrin glue by 'double needle' technique to treat sacral cyst. Methods: Clinical data of 20 cases with 'double-needle' injection of fibrin glue technology to treat sacral cyst were retrospectively analyzed. All patients had varying degrees of sacral nerve root compression symptoms. The treatment for sacral cyst was carried out after clear diagnosis was made. On the basis of CT-guided percutaneous injection of fibrin glue, the improved CT-guided percutaneous injection of fibrin glue by 'double-needle' technique was used to treat these patients. The average dose of fibrin glue was (5.9 ± 2.4) ml. The clinical results of improvement as to pain and neurological function were evaluated after follow-up of an average of 17 months. The assessment criteria were as follows: excellent, complete resolution of signs and symptoms, with the patient returning to his or her regular employment and no recurrence of cysts during 1 year of follow-up, good, symptoms and signs in the legs and perineal region resolved but with persistent pain in the lumbosacral region, which did not interfere with the patient's regular work (the cysts did not recur for 6 months during follow-up), fair, no improvement in clinical symptoms, but a decrease in cyst size on the imaging study, poor, no improvement in clinical symptoms and no observed changes in cyst size in imaging studies or recurrence. Results: Most patients experienced some degree of pain relief and functional improvement after fibrin glue therapy, with most experiencing complete or marked resolution of clinical symptoms. Nine patients reported excellent recovery, 8 reported good recovery, 2 reported fair recovery, and 1 reported poor recovery. The overall percentage of positive outcomes (excellent and good recovery) was 85%. No serious postoperative complications were discovered. Conclusions: CT guided percutaneous injection of the fibrin glue by

  9. Endobronchial Ultrasound-guided Transbronchial Needle Injection of Liposomal Amphotericin B for the Treatment of Symptomatic Aspergilloma.

    Science.gov (United States)

    Parikh, Mihir S; Seeley, Eric; Nguyen-Tran, Evelyn; Krishna, Ganesh

    2017-10-01

    Surgical treatment with lung resection has traditionally been the treatment of choice for pulmonary cavities containing aspergillomas that cause hemoptysis. Endobronchial ultrasound (EBUS) is a minimally invasive bronchoscopic technique that is commonly used for transbronchial needle aspiration of hilar and mediastinal lymph nodes as well as centrally located parenchymal lesions. Here, we describe a case of a 71-year-old woman who was found to have a cavitary lesion in the lung containing aspergillomas. Under direct ultrasound visualization with EBUS, liposomal amphotericin B was injected into the aspergillomas. These aspergillomas regressed after treatment. To our knowledge, this is the first reported treatment of aspergilloma with EBUS-guided transbronchial needle injection of liposomal amphotericin B.

  10. Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study.

    Science.gov (United States)

    Abi-Jaoudeh, Nadine; Mielekamp, Peter; Noordhoek, Niels; Venkatesan, Aradhana M; Millo, Corina; Radaelli, Alessandro; Carelsen, Bart; Wood, Bradford J

    2012-06-01

    To describe a novel technique for multimodality positron emission tomography (PET) fusion-guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure. Subjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded. Seven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13-54 min). Total procedure time was 95 minutes (range 51-240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3-6.2 min). An integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

  11. Diagnostic accuracy of 22/25-gauge core needle in endoscopic ultrasound-guided sampling: systematic review and meta-analysis.

    Science.gov (United States)

    Oh, Hyoung-Chul; Kang, Hyun; Lee, Jae Young; Choi, Geun Joo; Choi, Jung Sik

    2016-11-01

    To compare the diagnostic accuracy of endoscopic ultrasound-guided core needle aspiration with that of standard fine-needle aspiration by systematic review and meta-analysis. Studies using 22/25-gauge core needles, irrespective of comparison with standard fine needles, were comprehensively reviewed. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic curves for the diagnosis of malignancy were used to estimate the overall diagnostic efficiency. The pooled sensitivity, specificity, and DOR of the core needle for the diagnosis of malignancy were 0.88 (95% confidence interval [CI], 0.84 to 0.90), 0.99 (95% CI, 0.96 to 1), and 167.37 (95% CI, 65.77 to 425.91), respectively. The pooled sensitivity, specificity, and DOR of the standard needle were 0.84 (95% CI, 0.79 to 0.88), 1 (95% CI, 0.97 to 1), and 130.14 (95% CI, 34.00 to 495.35), respectively. The area under the curve of core and standard needle in the diagnosis of malignancy was 0.974 and 0.955, respectively. The core and standard needle were comparable in terms of pancreatic malignancy diagnosis. There was no significant difference in procurement of optimal histologic cores between core and standard needles (risk ratio [RR], 0.545; 95% CI, 0.187 to 1.589). The number of needle passes for diagnosis was significantly lower with the core needle (standardized mean difference, -0.72; 95% CI, -1.02 to -0.41). There were no significant differences in overall complications (RR, 1.26; 95% CI, 0.34 to 4.62) and technical failure (RR, 5.07; 95% CI, 0.68 to 37.64). Core and standard needles were comparable in terms of diagnostic accuracy, technical performance, and safety profile.

  12. Performance Accuracy of Hand-on-needle versus Hand-onsyringe Technique for Ultrasound-guided Regional Anesthesia Simulation for Emergency Medicine Residents

    Directory of Open Access Journals (Sweden)

    Brian Johnson

    2014-09-01

    Full Text Available Introduction: Ultrasound-guided nerve blocks (UGNB are increasingly used in emergency care. The hand-on-syringe (HS needle technique is ideally suited to the emergency department setting because it allows a single operator to perform the block without assistance. The HS technique is assumed to provide less exact needle control than the alternative two-operator hand-on-needle (HN technique; however this assumption has never been directly tested. The primary objective of this study was to compare accuracy of needle targeting under ultrasound guidance by emergency medicine (EM residents using HN and HS techniques on a standardized gelatinous simulation model. Methods: This prospective, randomized study evaluated task performance. We compared needle targeting accuracy using the HN and HS techniques. Each participant performed a set of structured needling maneuvers (both simple and difficult on a standardized partial-task simulator. We evaluated time to task completion, needle visualization during advancement, and accuracy of needle tip at targeting. Resident technique preference was assessed using a post-task survey. Results: We evaluated 60 tasks performed by 10 EM residents. There was no significant difference in time to complete the simple model (HN vs. HS, 18 seconds vs. 18 seconds, p=0.93, time to complete the difficult model (HN vs. HS, 56 seconds vs. 50 seconds, p=0.63, needle visualization, or needle tip targeting accuracy. Most residents (60% preferred the HS technique. Conclusion: For EM residents learning UGNBs, the HN technique was not associated with superior needle control. Our results suggest that the single-operator HS technique provides equivalent needle control when compared to the two-operator HN technique. [West J Emerg Med. 2014;15(6:641–646

  13. Use of CT-guided fine needle aspiration biopsy in epidermal growth factor receptor mutation analysis in patients with advanced lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Yi-Ping; Wang, Hai-Yan; Zhang, Jin; Feng, Yong (Dept. of Radiology, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China)), email: yipingzhuang2010@sina.com; Shi, Mei-Qi (Dept. of Chemotherapy, Jiangsu Cancer Inst. and Hospital, Nanjing, Jiangsu (China))

    2011-12-15

    Background. The safety of using a cutting needle when performing a core-needle biopsy is of major concern, in particular for small lung tumors or tumors near the hilum. Purpose. To investigate the usefulness of CT-guided fine needle aspiration biopsy (FNAB) of the lung in obtaining tumor tissue for epidermal growth factor receptor (EGFR) mutation analysis in advanced lung cancer patients. Material and Methods. Forty-three patients with stage IIIB-IV lung cancer were enrolled. In all patients, CT-guided FNAB was performed using an 18-gauge or 20-gauge Chiba aspiration needle for histology diagnosis and EGFR mutation analysis. Complications associated with CT-guided FNAB were observed, and the specimen mutational assessments were recorded. Results. The obtained tumor samples ranged from 0.5-1.5 cm in length and were adequate for histological and DNA analyses in all patients. No patient had a pneumothorax or hemoptysis. Minor needle tract bleeding appeared in eight patients. Mutation analysis was satisfactorily demonstrated in 23 mutations and 20 non-mutations. Ten and 13 mutations were identified by 18-gauge and 20-gauge needle biopsies, respectively. EFGR mutations, including 12 cases of EGFR exon 19 deletion and 11 cases of exon 21 point mutation, were present in 21 patients with adenocarcinomas, one with squamous cell carcinoma, and one with undifferentiated carcinoma. Conclusion. CT-guided FNAB is a feasible and safe technique for obtaining lung tumor tissues for EGFR gene mutation analysis

  14. C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters

    International Nuclear Information System (INIS)

    Tam, Alda; Mohamed, Ashraf; Pfister, Marcus; Rohm, Esther; Wallace, Michael J.

    2009-01-01

    C-arm cone beam computed tomography is an advanced 3D imaging technology that is currently available on state-of-the-art flat-panel-based angiography systems. The overlay of cross-sectional imaging information can now be integrated with real-time fluoroscopy. This overlay technology was used to guide the placement of three percutaneous translumbar inferior vena cava catheters.

  15. An ultra-high field strength MR image-guided robotic needle delivery system for in-bore small animal interventions.

    Science.gov (United States)

    Gravett, Matthew; Cepek, Jeremy; Fenster, Aaron

    2017-11-01

    The purpose of this study was to develop and validate an image-guided robotic needle delivery system for accurate and repeatable needle targeting procedures in mouse brains inside the 12 cm inner diameter gradient coil insert of a 9.4 T MR scanner. Many preclinical research techniques require the use of accurate needle deliveries to soft tissues, including brain tissue. Soft tissues are optimally visualized in MR images, which offer high-soft tissue contrast, as well as a range of unique imaging techniques, including functional, spectroscopy and thermal imaging, however, there are currently no solutions for delivering needles to small animal brains inside the bore of an ultra-high field MR scanner. This paper describes the mechatronic design, evaluation of MR compatibility, registration technique, mechanical calibration, the quantitative validation of the in-bore image-guided needle targeting accuracy and repeatability, and demonstrated the system's ability to deliver needles in situ. Our six degree-of-freedom, MR compatible, mechatronic system was designed to fit inside the bore of a 9.4 T MR scanner and is actuated using a combination of piezoelectric and hydraulic mechanisms. The MR compatibility and targeting accuracy of the needle delivery system are evaluated to ensure that the system is precisely calibrated to perform the needle targeting procedures. A semi-automated image registration is performed to link the robot coordinates to the MR coordinate system. Soft tissue targets can be accurately localized in MR images, followed by automatic alignment of the needle trajectory to the target. Intra-procedure visualization of the needle target location and the needle were confirmed through MR images after needle insertion. The effects of geometric distortions and signal noise were found to be below threshold that would have an impact on the accuracy of the system. The system was found to have negligible effect on the MR image signal noise and geometric distortion

  16. Ultrasound-guided fine needle aspiration of thyroid nodules: A consensus statement by the Korean Society of Thyroid Radiology

    International Nuclear Information System (INIS)

    Lee, Young Hen; Baek, Jung Hwan; Jung, So Lyoung; Kwak, Jin Young; Kim, Ji Hoon; Shin, Jung Hee

    2015-01-01

    Ultrasound (US)-guided fine needle aspiration (US-FNA) has played a crucial role in managing patients with thyroid nodules, owing to its safety and accuracy. However, even with US guidance, nondiagnostic sampling and infrequent complications still occur after FNA. Accordingly, the Task Force on US-FNA of the Korean Society of Thyroid Radiology has provided consensus recommendations for the US-FNA technique and related issues to improve diagnostic yield. These detailed procedures are based on a comprehensive analysis of the current literature and from the consensus of experts.

  17. Practical guidelines for ultrasound-guided core needle biopsy of soft-tissue lesions: Transformation from beginner to specialist

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Yoon; Chung, Hye Won; Oh, Tack Sun; Lee, Jong Seok [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-04-15

    Ultrasound-guided core needle biopsy (US-CNB) is an important step in the diagnosis of musculoskeletal soft-tissue lesions. To maximize efficacy and minimize the complications of US-CNB, it is critical to collaborate with a multidisciplinary team and to understand the particular considerations of US-CNB for these lesions. The purpose of this article is to provide a systematic review and step-by-step tips for using US-CNB to diagnose musculoskeletal soft-tissue lesions.

  18. Image-guided modified deep anterior lamellar keratoplasty (DALK) corneal transplant using intraoperative optical coherence tomography

    Science.gov (United States)

    Tao, Yuankai K.; LaBarbera, Michael; Ehlers, Justis P.; Srivastava, Sunil K.; Dupps, William J.

    2015-03-01

    Deep anterior lamellar keratoplasty (DALK) is an alternative to full-thickness corneal transplant and has advantages including the absence of allograft rejection; shortened duration of topical corticosteroid treatment and reduced associated risk of glaucoma, cataract, or infection; and enables use of grafts with poor endothelial quality. DALK begins by performing a trephination of approximately 80% stromal thickness, as measured by pachymetry. After removal of the anterior stoma, a needle is inserted into the residual stroma to inject air or viscoelastic to dissect Descemet's membrane. These procedures are inherently difficult and intraoperative rates of Descemet's membrane perforation between 4-39% have been reported. Optical coherence tomography (OCT) provides high-resolution images of tissue microstructures in the cornea, including Descemet's membrane, and allows quantitation of corneal layer thicknesses. Here, we use crosssectional intraoperative OCT (iOCT) measurements of corneal thickness during surgery and a novel micrometeradjustable biopsy punch to precision-cut the stroma down to Descemet's membrane. Our prototype cutting tool allows us to establish a dissection plane at the corneal endothelium interface, mitigates variability in cut-depths as a result of tremor, reduces procedure complexity, and reduces complication rates. iOCT-guided modified DALK procedures were performed on 47 cadaveric porcine eyes by non-experts and achieved a perforation rate of ~5% with a mean corneal dissection time care.

  19. [Fluoroscopy dose reduction of computed tomography guided chest interventional radiology using real-time iterative reconstruction].

    Science.gov (United States)

    Hasegawa, Hiroaki; Mihara, Yoshiyuki; Ino, Kenji; Sato, Jiro

    2014-11-01

    The purpose of this study was to evaluate the radiation dose reduction to patients and radiologists in computed tomography (CT) guided examinations for the thoracic region using CT fluoroscopy. Image quality evaluation of the real-time filtered back-projection (RT-FBP) images and the real-time adaptive iterative dose reduction (RT-AIDR) images was carried out on noise and artifacts that were considered to affect the CT fluoroscopy. The image standard deviation was improved in the fluoroscopy setting with less than 30 mA on 120 kV. With regard to the evaluation of artifact visibility and the amount generated by the needle attached to the chest phantom, there was no significant difference between the RT-FBP images with 120 kV, 20 mA and the RT-AIDR images with low-dose conditions (greater than 80 kV, 30 mA and less than 120 kV, 20 mA). The results suggest that it is possible to reduce the radiation dose by approximately 34% at the maximum using RT-AIDR while maintaining image quality equivalent to the RT-FBP images with 120 V, 20 mA.

  20. Cone-Beam Computed Tomography-Guided Percutaneous Radiologic Gastrostomy

    International Nuclear Information System (INIS)

    Moehlenbruch, Markus; Nelles, Michael; Thomas, Daniel; Willinek, Winfried; Gerstner, Andreas; Schild, Hans H.; Wilhelm, Kai

    2010-01-01

    The purpose of this study was to investigate the feasibility of a flat-detector C-arm-guided radiographic technique (cone-beam computed tomography [CBCT]) for percutaneous radiologic gastrostomy (PRG) insertion. Eighteen patients (13 men and 5 women; mean age 62 years) in whom percutaneous endoscopic gastrostomy (PEG) had failed underwent CBCT-guided PRG insertion. PEG failure or unsuitability was caused by upper gastrointestinal tract obstruction in all cases. Indications for gastrostomy were esophageal and head and neck malignancies, respectively. Before the PRG procedure, initial C-arm CBCT scans were acquired. Three- and 2-dimensional soft-tissue reconstructions of the epigastrium region were generated on a dedicated workstation. Subsequently, gastropexy was performed with T-fasteners after CBCT-guided puncture of the stomach bubble, followed by insertion of an 14F balloon-retained catheter through a peel-away introducer. Puncture of the stomach bubble and PRG insertion was technically successful in all patients without alteration of the epigastric region. There was no malpositioning of the tube or other major periprocedural complications. In 2 patients, minor complications occurred during the first 30 days of follow-up (PRG malfunction: n = 1; slight infection: n = 1). Late complications, which were mainly tube disturbances, were observed in 2 patients. The mean follow-up time was 212 days. CBCT-guided PRG is a safe, well-tolerated, and successful method of gastrostomy insertion in patients in whom endoscopic gastrostomy is not feasible. CBCT provides detailed imaging of the soft tissue and surrounding structures of the epigastric region in one diagnostic tour and thus significantly improves the planning of PRG procedures.

  1. Diffuse optical tomography for breast cancer imaging guided by computed tomography: A feasibility study.

    Science.gov (United States)

    Baikejiang, Reheman; Zhang, Wei; Li, Changqing

    2017-01-01

    Diffuse optical tomography (DOT) has attracted attentions in the last two decades due to its intrinsic sensitivity in imaging chromophores of tissues such as hemoglobin, water, and lipid. However, DOT has not been clinically accepted yet due to its low spatial resolution caused by strong optical scattering in tissues. Structural guidance provided by an anatomical imaging modality enhances the DOT imaging substantially. Here, we propose a computed tomography (CT) guided multispectral DOT imaging system for breast cancer imaging. To validate its feasibility, we have built a prototype DOT imaging system which consists of a laser at the wavelength of 650 nm and an electron multiplying charge coupled device (EMCCD) camera. We have validated the CT guided DOT reconstruction algorithms with numerical simulations and phantom experiments, in which different imaging setup parameters, such as projection number of measurements and width of measurement patch, have been investigated. Our results indicate that an air-cooling EMCCD camera is good enough for the transmission mode DOT imaging. We have also found that measurements at six angular projections are sufficient for DOT to reconstruct the optical targets with 2 and 4 times absorption contrast when the CT guidance is applied. Finally, we have described our future research plan on integration of a multispectral DOT imaging system into a breast CT scanner.

  2. Guided wave tomography in anisotropic media using recursive extrapolation operators

    Science.gov (United States)

    Volker, Arno

    2018-04-01

    Guided wave tomography is an advanced technology for quantitative wall thickness mapping to image wall loss due to corrosion or erosion. An inversion approach is used to match the measured phase (time) at a specific frequency to a model. The accuracy of the model determines the sizing accuracy. Particularly for seam welded pipes there is a measurable amount of anisotropy. Moreover, for small defects a ray-tracing based modelling approach is no longer accurate. Both issues are solved by applying a recursive wave field extrapolation operator assuming vertical transverse anisotropy. The inversion scheme is extended by not only estimating the wall loss profile but also the anisotropy, local material changes and transducer ring alignment errors. This makes the approach more robust. The approach will be demonstrated experimentally on different defect sizes, and a comparison will be made between this new approach and an isotropic ray-tracing approach. An example is given in Fig. 1 for a 75 mm wide, 5 mm deep defect. The wave field extrapolation based tomography clearly provides superior results.

  3. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours

    International Nuclear Information System (INIS)

    Pianta, Marcus; Chock, Eric; Schlicht, Stephen; McCombe, David

    2015-01-01

    This single-centre study retrospectively reviews the complications in patients that have occurred following peripheral nerve sheath tumour biopsy, and assesses whether there is an association with biopsy technique or underlying lesion characteristics. 41 consecutive core needle biopsies of proven peripheral nerve sheath tumours over a 2-year period in a tertiary teaching hospital were reviewed. Patient demographics and symptoms, tumour characteristics and radiological appearances were recorded. Biopsy and surgical histology were correlated, and post-biopsy and surgical complications analyzed. 41 biopsies were performed in 38 patients. 68 % schwannomas, 24 % neurofibromas and 7 % malignant peripheral nerve sheath tumours. Biopsy histology correlated with surgery in all cases. 71 % of lesions were surgically excised. 60 % of patients reported pain related to their lesion. Following the biopsy, 12 % reported increased pain, which resolved in all cases. Pain exacerbation was noted in tumours smaller in size, more superficial and in closer proximity of the biopsy needle tip to the traversing nerve. Number of biopsy needle passes was not associated with an increased incidence of procedure-related pain. Core biopsy of a suspected peripheral nerve sheath tumour may be performed safely before excisional surgery to confirm lesion histology and assist prognosis. There is excellent correlation between core biopsy and excised surgical specimen histology. The most common complication of pain exacerbation is seen in a minority and is temporary, and more likely with smaller, more superficial lesions and a closer needle-tip to traversing nerve distance during biopsy. (orig.)

  4. Accuracy and complications of CT-guided core needle biopsy of peripheral nerve sheath tumours

    Energy Technology Data Exchange (ETDEWEB)

    Pianta, Marcus; Chock, Eric; Schlicht, Stephen [St Vincent' s Hospital, Fitzroy, VIC (Australia); McCombe, David [St Vincent' s Hospital and Victorian Hand Surgery Associates, Victoria (Australia)

    2015-09-15

    This single-centre study retrospectively reviews the complications in patients that have occurred following peripheral nerve sheath tumour biopsy, and assesses whether there is an association with biopsy technique or underlying lesion characteristics. 41 consecutive core needle biopsies of proven peripheral nerve sheath tumours over a 2-year period in a tertiary teaching hospital were reviewed. Patient demographics and symptoms, tumour characteristics and radiological appearances were recorded. Biopsy and surgical histology were correlated, and post-biopsy and surgical complications analyzed. 41 biopsies were performed in 38 patients. 68 % schwannomas, 24 % neurofibromas and 7 % malignant peripheral nerve sheath tumours. Biopsy histology correlated with surgery in all cases. 71 % of lesions were surgically excised. 60 % of patients reported pain related to their lesion. Following the biopsy, 12 % reported increased pain, which resolved in all cases. Pain exacerbation was noted in tumours smaller in size, more superficial and in closer proximity of the biopsy needle tip to the traversing nerve. Number of biopsy needle passes was not associated with an increased incidence of procedure-related pain. Core biopsy of a suspected peripheral nerve sheath tumour may be performed safely before excisional surgery to confirm lesion histology and assist prognosis. There is excellent correlation between core biopsy and excised surgical specimen histology. The most common complication of pain exacerbation is seen in a minority and is temporary, and more likely with smaller, more superficial lesions and a closer needle-tip to traversing nerve distance during biopsy. (orig.)

  5. Development and Evaluation of a Novel Curved Biopsy Device for CT-Guided Biopsy of Lesions Unreachable Using Standard Straight Needle Trajectories

    Energy Technology Data Exchange (ETDEWEB)

    Schulze-Hagen, Maximilian Franz, E-mail: mschulze@ukaachen.de; Pfeffer, Jochen; Zimmermann, Markus; Liebl, Martin [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology (Germany); Stillfried, Saskia Freifrau von [University Hospital RWTH Aachen, Department of Pathology (Germany); Kuhl, Christiane; Bruners, Philipp; Isfort, Peter [University Hospital RWTH Aachen, Department of Diagnostic and Interventional Radiology (Germany)

    2017-06-15

    PurposeTo evaluate the feasibility of a novel curved CT-guided biopsy needle prototype with shape memory to access otherwise not accessible biopsy targets.Methods and MaterialsA biopsy needle curved by 90° with specific radius was designed. It was manufactured using nitinol to acquire shape memory, encased in a straight guiding trocar to be driven out for access of otherwise inaccessible targets. Fifty CT-guided punctures were conducted in a biopsy phantom and 10 CT-guided punctures in a swine corpse. Biposies from porcine liver and muscle tissue were separately gained using the biopsy device, and histological examination was performed subsequently.ResultsMean time for placement of the trocar and deployment of the inner biopsy needle was ~205 ± 69 and ~93 ± 58 s, respectively, with a mean of ~4.5 ± 1.3 steps to reach adequate biopsy position. Mean distance from the tip of the needle to the target was ~0.7 ± 0.8 mm. CT-guided punctures in the swine corpse took relatively longer and required more biopsy steps (~574 ± 107 and ~380 ± 148 s, 8 ± 2.6 steps). Histology demonstrated appropriate tissue samples in nine out of ten cases (90%).ConclusionsTargets that were otherwise inaccessible via standard straight needle trajectories could be successfully reached with the curved biopsy needle prototype. Shape memory and preformed size with specific radius of the curved needle simplify the target accessibility with a low risk of injuring adjacent structures.

  6. Role of endoscopic ultrasound-guided fine needle aspiration and ultrasound-guided fine-needle aspiration in diagnosis of cystic pancreatic lesions

    Science.gov (United States)

    Okasha, Hussein Hassan; Ashry, Mahmoud; Imam, Hala M. K.; Ezzat, Reem; Naguib, Mohamed; Farag, Ali H.; Gemeie, Emad H.; Khattab, Hani M.

    2015-01-01

    Background and Objective: The addition of fine-needle aspiration (FNA) to different imaging modalities has raised the accuracy for diagnosis of cystic pancreatic lesions. We aim to differentiate benign from neoplastic pancreatic cysts by evaluating cyst fluid carcinoembryonic antigen (CEA), carbohydrate antigen (CA19-9), and amylase levels and cytopathological examination, including mucin stain. Patients and Methods: This prospective study included 77 patients with pancreatic cystic lesions. Ultrasound-FNA (US-FNA) or endoscopic ultrasound-FNA (EUS-FNA) was done according to the accessibility of the lesion. The aspirated specimens were subjected to cytopathological examination (including mucin staining), tumor markers (CEA, CA19-9), and amylase level. Results: Cyst CEA value of 279 or more showed high statistical significance in differentiating mucinous from nonmucinous lesions with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 73%, 60%, 50%, 80%, and 65%, respectively. Cyst amylase could differentiate between neoplastic and nonneoplastic cysts at a level of 1043 with sensitivity of 58%, specificity of 75%, PPV of 73%, NPV of 60%, and accuracy of 66%. CA19-9 could not differentiate between neoplastic and nonneoplastic cysts. Mucin examination showed a sensitivity of 85%, specificity of 95%, PPV of 92%, NPV of 91%, and accuracy of 91% in differentiating mucinous from non-mucinous lesions. Cytopathological examination showed a sensitivity of 81%, specificity of 94%, PPV of 94%, NPV of 83%, and accuracy of 88%. Conclusion: US or EUS-FNA with analysis of cyst CEA level, CA19-9, amylase, mucin stain, and cytopathological examination increases the diagnostic accuracy of cystic pancreatic lesions. PMID:26020048

  7. Size and Ultrasound Features Affecting Results of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

    Science.gov (United States)

    Dong, YiJie; Mao, MinJing; Zhan, WeiWei; Zhou, JianQiao; Zhou, Wei; Yao, JieJie; Hu, YunYun; Wang, Yan; Ye, TingJun

    2017-11-09

    Our goal was to assess the diagnostic efficacy of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules according to size and US features. A retrospective correlation was made with 1745 whole thyroidectomy and hemithyroidectomy specimens with preoperative US-guided FNA results. All cases were divided into 5 groups according to nodule size (≤5, 5.1-10, 10.1-15, 15.1-20, and >20 mm). For target nodules, static images and cine clips of conventional US and color Doppler were obtained. Ultrasound images were reviewed and evaluated by two radiologists with at least 5 years US working experience without knowing the results of pathology, and then agreement was achieved. The Bethesda category I rate was higher in nodules larger than 15 mm (P 20 mm) with several US features tended to yield false-negative FNA results. © 2017 by the American Institute of Ultrasound in Medicine.

  8. Optical Coherence Tomography-Guided Decisions in Retinoblastoma Management.

    Science.gov (United States)

    Soliman, Sameh E; VandenHoven, Cynthia; MacKeen, Leslie D; Héon, Elise; Gallie, Brenda L

    2017-06-01

    Assess the role of handheld optical coherence tomography (OCT) in guiding management decisions during diagnosis, treatment, and follow-up of eyes affected by retinoblastoma. Retrospective, noncomparative, single-institution case series. All children newly diagnosed with retinoblastoma from January 2011 to December 2015 who had an OCT session during their active treatment at The Hospital for Sick Children (SickKids) in Toronto, Canada. The OCT sessions for fellow eyes of unilateral retinoblastoma without any suspicious lesion and those performed more than 6 months after the last treatment were excluded. Data collected included age at presentation, sex, family history, RB1 mutation status, 8th edition TNMH cancer staging and International Intraocular Retinoblastoma Classification (IIRC), and number of OCT sessions per eye. Details of each session were scored for indication-related details (informative or not) and assessed for guidance (directive or not), diagnosis (staging changed, new tumors found or excluded), treatment (modified, stopped, or modality shifted), or follow-up modified. Frequency of OCT-guided management decisions, stratified by indication and type of guidance (confirmatory vs. influential). Sixty-three eyes of 44 children had 339 OCT sessions over the course of clinical management (median number of OCT scans per eye, 5; range, 1-15). The age at presentation and presence of a heritable RB1 mutation significantly correlated with an increased number of OCT sessions. Indications included evaluation of post-treatment scar (55%) or fovea (16%), and posterior pole scanning for new tumors (11%). Of all sessions, 92% (312/339) were informative; 19 of 27 noninformative sessions had large, elevated lesions; of these, 14 of 19 were T2a or T2b (IIRC group C or D) eyes. In 94% (293/312) of the informative sessions, OCT directed treatment decisions (58%), diagnosis (16%), and follow-up (26%). Optical coherence tomography influenced and changed management from pre

  9. Diagnosis of verminous pneumonia via sonography-guided fine-needle pulmonary parenchymal aspiration in a cat

    Directory of Open Access Journals (Sweden)

    Jennifer Gambino

    2016-04-01

    Full Text Available Case summary A 9-year-old, male neutered, indoor–outdoor domestic shorthair cat from the northern Alabama countryside presented for a 3 week history of coughing, lethargy and an episode of self-resolving dyspnea that occurred 1 week prior to presentation. Three-view thoracic radiographs revealed a moderate-to-severe, diffuse, mixed bronchial to structured interstitial (miliary-to-nodular pulmonary pattern in all lung lobes with peribronchial cuffing and multifocal areas of mild patchy alveolar opacity. Ultrasound-guided evaluation and fine-needle aspiration of the caudodorsal lung parenchyma was performed with sedation. Cytology revealed many widely scattered Aelurostrongylus abstrusus larvae and ova. Upon the confirmed diagnosis of A abstrusus verminous pneumonia, treatment with fenbendazole and selamectin resulted in complete resolution of clinical signs within 6 weeks of the initial diagnosis. Relevance and novel information We report herein the first documented case in the Americas of A abstrusus verminous pneumonia diagnosed via cytologic evaluation of an in vivo, percutaneous ultrasound-guided fine-needle aspirate of affected lung. Additionally, to our knowledge, we offer the first account of the sonographic (pulmonary features of the disease.

  10. Success rates for computed tomography-guided musculoskeletal biopsies performed using a low-dose technique

    International Nuclear Information System (INIS)

    Motamedi, Kambiz; Levine, Benjamin D.; Seeger, Leanne L.; McNitt-Gray, Michael F.

    2014-01-01

    To evaluate the success rate of a low-dose (50 % mAs reduction) computed tomography (CT) biopsy technique. This protocol was adopted based on other successful reduced-CT radiation dose protocols in our department, which were implemented in conjunction with quality improvement projects. The technique included a scout view and initial localizing scan with standard dose. Additional scans obtained for further guidance or needle adjustment were acquired by reducing the tube current-time product (mAs) by 50 %. The radiology billing data were searched for CT-guided musculoskeletal procedures performed over a period of 8 months following the initial implementation of the protocol. These were reviewed for the type of procedure and compliance with the implemented protocol. The compliant CT-guided biopsy cases were then retrospectively reviewed for patient demographics, tumor pathology, and lesion size. Pathology results were compared to the ultimate diagnoses and were categorized as diagnostic, accurate, or successful. Of 92 CT-guided procedures performed during this period, two were excluded as they were not biopsies (one joint injection and one drainage), 19 were excluded due to non-compliance (operators neglected to follow the protocol), and four were excluded due to lack of available follow-up in our electronic medical records. A total of 67 compliant biopsies were performed in 63 patients (two had two biopsies, and one had three biopsies). There were 32 males and 31 females with an average age of 50 (range, 15-84 years). Of the 67 biopsies, five were non-diagnostic and inaccurate and thus unsuccessful (7 %); five were diagnostic but inaccurate and thus unsuccessful (7 %); 57 were diagnostic and accurate thus successful (85 %). These results were comparable with results published in the radiology literature. The success rate of CT-guided biopsies using a low-dose protocol is comparable to published rates for conventional dose biopsies. The implemented low-dose protocol

  11. Success rates for computed tomography-guided musculoskeletal biopsies performed using a low-dose technique

    Energy Technology Data Exchange (ETDEWEB)

    Motamedi, Kambiz; Levine, Benjamin D.; Seeger, Leanne L.; McNitt-Gray, Michael F. [UCLA Health System, Radiology, Los Angeles, CA (United States)

    2014-11-15

    To evaluate the success rate of a low-dose (50 % mAs reduction) computed tomography (CT) biopsy technique. This protocol was adopted based on other successful reduced-CT radiation dose protocols in our department, which were implemented in conjunction with quality improvement projects. The technique included a scout view and initial localizing scan with standard dose. Additional scans obtained for further guidance or needle adjustment were acquired by reducing the tube current-time product (mAs) by 50 %. The radiology billing data were searched for CT-guided musculoskeletal procedures performed over a period of 8 months following the initial implementation of the protocol. These were reviewed for the type of procedure and compliance with the implemented protocol. The compliant CT-guided biopsy cases were then retrospectively reviewed for patient demographics, tumor pathology, and lesion size. Pathology results were compared to the ultimate diagnoses and were categorized as diagnostic, accurate, or successful. Of 92 CT-guided procedures performed during this period, two were excluded as they were not biopsies (one joint injection and one drainage), 19 were excluded due to non-compliance (operators neglected to follow the protocol), and four were excluded due to lack of available follow-up in our electronic medical records. A total of 67 compliant biopsies were performed in 63 patients (two had two biopsies, and one had three biopsies). There were 32 males and 31 females with an average age of 50 (range, 15-84 years). Of the 67 biopsies, five were non-diagnostic and inaccurate and thus unsuccessful (7 %); five were diagnostic but inaccurate and thus unsuccessful (7 %); 57 were diagnostic and accurate thus successful (85 %). These results were comparable with results published in the radiology literature. The success rate of CT-guided biopsies using a low-dose protocol is comparable to published rates for conventional dose biopsies. The implemented low-dose protocol

  12. Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer diagnosis and staging in 179 patients

    Directory of Open Access Journals (Sweden)

    Antonio Bugalho

    2013-09-01

    Full Text Available Background: Linear endobronchial ultrasound-guided transbronchial needle aspiration (eBUStBNA is an important minimally invasive procedure for non-small cell lung cancer (NScLc staging. It is also a valid method for diagnosing extraluminal lesions adjacent to the tracheobronchial tree. Aim: to evaluate our eBUS-tBNA performance regarding diagnostic yield, safety and learning curve for lung cancer diagnosis and staging. Material and methods: All patients undergoing eBUS-tBNA for lung cancer diagnosis or staging were included. they were divided into three different groups: paratracheal and parabronchial masses sent for diagnosis (Group 1; peripheral lung lesions with abnormal mediastinal lymph nodes sent for diagnosis and staging (Group 2; NScLc patients sent for mediastinal staging (Group 3. the learning curve was assessed for yield, accuracy, procedure time, size and number of lesions punctured per patient Results: A total of 179 patients were included and 372 lesions were punctured. the overall yield and accuracy were 88% and 92.7%, respectively. In Group 1, eBUS-tBNA was performed in 48 patients and sensitivity was 86.1% and accuracy was 87.5%. For the 87 patients included in Group 2, yield was 86.7%, accuracy was 93.1% and cancer prevalence was 51.7%. the diagnostic yield and accuracy in Group 3 was 95% and 97.7% respectively. eBUS-tBNA practice led to an increase number of sites punctured per patient in a shorter time, without complications. Conclusion: eBUS-tBNA is an effective method for diagnosing and staging lung cancer patients. the procedure is clearly safe. Handling and performance improves with the number of procedures executed. Resumo: Introdução: A punção aspirativa transbrônquica guiada por ecoendoscopia brônquica linear (eBUS-tBNA é um importante procedimento minimamente invasivo para o estadiamento do cancro do pulmão de não pequenas células (cPNPc. É, também, um método válido para o diagnóstico de les

  13. Transbronchial needle aspiration with a new electromagnetically-tracked TBNA needle

    Science.gov (United States)

    Choi, Jae; Popa, Teo; Gruionu, Lucian

    2009-02-01

    Transbronchial needle aspiration (TBNA) is a common method used to collect tissue for diagnosis of different chest diseases and for staging lung cancer, but the procedure has technical limitations. These limitations are mostly related to the difficulty of accurately placing the biopsy needles into the target mass. Currently, pulmonologists plan TBNA by examining a number of Computed Tomography (CT) scan slices before the operation. Then, they manipulate the bronchoscope down the respiratory track and blindly direct the biopsy. Thus, the biopsy success rate is low. The diagnostic yield of TBNA is approximately 70 percent. To enhance the accuracy of TBNA, we developed a TBNA needle with a tip position that can be electromagnetically tracked. The needle was used to estimate the bronchoscope's tip position and enable the creation of corresponding virtual bronchoscopic images from a preoperative CT scan. The TBNA needle was made with a flexible catheter embedding Wang Transbronchial Histology Needle and a sensor tracked by electromagnetic field generator. We used Aurora system for electromagnetic tracking. We also constructed an image-guided research prototype system incorporating the needle and providing a user-friendly interface to assist the pulmonologist in targeting lesions. To test the feasibility of the accuracy of the newly developed electromagnetically-tracked needle, a phantom study was conducted in the interventional suite at Georgetown University Hospital. Five TBNA simulations with a custom-made phantom with a bronchial tree were performed. The experimental results show that our device has potential to enhance the accuracy of TBNA.

  14. The Role of Fine Needle Aspiration in the Diagnosis of Parotid Gland Tumors: Correlation With Preoperative Computerized Tomography Tumor Size.

    Science.gov (United States)

    Ghantous, Yasmine; Naddaf, Raja; Barak, Michal; Abd-Elraziq, Murad; Abu Eln-Naaj, Imad

    2016-03-01

    The role of fine needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses is still controversial, regarding its sensitivity and specificity that vary between 41% and 100% and between 86% and 100% respectively.The aim of this study was to identify the specificity and sensitivity of FNAC of parotid gland tumors in relation to the tumor size as characterized preoperatively by computer tomography. The medical files of 79 patients whom were referred to the MaxilloFacila Surgery Department, Rambam medical center, over a 10.5-year period (2000-2010) were analyzed retrospectively.The extensity of the operation was determined by the location of the tumor as presented in computed tomography (CT) radiography, and preoperative FNAC examination.The majority of the masses were located in the superficial lobe (88.52%), and only 11.48% of the patients were located in the deep lobe (8:1 ratio). FNAC results were nondiagnostic in 7 patients (8.86%), 62 patients were diagnosed as inflammatory and benign lesion in (78.48%), malignant tumors were diagnosed in 10 patients (12.65%).The sensitivity in our study was 90%, the specificity was 98%, positive predictive value was 90%, negative predictive value was 98%, and diagnostic accuracy was 88%. The positive predictive value was 90%, the negative predictive value was 98%.Analyzing the effect of the preoperative CT size upon the accuracy of the FNAC diagnosis, we found that lesion with preoperative CT size greater than 24 mm has a more accurate FNAC result (P = 0.034).

  15. A foreign body reaction to Surgicel® in a lymph node diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

    Directory of Open Access Journals (Sweden)

    Diana Badenes

    2017-01-01

    Full Text Available Surgicel ® (Ethicon, North Ryde, NSW, Australia is an absorbable sheet of oxidized cellulose polyanhydroglucuronic acid polymer used as an hemostatic in cardiovascular and thoracic surgery. In some cases, the retained material may cause foreign body granulomatous reactions and simulate tumor recurrence, an abscess, an hematoma, or an infection. We report the case of a 55-year-old patient who was operated of a lung adenocarcinoma. In the thoracic computed tomography scan 1 year after the surgery, a right paratracheal lymph node was detected, so endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA was performed suspecting recurrence of the tumor. The cytology results of the lymph node showed a nonnecrotizing granulomatous reaction secondary to Surgicel ® , used as an hemostatic during the surgery. The objective of presenting this case is to consider foreign body reaction to Surgicel ® in the differential diagnosis of postoperative suspicion of neoplastic recurrence, and on the other hand, to note that EBUS-TBNA enables diagnosis.

  16. Incidental primary mediastinal choriocarcinoma diagnosed by endobronchial ultrasound-guided fine needle aspiration in a patient presenting with transient ischemic attack and stroke.

    Science.gov (United States)

    Francischetti, Ivo M B; Cajigas, Antonio; Suhrland, Mark; Farinhas, Joaquim M; Khader, Samer

    2017-08-01

    We describe a case of a 41-year old male patient with no significant prior medical history who presents with symptoms of Transient Ischemic Attack and stroke. Magnetic Resonance Imaging (MRI) of the brain identified areas of ischemia in the left side, and angiography showed occlusion of the left Medial Cerebral Artery (MCA). Cardiac Transthoracic Echocardiogram (TTE) for stroke evaluation incidentally noted a mediastinal abnormality leading to cancer work-up. Computer Tomography (CT) and 18 F-fluorodeoxyglucose (FDG) PET-CT scan of the chest incidentally revealed an avid 6 cm paraesophagial/subcarinal mass. Further diagnostic work-up with endoscopic and endobronchial ultra sound (EBUS)-guided fine needle aspiration (FNA) of the mass yielded a cytology diagnosis of Germ Cell Tumor (GCT), with choriocarcinoma component. Additionally, high plasma levels of β-human chorionic gonadotrophin (β-HCG) were detected with no evidence of testicular tumor. This exceedingly rare presentation for a primary mediastinal choriocarcinoma underscores the importance of complete investigation of young patients presenting with neurological symptoms compatible with ischemic events. Diagn. Cytopathol. 2017;45:738-743. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Ultrasonography-guided core needle biopsy for the thyroid nodule: does the procedure hold any benefit for the diagnosis when fine-needle aspiration cytology analysis shows inconclusive results?

    Science.gov (United States)

    Hahn, S Y; Han, B-K; Ko, E Y; Ko, E S

    2013-01-01

    Objective: We evaluated the diagnostic role of ultrasonography-guided core needle biopsy (CNB) according to ultrasonography features of thyroid nodules that had inconclusive ultrasonography-guided fine-needle aspiration (FNA) results. Methods: A total of 88 thyroid nodules in 88 patients who underwent ultrasonography-guided CNB because of previous inconclusive FNA results were evaluated. The patients were classified into three groups based on ultrasonography findings: Group A, which was suspicious for papillary thyroid carcinoma (PTC); Group B, which was suspicious for follicular (Hurthle cell) neoplasm; and Group C, which was suspicious for lymphoma. The final diagnoses of the thyroid nodules were determined by surgical confirmation or follow-up after ultrasonography-guided CNB. Results: Of the 88 nodules, the malignant rate was 49.1% in Group A, 12.0% in Group B and 90.0% in Group C. The rates of conclusive ultrasonography-guided CNB results after previous incomplete ultrasonography-guided FNA results were 96.2% in Group A, 64.0% in Group B and 90.0% in Group C (p=0.001). 12 cases with inconclusive ultrasonography-guided CNB results were finally diagnosed as 8 benign lesions, 3 PTCs and 1 lymphoma. The number of previous ultrasonography-guided FNA biopsies was not significantly different between the conclusive and the inconclusive result groups of ultrasonography-guided CNB (p=0.205). Conclusion: Ultrasonography-guided CNB has benefit for the diagnosis of thyroid nodules with inconclusive ultrasonography-guided FNA results. However, it is still not helpful for the differential diagnosis in 36% of nodules that are suspicious for follicular neoplasm seen on ultrasonography. Advances in knowledge: This study shows the diagnostic contribution of ultrasonography-guided CNB as an alternative to repeat ultrasonography-guided FNA or surgery. PMID:23564885

  18. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Im [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Park, Chang Min; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of)

    2015-07-15

    To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions. From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups. There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8 % vs. 23.1 %, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6 %) than conventional-group (4.2 %) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002). The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB. (orig.)

  19. Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions.

    Science.gov (United States)

    Khosla, Rahul; McLean, Anna W; Smith, Jessica A

    2016-01-01

    Computed tomography (CT) guided biopsies have long been the standard technique to obtain tissue from the thoracic cavity and is traditionally performed by interventional radiologists. Ultrasound (US) guided biopsy of pleural-based lesions, performed by pulmonologists is gaining popularity and has the advantage of multi-planar imaging, real-time technique, and the absence of radiation exposure to patients. In this study, we aim to determine the diagnostic accuracy, the time to diagnosis after the initial consult placement, and the complications rates between the two different modalities. A retrospective study of electronic medical records was done of patients who underwent CT-guided biopsies and US-guided biopsies for pleural-based lesions between 2005 and 2014 and the data collected were analyzed for comparing the two groups. A total of 158 patients underwent 162 procedures during the study period. 86 patients underwent 89 procedures in the US group, and 72 patients underwent 73 procedures in the CT group. The overall yield in the US group was 82/89 (92.1%) versus 67/73 (91.8%) in the CT group (P = 1.0). Average days to the procedure was 7.2 versus 17.5 (P = 0.00001) in the US and CT group, respectively. Complication rate was higher in CT group 17/73 (23.3%) versus 1/89 (1.1%) in the US group (P guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate and a significantly reduced time to the procedure.

  20. Ultrasound-guided percutaneous needle electrolysis in chronic lateral epicondylitis: short-term and long-term results

    Science.gov (United States)

    Valera-Garrido, Fermín; Minaya-Muñoz, Francisco; Medina-Mirapeix, Francesc

    2014-01-01

    Background Ultrasound (US)-guided percutaneous needle electrolysis (PNE) is a novel minimally invasive approach which consists of the application of a galvanic current through an acupuncture needle. Objective To evaluate the clinical and ultrasonographic effectiveness of a multimodal programme (PNE, eccentric exercise (EccEx) and stretching) in the short term for patients with chronic lateral epicondylitis, and to determine whether the clinical outcomes achieved decline over time. Methods A one-way repeated measures study was performed in a clinical setting in 36 patients presenting with lateral epicondylitis. The patients received one session of US-guided PNE per week over 4–6 weeks, associated with a home programme of EccEx and stretching. The main outcome measures were severity of pain, disability (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire), structural tendon changes (US), hypervascularity and patients’ perceptions of overall outcome. Measurements at 6, 26 and 52 weeks follow-up included recurrence rates (increase in severity of pain or disability compared with discharge), perception of overall outcome and success rates. Results All outcome measures registered significant improvements between pre-intervention and discharge. Most patients (n=30, 83.3%) rated the overall outcome as ‘successful’ at 6 weeks. The ultrasonographic findings showed that the hypoechoic regions and hypervascularity of the extensor carpi radialis brevis changed significantly. At 26 and 52 weeks, all participants (n=32) perceived a ‘successful’ outcome. Recurrence rates were null after discharge and at follow-up at 6, 26 and 52 weeks. Conclusions Symptoms and degenerative structural changes of chronic lateral epicondylitis are reduced after US-guided PNE associated with EccEx and stretching, with encouragingly low recurrences in the mid to long term. Trial registration number ClinicalTrials.gov identifier: NCT02085928. PMID:25122629

  1. WE-AB-BRA-10: Assessment of Fiber Bragg Grating (FBG)-Based Sensing for Real-Time Needle Tracking During MR-Guided Brachytherapy

    International Nuclear Information System (INIS)

    Borot de Battisti, M; Maenhout, M; Lagendijk, J J W; Van Vulpen, M; Moerland, M A; Denis de Senneville, B; Hautvast, G; Binnekamp, D

    2016-01-01

    Purpose: This study assesses the potential of Fiber Bragg Grating (FBG)-based sensing for real-time needle (including catheter or tube) tracking during MR-guided HDR brachytherapy. Methods: The proposed FBG-based sensing tracking approach involves a MR-compatible stylet composed of three optic fibers with nine sets of embedded FBG sensors each. When the stylet is inserted inside the lumen of the needle, the FBG sensing system can measure the needle’s deflection. For localization of the needle in physical space, the position and orientation of the stylet base are mandatory. For this purpose, we propose to fix the stylet base and determine its position and orientation using a MR-based calibration as follows. First, the deflection of a needle inserted in a phantom in two different configurations is measured during simultaneous MR-imaging. Then, after segmentation of the needle shapes on the MR-images, the position and orientation of the stylet base is determined using a rigid registration of the needle shapes on both MR and FBG-based measurements. The calibration method was assessed by measuring the deflection of a needle in a prostate phantom in five different configurations using FBG-based sensing during simultaneous MR-imaging. Any two needle shapes were employed for the calibration step and the proposed FGB-tracking approach was subsequently evaluated on the other three needles configurations. The tracking accuracy was evaluated by computing the Euclidian distance between the 3D FBG vs. MR-based measurements. Results: Over all needle shapes tested, the average(standard deviation) Euclidian distance between the FBG and MR-based measurements was 0.79mm(0.37mm). The update rate and latency of the FBG-based measurements were 100ms and 300ms respectively. Conclusion: The proposed FBG-based protocol can measure the needle position with an accuracy, precision, update rate and latency eligible for accurate needle steering during MR-guided HDR brachytherapy. M. Borot de

  2. The Utility of Endoscopic Ultrasound Guided Fine Needle Aspiration in the Diagnosis of Infectious Diseases—Report of Three Cases

    Directory of Open Access Journals (Sweden)

    Mauro Ajaj Saieg

    2013-01-01

    Full Text Available Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA is a fast and minimally invasive methodology with a crucial impact on patients’ management. It has an important and established role in the diagnosis and staging of mediastinal and abdominal malignancies, but little is discussed in the literature on the usefulness of this technique in the diagnosis of infectious diseases. In the current report, we present three different cases where EUS was essential for reaching the diagnosis of tuberculosis and paracoccidiodomicosis in cases otherwise seen as malignant. In conclusion, EUS was successful not only in obtaining enough cells for morphological analysis, but also for the production of cell blocks and assessment of the presence of the microorganisms by special stains. EUS allied to fine needle biopsy was an important tool in determining diagnoses of enlarged lymph nodes, revealing the diagnosis of infectious diseases in cases otherwise seen as malignant. The wide use of this methodology in cases such as those reported here cannot only rule out malignancy, but also aid critically ill patients by installing early proper therapy without the need for aggressive interventions.

  3. Experimental Results of Guided Wave Travel Time Tomography

    Science.gov (United States)

    Volker, Arno; Mast, Arjan; Bloom, Joost

    2010-02-01

    Corrosion is one of the industries major issues regarding the integrity of assets. Currently inspections are conducted at regular intervals to ensure a sufficient integrity level of these assets. Both economical and social requirements are pushing the industry to even higher levels of availability, reliability and safety of installations. The concept of predictive maintenance using permanent sensors that monitor the integrity of an installation is an interesting addition to the current method of periodic inspections reducing uncertainty and extending inspection intervals. Guided wave travel time tomography is a promising method to monitor the wall thickness quantitatively over large areas. Obviously the robustness and reliability of such a monitoring system is of paramount importance. Laboratory experiments have been carried out on a 10″ pipe with a nominal wall thickness of 8 mm. Multiple, inline defects have been created with a realistic morphology. The depth of the defects was increased stepwise from 0.5 mm to 2 mm. Additionally the influences of the presence of liquid inside the pipe and surface roughness have been evaluated as well. Experimental results show that this method is capable of providing quantitative wall thickness information over a distance of 4 meter, with a sufficient accuracy such that results can be used for trending. The method has no problems imaging multiple defects.

  4. Endobronchial ultrasound-guided transbronchial needle aspiration is a sensitive method to evaluate patients who should not undergo pulmonary metastasectomy†

    DEFF Research Database (Denmark)

    Eckardt, Jens; Licht, Peter Bjørn

    2015-01-01

    metastasectomy with systematic sampling of mediastinal lymph nodes for histological evaluation. RESULTS: One hundred and three eligible patients were referred for EBUS-TBNA during a 4-year period. The primary cancers were located in the colon/rectum (n = 64), kidney (n = 16) and other sites (n = 23). EBUS......OBJECTIVES: Pulmonary metastasectomy is considered an effective treatment in selected patients with extrapulmonary cancer and oligometastatic disease. We know that the presence of mediastinal lymph node metastases reduces survival significantly, but the mediastinum is rarely evaluated before...... metastasectomy in these patients. We prospectively evaluated how endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) could identify metastases to the mediastinal lymph nodes in patients referred for pulmonary metastasectomy. METHODS: All patients with extrapulmonary cancer...

  5. Ultrasonic guided wave tomography for wall thickness mapping in pipes

    Science.gov (United States)

    Willey, Carson L.

    Corrosion and erosion damage pose fundamental challenges to operation of oil and gas infrastructure. In order to manage the life of critical assets, plant operators must implement inspection programs aimed at assessing the severity of wall thickness loss (WTL) in pipelines, vessels, and other structures. Maximum defect depth determines the residual life of these structures and therefore represents one of the key parameters for robust damage mitigation strategies. In this context, continuous monitoring with permanently installed sensors has attracted significant interest and currently is the subject of extensive research worldwide. Among the different monitoring approaches being considered, significant promise is offered by the combination of guided ultrasonic wave technology with the principles of model based inversion under the paradigm of what is now referred to as guided wave tomography (GWT). Guided waves are attractive because they propagate inside the wall of a structure over a large distance. This can yield significant advantages over conventional pulse-echo thickness gage sensors that provide insufficient area coverage -- typically limited to the sensor footprint. While significant progress has been made in the application of GWT to plate-like structures, extension of these methods to pipes poses a number of fundamental challenges that have prevented the development of sensitive GWT methods. This thesis focuses on these challenges to address the complex guided wave propagation in pipes and to account for parametric uncertainties that are known to affect model based inversion and which are unavoidable in real field applications. The main contribution of this work is the first demonstration of a sensitive GWT method for accurately mapping the depth of defects in pipes. This is achieved by introducing a novel forward model that can extract information related to damage from the complex waveforms measured by pairs of guided wave transducers mounted on the pipe

  6. Value of Artisanal Simulators to Teach Ultrasound-Guided Percutaneous Biopsy Using a Tru-Cut Needle for Veterinary and Medical Students

    Science.gov (United States)

    de Araújo Setin, Raíza; Fortes Cirimbelli, Carolina; Mazeto Ercolin, Anna Carolina; Pires, Sâmara Turbay; Disselli, Tamiris; Ferrarini Nunes Soares Hage, Maria Cristina

    2018-01-01

    The present study aimed to evaluate the applicability of artisanal simulators to teach veterinary and medical students the ultrasound-guided percutaneous biopsy using a tru-cut needle. The artisanal simulators consisted of bovine liver between two layers of commercially available grape gelatin. Students were paired, with one doing the biopsy and…

  7. Endoscopic ultrasound-guided fine-needle aspiration cytology in the evaluation of suspected tuberculosis in patients with isolated mediastinal lymphadenopathy

    DEFF Research Database (Denmark)

    Puri, R.; Vilmann, P.; Sud, R.

    2010-01-01

    Patients with suspected tuberculosis without pulmonary lesions and with mediastinal lymphadenopathy often pose a diagnostic challenge. Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) cytology is an established modality to evaluate mediastinal and abdominal lesions. The aim...... of the present study was to evaluate the role of EUS-FNA in isolated mediastinal lymphadenopathy in patients suspected of having tuberculosis....

  8. Augmented Reality-Guided Lumbar Facet Joint Injections.

    Science.gov (United States)

    Agten, Christoph A; Dennler, Cyrill; Rosskopf, Andrea B; Jaberg, Laurenz; Pfirrmann, Christian W A; Farshad, Mazda

    2018-05-08

    The aim of this study was to assess feasibility and accuracy of augmented reality-guided lumbar facet joint injections. A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality-guided and 20 computed tomography (CT)-guided facet joint injections each: for each augmented reality-guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality-guided and CT-guided facet joint injections. In total, 39/40 (97.5%) of augmented reality-guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality-guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P Augmented reality-guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.

  9. Brain areas involved in acupuncture needling sensation of de qi: a single-photon emission computed tomography (SPECT) study.

    Science.gov (United States)

    Chen, Jia-Rong; Li, Gan-Long; Zhang, Gui-Feng; Huang, Yong; Wang, Shu-Xia; Lu, Na

    2012-12-01

    De qi is a sensory response elicited by acupuncture stimulation. According to traditional Chinese medicine (TCM), de qi is essential for clinical efficacy. However, the understanding of the neurobiological basis of de qi is still limited. To investigate the relationship between brain activation and de qi by taking a single-photon emission computed tomography (SPECT) scan while applying acupuncture at TE5. A total of 24 volunteers were randomly divided into 4 groups, and received verum or sham acupuncture at true acupuncture point TE5 or a nearby sham point according to grouping. All subjects then received a (99m)Tc-ethylcysteinate dimer (ECD) SPECT scan. All six subjects in the verum acupuncture at true acupuncture point group experienced de qi sensation; in contrast, all six subjects in the sham acupuncture at the sham point group responded with nothing other than non-sensation. Compared to the scan results from subjects who experienced non-sensation, SPECT scans from subjects with de qi sensation demonstrated significant activated points mainly located in brodmann areas 6, 8, 19, 21, 28, 33, 35, 37, 47, the parahippocampal gyrus, lentiform nucleus, claustrum and red nucleus; deactivated points were seen in brodmann areas 9 and 25. Verum acupuncture at true acupuncture points is more likely to elicit de qi sensation. De qi sensations mainly resulted in brain area activations, but not deactivations. These brain areas are related to the curative effect of Te5. The acupuncture needle sensations of de qi and sharp pain are associated with different patterns of activations and deactivations in the brain.

  10. A Case of Bilateral Acute Calcific Tendinitis of the Gluteus Medius, Treated by Ultrasound-guided Needle Lavage and Corticosteroid Injection

    OpenAIRE

    Vereecke, Elke; Mermuys, Koen; Casselman, Jan

    2015-01-01

    Calcium hydroxyapatite deposition disease is a common pathology, most frequently located in the rotator cuff tendons of the shoulder, for which different therapeutic approaches are used. Ultrasound guided needle lavage and injection of anesthetic/corticosteroid is a well-known and extensively described treatment for calcific tendinits of the rotator cuff. We present a case of bilateral calcific tendinitis of the gluteus medius tendon, both sides successfully treated using ultrasound guided ne...

  11. Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

    Energy Technology Data Exchange (ETDEWEB)

    Tyng, Chiang Jeng; Santos, Erich Frank Vater; Guerra, Luiz Felipe Alves; Bitencourt, Almir Galvao Vieira; Barbosa, Paula Nicole Vieira Pinto; Chojniak, Rubens [A. C. Camargo Cancer Center, Sao Paulo, SP (Brazil); Universidade Federal do Espirito Santo (HUCAM/UFES), Vitoria, ES (Brazil). Hospital Universitario Cassiano Antonio de Morais. Radiologia e Diagnostico por Imagem

    2017-03-15

    Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications. (author)

  12. Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

    International Nuclear Information System (INIS)

    Tyng, Chiang Jeng; Santos, Erich Frank Vater; Guerra, Luiz Felipe Alves; Bitencourt, Almir Galvao Vieira; Barbosa, Paula Nicole Vieira Pinto; Chojniak, Rubens; Universidade Federal do Espirito Santo

    2017-01-01

    Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications. (author)

  13. CT-guided biopsy of pulmonary lesions : a comparison of diagnostic accuracy and complication rate between automated gun biopsy and fine needle aspiration biopsy

    International Nuclear Information System (INIS)

    Kim, Keon Woo; Kang, Duk Sik

    1998-01-01

    The purpose of this study is to compare the efficacy and safety of CT-guided automated gun biopsy with those of fine needle aspiration biopsy of pulmonary lesions. Under CT guidance, we performed automated gu biopsies in 115 cases of 109 patients and fine needle aspiration biopsies in 119 cases of 108 patients with pulmonary lesions. Between the two methods, we compared the diagnostic rate, diagnostic accuracy and frequency of compilations according to the depth and diameter of pulmonary lesions. The overall diagnostic rates of automated gun biopsy and fine needle aspiration biopsy were 76.5 % (88/115) and 64.7 % (77/119) respectively. There was a significant statistical difference (p=0.048), especially in the case of malignant lesions less than 3 cm (p=0.027) and more than 6 cm in maximal diameter (p=0.008), and in the lesions located from 1 cm to less than 3 cm from the pleural (p=0.030), as seen on CT. There was no significant statistical difference in the frequency of complications. Automated gun biopsy of pulmonary lesions under CT guidance is safe, with complications rate comparable to those of fine needle aspiration biopsy. A higher overall diagnostic rate can be achieved by automated gun biopsy than by fine needle aspiration biopsy. For the diagnosis of pulmonary lesions under CT guidance, automated gun biopsy is therefore a more useful procedure than fine needle aspiration biopsy. (author). 24 refs., 3 tabs

  14. CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years.

    Science.gov (United States)

    Yin, Zhongyuan; Liang, Zhiwen; Li, Pengcheng; Wang, Qiong

    2017-08-01

    To retrospectively evaluate the diagnostic performance and complications of a CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach. From January 2009 to December 2014, we used a coaxial positioning system and an 18G cutting-type biopsy device to perform CT-guided percutaneous transpulmonary needle biopsies of mediastinal nodes for 127 patients. The diagnostic performance, complication rate, influencing factors, distribution of mediastinal nodes and pathological diagnoses were investigated. Among 127 patients, pathologic analyses showed that all of the biopsies were technically successful. The sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. As for complications, the ratios for pneumothorax and hemoptysis were 33.9% and 4.7%, respectively. Multivariate analyses revealed that the distance from the pleura to the target lesion (P = 0.008) and the numbers of visceral pleura injuries (P = 0.006) were the two most significant risk factors for pneumothorax, and that the distance from the pleura to the target lesion (P = 0.004) was the most significant risk factor for hemoptysis. CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach is a safe and efficient diagnostic method. • CT-guided core needle biopsy is an accurate technique for diagnosing mediastinal nodes. • The rates of complications are similar to those for pulmonary lesion biopsy. • Pneumothorax risk factors include distance from pleura to target lesion and number of visceral pleura. • Distance from pleura to target lesion is the risk factor for hemoptysis. • CT-guided core needle biopsy is an important diagnostic method for mediastinal nodes.

  15. Guided mass spectrum labelling in atom probe tomography

    Energy Technology Data Exchange (ETDEWEB)

    Haley, D., E-mail: daniel.haley@materials.ox.ac.uk [Max-Planck-Institut für Eisenforschung, Max-Plack Straße 1, Düsseldorf (Germany); Department of Materials, University of Oxford, Parks Road, Oxford OX1 3PH (United Kingdom); Choi, P.; Raabe, D. [Max-Planck-Institut für Eisenforschung, Max-Plack Straße 1, Düsseldorf (Germany)

    2015-12-15

    Atom probe tomography (APT) is a valuable near-atomic scale imaging technique, which yields mass spectrographic data. Experimental correctness can often pivot on the identification of peaks within a dataset, this is a manual process where subjectivity and errors can arise. The limitations of manual procedures complicate APT experiments for the operator and furthermore are a barrier to technique standardisation. In this work we explore the capabilities of computer-guided ranging to aid identification and analysis of mass spectra. We propose a fully robust algorithm for enumeration of the possible identities of detected peak positions, which assists labelling. Furthermore, a simple ranking scheme is developed to allow for evaluation of the likelihood of each possible identity being the likely assignment from the enumerated set. We demonstrate a simple, yet complete work-chain that allows for the conversion of mass-spectra to fully identified APT spectra, with the goal of minimising identification errors, and the inter-operator variance within APT experiments. This work chain is compared to current procedures via experimental trials with different APT operators, to determine the relative effectiveness and precision of the two approaches. It is found that there is little loss of precision (and occasionally gain) when participants are given computer assistance. We find that in either case, inter-operator precision for ranging varies between 0 and 2 “significant figures” (2σ confidence in the first n digits of the reported value) when reporting compositions. Intra-operator precision is weakly tested and found to vary between 1 and 3 significant figures, depending upon species composition levels. Finally it is suggested that inconsistencies in inter-operator peak labelling may be the largest source of scatter when reporting composition data in APT. - Highlights: • Demonstration of a complete, but simple, automation chain for APT spectra analysis. • Algorithm for

  16. Guided mass spectrum labelling in atom probe tomography

    International Nuclear Information System (INIS)

    Haley, D.; Choi, P.; Raabe, D.

    2015-01-01

    Atom probe tomography (APT) is a valuable near-atomic scale imaging technique, which yields mass spectrographic data. Experimental correctness can often pivot on the identification of peaks within a dataset, this is a manual process where subjectivity and errors can arise. The limitations of manual procedures complicate APT experiments for the operator and furthermore are a barrier to technique standardisation. In this work we explore the capabilities of computer-guided ranging to aid identification and analysis of mass spectra. We propose a fully robust algorithm for enumeration of the possible identities of detected peak positions, which assists labelling. Furthermore, a simple ranking scheme is developed to allow for evaluation of the likelihood of each possible identity being the likely assignment from the enumerated set. We demonstrate a simple, yet complete work-chain that allows for the conversion of mass-spectra to fully identified APT spectra, with the goal of minimising identification errors, and the inter-operator variance within APT experiments. This work chain is compared to current procedures via experimental trials with different APT operators, to determine the relative effectiveness and precision of the two approaches. It is found that there is little loss of precision (and occasionally gain) when participants are given computer assistance. We find that in either case, inter-operator precision for ranging varies between 0 and 2 “significant figures” (2σ confidence in the first n digits of the reported value) when reporting compositions. Intra-operator precision is weakly tested and found to vary between 1 and 3 significant figures, depending upon species composition levels. Finally it is suggested that inconsistencies in inter-operator peak labelling may be the largest source of scatter when reporting composition data in APT. - Highlights: • Demonstration of a complete, but simple, automation chain for APT spectra analysis. • Algorithm for

  17. A Fresh Cadaver Model for the Instruction of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

    Science.gov (United States)

    McCrary, Hilary C; Faucett, Erynne A; Hurbon, Audriana N; Milinic, Tijana; Cervantes, Jose A; Kent, Sean L; Adamas-Rappaport, William J

    2017-07-01

    Objective The aim of our study is to determine if a fresh cadaver model (FCM) for the instruction of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules is a practical method for instruction. Study Design Pre- and postinstruction assessment of medical students' ability to perform US-guided FNA of artificially created thyroid nodules placed adjacent to the thyroid gland of a fresh cadaver. Setting University-based fresh cadaver laboratory. Subjects and Methods Study participants included a total of 17 first- and second-year medical students with minimal US training. Technical skills were assessed using a 10-item checklist. In addition, a cognitive assessment regarding the indications, contraindications, and complications of the procedure was completed. A postinstruction assessment was provided for participants 5 weeks after their initial assessment. Differences between pre- and postinstruction assessment scores of technical skills were analyzed using McNemar's test. The mean cognitive knowledge gain was analyzed using a paired 2-sample t test. Results Eight of 10 items on the skills checklist were statistically significant between pre- and postinstruction skills assessment ( P < .05). There was a statistically significant change in cognitive knowledge gain regarding the contraindications of the procedure ( P = .001), but not for indications or complications ( P = .104 and P = .111, respectively). Conclusion US-guided FNA continues to be an important diagnostic procedure in the workup of thyroid nodules, making it an essential skill to integrate into surgical skills lab. Our FCM for the instruction of US-guided FNA is the first of its kind, and this pilot study shows this is a viable method for instruction.

  18. Technical Note: Error metrics for estimating the accuracy of needle/instrument placement during transperineal magnetic resonance/ultrasound-guided prostate interventions.

    Science.gov (United States)

    Bonmati, Ester; Hu, Yipeng; Villarini, Barbara; Rodell, Rachael; Martin, Paul; Han, Lianghao; Donaldson, Ian; Ahmed, Hashim U; Moore, Caroline M; Emberton, Mark; Barratt, Dean C

    2018-04-01

    Image-guided systems that fuse magnetic resonance imaging (MRI) with three-dimensional (3D) ultrasound (US) images for performing targeted prostate needle biopsy and minimally invasive treatments for prostate cancer are of increasing clinical interest. To date, a wide range of different accuracy estimation procedures and error metrics have been reported, which makes comparing the performance of different systems difficult. A set of nine measures are presented to assess the accuracy of MRI-US image registration, needle positioning, needle guidance, and overall system error, with the aim of providing a methodology for estimating the accuracy of instrument placement using a MR/US-guided transperineal approach. Using the SmartTarget fusion system, an MRI-US image alignment error was determined to be 2.0 ± 1.0 mm (mean ± SD), and an overall system instrument targeting error of 3.0 ± 1.2 mm. Three needle deployments for each target phantom lesion was found to result in a 100% lesion hit rate and a median predicted cancer core length of 5.2 mm. The application of a comprehensive, unbiased validation assessment for MR/US guided systems can provide useful information on system performance for quality assurance and system comparison. Furthermore, such an analysis can be helpful in identifying relationships between these errors, providing insight into the technical behavior of these systems. © 2018 American Association of Physicists in Medicine.

  19. CT-guided percutaneous core needle biopsy in deep seated musculoskeletal lesions: a prospective study of 128 cases

    International Nuclear Information System (INIS)

    Puri, A.; Shingade, V.U.; Agarwal, M.G.; Anchan, C.; Juvekar, S.; Desai, S.; Jambhekar, N.A.

    2006-01-01

    Although large lesions of the limbs can easily be biopsied without image guidance, lesions in the spine, paraspinal area and pelvis are difficult to target, and benefit from CT guidance to improve the accuracy of targeting the lesion for biopsy purposes. A prospective study of CT-guided core needle biopsies for deep-seated musculoskeletal lesions was conducted at a referral cancer institute over a 4-year period with the aim of assessing the safety and efficacy of the procedure. From January 2000 to December 2003, 136 consecutive CT-guided biopsy sessions were undertaken for musculoskeletal lesions in 128 patients comprising 73 males and 55 females. The following data was recorded in all patients: demographic data, suspected clinicoradiological diagnosis, data related to core biopsy session (date, site, approach, total time required in minutes, number of cores, surgeon satisfaction with adequacy of cores), patient discomfort, complications, histopathology report and number of further sessions if material obtained during the first biopsy session was not confirmatory. The sample obtained during the biopsy session was considered inconclusive if, in the opinion of the pathologist, inadequate or non-representative tissue had been obtained. The diagnosis was considered inaccurate if the final histopathological diagnosis did not match with the biopsy diagnosis, or if subsequent clinicoradiological evaluation at follow up did not correlate with the biopsy diagnosis in those patients who were treated with modalities other than surgery. In 121 patients, a single session was sufficient to obtain representative material, whilst for six patients two sessions, and for one patient three sessions were necessary. The time taken for biopsy, including the pre-biopsy CT examination time, varied from 15 min to 60 min (median 30 min). For 110 bony lesions 116 sessions were required, and for 18 soft-tissue lesions 20 sessions were required. 108 biopsy sessions yielded a diagnosis, whilst

  20. The role of ultrasound and ultrasound-guided fine needle aspiration biopsy of lymph nodes in patients with skin tumours

    International Nuclear Information System (INIS)

    Solivetti, Francesco Maria; Elia, Fulvia; Santaguida, Maria Giulia; Guerrisi, Antonino; Visca, Paolo; Cercato, Maria Cecilia; Di Carlo, Aldo

    2014-01-01

    The primary aim of this study was to evaluate the diagnostic accuracy of ultrasound (US) in the study of superficial lymph nodes during the follow-up of patients surgically treated for skin tumours. The secondary objective was to compare positive cytological results with histological reports. From 2004 to 2011, 480 patients (male/female: 285/195; median age 57 years; prevalent skin tumour: melanoma) underwent US-guided fine-needle aspiration biopsy (FNAB) of suspicious recurrent lymph nodes. An expert radiologist first performed US testing of the lymph nodes, expressing either a negative or positive outcome of the test. Subsequently, US-guided FNAB was performed. FNAB positive patients were subjected to lymphadenectomy; the patients who tested negative underwent the follow-up. The size of lymph nodes was ≤ 2 cm in 90% of cases. Out of the 336 (70%) US “positive” patients, 231 (68.8%) were FNAB positives. Out of the 144 (30%) US “negatives”, 132 (91.7%) were FNAB negatives. The sensitivity and specificity of the US were 95% and 55.7%, respectively; the negative predictive value was 91.7% and the positive predictive value was 68.8%. Definitive histological results confirmed FNAB positivity in 97.5% of lymphadenectomies. US is a sensitive method in the evaluation of superficial lymph nodes during the follow-up of patients with skin tumours. High positive predictive value of cytology was confirmed

  1. The value of preoperative ultrasound guided fine-needle aspiration cytology of radiologically suspicious axillary lymph nodes in breast cancer

    Directory of Open Access Journals (Sweden)

    Torill Sauer

    2014-01-01

    Full Text Available Background: Preoperative ultrasound (US and eventually US-guided fine-needle aspiration cytology (FNAC of suspicious axillary lymph nodes (ALN is a standard procedure in the work-up of suspicious breast lesions. Preoperative US FNAC may prevent sentinel node biopsy (SNB procedure in 24-30% of patients with early stage breast carcinoma. The aim of this study was to evaluate the institutional results of this preoperative diagnostic procedure. Materials and Methods: A total of 182 cases of preoperative FNAC of suspicious ALN where retrieved from the pathology files. The results were compared with the final histology and staging. False negative (FN FNAC cases were reviewed and possibly missed metastatic cases (2 were immunostained with the epithelial marker AE1/AE3. Results: There were no false positives, whereas 16 cases were FN. In all but one case the FN′s represented sampling error. Half of the 16 FN cases in this series were macrometastases. Discussion: About 83% of the preoperatively aspirated cases were N+, indicating that a radiologically suspicious ALN has a very high risk of being metastatic. Preoperative US guided FNAC from radiologically suspicious ALN is highly efficient in detecting metastases. Depending on national guidelines, a preoperative, positive ALN FNAC might help to stratify the patients as to SNB and/or ALN dissection.

  2. Musculoskeletal ultrasound: how to treat calcific tendinitis of the rotator cuff by ultrasound-guided single-needle lavage technique.

    Science.gov (United States)

    Lee, Kenneth S; Rosas, Humberto G

    2010-09-01

    The purpose of this video article is to illustrate the ultrasound appearance of calcium deposition in the rotator cuff and provide a detailed step-by-step protocol for performing the ultrasound-guided single-needle lavage technique for the treatment of calcific tendinitis with emphasis on patient positioning, necessary supplies, real-time lavage technique, and steroid injection into the subacromial subdeltoid bursa. Musculoskeletal ultrasound is well established as a safe, cost-effective imaging tool in diagnosing and treating common musculoskeletal disorders. Calcific tendinitis of the rotator cuff is a common disabling cause of shoulder pain. Although most cases are self-limiting, a subset of patients is refractory to conservative therapy and requires treatment intervention. Ultrasound-guided lavage is an effective and safe minimally-invasive treatment not readily offered in the United States as an alternative to surgery, perhaps because of the limited prevalence of musculoskeletal ultrasound programs and limited training. On completion of this video article, the participant should be able to develop an appropriate diagnostic and therapeutic algorithm for the treatment of calcific tendinitis of the rotator cuff using ultrasound.

  3. Computer tomography guided lung biopsy using interactive breath-hold control

    DEFF Research Database (Denmark)

    Ashraf, Haseem; Krag-Andersen, Shella; Naqibullah, Matiullah

    2017-01-01

    Background: Interactive breath-hold control (IBC) may improve the accuracy and decrease the complication rate of computed tomography (CT)-guided lung biopsy, but this presumption has not been proven in a randomized study. Methods: Patients admitted for CT-guided lung biopsy were randomized...

  4. Utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration in patients with mediastinal and hilar lymphadenopathy: Western region experience.

    Science.gov (United States)

    Aljohaney, Ahmed A

    2018-01-01

    The aim of the study was to evaluate the clinical utility and safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with mediastinal and hilar lymphadenopathy and to explicitly describe the utility of this procedure in patient's outcome. A retrospective review and analysis was conducted on 52 patients with mediastinal or hilar lymphadenopathy who underwent EBUS-TBNA from June 2012 to June 2016. All the patients were evaluated by computed tomography (CT) chest with contrast before EBUS examination. Enlarged mediastinal or hilar lymph node was defined as >1 cm short axis on the enhanced CT. Among the 52 patients studied, 57.7% were presented with mediastinal or hilar lymphadenopathy for diagnosis and 42.3% presented with suspected mediastinal malignancy. Paratracheal stations were the most common site for puncture in 33 lymph nodes (43%). The best diagnostic yield was obtained from subcarinal stations and the lowest yield from the hilar stations. Surgical biopsies confirmed lymphoma in six patients, tuberculosis (TB) in three, sarcoidosis in two and one had metastatic adenocarcinoma of unknown primary. The sensitivity, specificity, positive predictive value, and negative predictive value of EBUS-TBNA for diagnosis of mediastinal and hilar lymph node abnormalities were 78.6%, 100%, 100%, and 80%, respectively. The diagnostic yield of EBUS-TBNA in malignant and benign conditions was 79.0%. EBUS-TBNA is a safe and efficacious procedure which can be performed using conscious sedation with high yields. It can be used for the staging of malignancies as well as for the diagnosis of inflammatory and infectious conditions such as sarcoidosis and TB.

  5. Computed tomography guided navigation assisted percutaneous ablation of osteoid osteoma in a 7-year-old patient: the low dose approach

    Energy Technology Data Exchange (ETDEWEB)

    Krokidis, Miltiadis; Tappero, Carlo; Bogdanovic, Daniel; Stamm, Anna-Christina [Inselspital, Bern University Hospital, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Ziebarth, Kai [Inselspital, Bern University Hospital, Department of Pediatric Surgery, Bern (Switzerland)

    2017-07-15

    Osteoid osteoma (OO) is a benign tumour that can cause severe pain and functional limitation to children and young adults; the treatment of choice is image-guided ablation. Due to the very small size of the lesion, detection and accurate needle placement may be challenging. Computed tomography (CT) offers very detailed imaging of the skeleton and is the modality of choice for the detection of small OO and for ablation guidance. Nevertheless, CT-guided positioning of the ablation applicator is linked to significant radiation exposure, particularly for the paediatric population. This case describes the successful use of a novel CT-based navigation system that offers the possibility of accurate ablation with only minimal radiation exposure in a paediatric patient. (orig.)

  6. Complications after CT guided trans thoracic needle biopsy: a 1000 patients-series of pulmonary lesions

    International Nuclear Information System (INIS)

    Velan, Osvaldo; Ayzaguer, Alejandro

    2000-01-01

    To evaluate the complications of the percutaneous biopsy (PB) of pulmonary lesions, the predisposing factors and the behavior to be followed, we compared our experience with the one from other authors. We reviewed 1000 pulmonary biopsies (687 males), finding 78 pneumothorax (4 drained with tube and hospital admittance; 11 drained at the moment of the examination; the rest controlled), 65 pulmonary hemorrhages (1 died). Other complications were: a) hemoptysis (n=9); b) pain (n=4); c) hemo pleura (n=3); d) hypotension (n=1); e) cough (n=1). The PB is a top alternative to establish the etiology of the pulmonary lesion. As with any surgery, there is always the potential risk of complications. In our case, the most frequent ones were the pneumothorax and the intrapulmonary hemorrhage, with or without hemoptysis. With most of the pneumothorax an expectant management was observed, or else they were drained by the physician. When comparing the experience of other authors about the pneumothorax, we underline the following differences: a) Higher incidence in biopsies with posterior access in the middle third of the lung; b) Less total incidence (7,8%); c) Higher incidence of pneumothorax in masses with pleural contact without healthy lung in the needle path (30%); d) The size of the lesion up to 4 cm in diameter was not a significant predisposing factor; e) The conservative management in most of the cases. Although rare, other complications existed, including the death of one patient. (author)

  7. Percutaneous tenotomy: development of a novel, percutaneous, ultrasound-guided needle-cutting technique for division of tendons and other connective tissue structures

    International Nuclear Information System (INIS)

    Hopkins, James; Sampson, Matthew

    2014-01-01

    A variety of surgical procedures derive therapeutic benefit from the division of retinacular, ligamentous or tendinous structures. Examples include carpal tunnel release for median nerve impingement, annular pulley release for trigger finger and tendon division for spastic muscular contractures. Here, using an animal cadaveric model, we describe the first steps in determining the feasibility of a novel, percutaneous, ultrasound-guided needle-cutting technique to achieve the same ends. The technique we describe involves the creation of an effective needle tenotomy device via a simple modification to an 18G coaxial, beveled needle. The technique holds promise for the development of a minimally invasive alternative approach that utilises readily available technology and equipment with minimisation of morbidity and cost associated with open procedures.

  8. Computerized Tomography and its Applications : a Guided Tour

    NARCIS (Netherlands)

    Roerdink, J.B.T.M.

    1992-01-01

    We present a review of the mathematical principles of computerized tomography. Topics treated include the role of the Radon transform and related transforms, inversion formulas, uniqueness, ill-posedness and stability, practical reconstruction algorithms, and various generalizations such as

  9. MRI guided needle localization in a patient with recurrence pleomorphic sarcoma and post-operative scarring

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Ching-Di [Chang Gung University College of Medicine, Department of Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung (China); Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Wei, Jesse; Wu, Jim S. [Harvard Medical School, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Goldsmith, Jeffrey D. [Harvard Medical School, Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA (United States); Gebhardt, Mark C. [Harvard Medical School, Department of Orthopedic Surgery, Beth Israel Deaconess Medical Center, Boston, MA (United States)

    2017-07-15

    MRI-guided wire localization is commonly used for surgical localization of breast lesions. Here we introduce an alternative use of this technique to help with surgical resection of a recurrent pleomorphic sarcoma embedded in extensive post-treatment scar tissue. We describe a case of recurrent pleomorphic soft tissue sarcoma in the thigh after treatment with neoadjuvant therapy, surgery, and radiation. Due to the distortion of the normal tissue architecture and formation of extensive scar tissue from prior treatment, wire localization under MRI was successfully used to assist the surgeon in identifying the recurrent tumor for removal. (orig.)

  10. Handheld single photon emission computed tomography (handheld SPECT) navigated video-assisted thoracoscopic surgery of computer tomography-guided radioactively marked pulmonary lesions.

    Science.gov (United States)

    Müller, Joachim; Putora, Paul Martin; Schneider, Tino; Zeisel, Christoph; Brutsche, Martin; Baty, Florent; Markus, Alexander; Kick, Jochen

    2016-09-01

    Radioactive marking can be a valuable extension to minimally invasive surgery. The technique has been clinically applied in procedures involving sentinel lymph nodes, parathyroidectomy as well as interventions in thoracic surgery. Improvements in equipment and techniques allow one to improve the limits. Pulmonary nodules are frequently surgically removed for diagnostic or therapeutic reasons; here video-assisted thoracoscopic surgery (VATS) is the preferred technique. VATS might be impossible with nodules that are small or located deep in the lung. In this study, we examined the clinical application and safety of employing the newly developed handheld single photon emission tomography (handheld SPECT) device in combination with CT-guided radioactive marking of pulmonary nodules. In this pilot study, 10 subjects requiring surgical resection of a pulmonary nodule were included. The technique involved CT-guided marking of the target nodule with a 20-G needle, with subsequent injection of 25-30 MBq (effective: 7-14 MBq) Tc-99m MAA (Macro Albumin Aggregate). Quality control was made with conventional SPECT-CT to confirm the correct localization and exclude possible complications related to the puncture procedure. VATS was subsequently carried out using the handheld SPECT to localize the radioactivity intraoperatively and therefore the target nodule. A 3D virtual image was superimposed on the intraoperative visual image for surgical guidance. In 9 of the 10 subjects, the radioactive application was successfully placed directly in or in the immediate vicinity of the target nodule. The average size of the involved nodules was 9 mm (range 4-15). All successfully marked nodules were subsequently completely excised (R0) using VATS. The procedure was well tolerated. An asymptomatic clinically insignificant pneumothorax occurred in 5 subjects. Two subjects were found to have non-significant discrete haemorrhage in the infiltration canal of the needle. In a single subject, the

  11. Combined Fluoroscopy- and CT-Guided Transthoracic Needle Biopsy Using a C-Arm Cone-Beam CT System: Comparison with Fluoroscopy-Guided Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Cheung, Joo Yeon; Kim, Yoo Kyung; Shim, Sung Shine; Lim, Soo Mee [School of Medicine, Ewha Womans University, Seoul (Korea, Republic of)

    2011-02-15

    The aim of this study was to evaluate the usefulness of combined fluoroscopy- and CT-guided transthoracic needle biopsy (FC-TNB) using a cone beam CT system in comparison to fluoroscopy-guided TNB (F-TNB). We retrospectively evaluated 74 FC-TNB cases (group A) and 97 F-TNB cases (group B) to compare their respective diagnostic accuracies according to the size and depth of the lesion, as well as complications, procedure time, and radiation dose. The sensitivity for malignancy and diagnostic accuracy for small (< 30 mm in size) and deep ({>=} 50 mm in depth) lesions were higher in group A (91% and 94%, 92% and 94%) than in group B (73% and 81%, 84% and 88%), however not statistically significant (p > 0.05). Concerning lesions {>=} 30 mm in size and < 50 mm in depth, both groups displayed similar results (group A, 91% and 92%, 80% and 87%: group B, 90% and 92%, 86% and 90%). Pneumothorax occurred 26% of the time in group A and 14% for group B. The mean procedure time and patient skin dose were significantly higher in group A (13.6 {+-} 4.0 minutes, 157.1 {+-} 76.5 mGy) than in group B (9.0 {+-} 3.5 minutes, 21.9 {+-} 15.2 mGy) (p < 0.05). Combined fluoroscopy- and CT-guided TNB allows the biopsy of small (< 30 mm) and deep lesions ({>=} 50 mm) with high diagnostic accuracy and short procedure times, whereas F-TNB is still a useful method for large and superficial lesions with a low radiation dose

  12. The clinical utility of multimodal MR image-guided needle biopsy in cerebral gliomas.

    Science.gov (United States)

    Yao, Chengjun; Lv, Shunzeng; Chen, Hong; Tang, Weijun; Guo, Jun; Zhuang, Dongxiao; Chrisochoides, Nikos; Wu, Jinsong; Mao, Ying; Zhou, Liangfu

    2016-01-01

    Our aim was to evaluate the diagnostic value of multimodal Magnetic Resonance (MR) Image in the stereotactic biopsy of cerebral gliomas, and investigate its implications. Twenty-four patients with cerebral gliomas underwent (1)H Magnetic Resonance Spectroscopy ((1)H-MRS)- and intraoperative Magnetic Resonance Imaging (iMRI)-supported stereotactic biopsy, and 23 patients underwent only the preoperative MRI-guided biopsy. The diagnostic yield, morbidity and mortality rates were analyzed. In addition, 20 patients underwent subsequent tumor resection, thus the diagnostic accuracy of the biopsy was further evaluated. The diagnostic accuracies of biopsies evaluated by tumor resection in the trial groups were better than control groups (92.3% and 42.9%, respectively, p = 0.031). The diagnostic yield in the trial groups was better than the control groups, but the difference was not statistically significant (100% and 82.6%, respectively, p = 0.05). The morbidity and mortality rates were similar in both groups. Multimodal MR image-guided glioma biopsy is practical and valuable. This technique can increase the diagnostic accuracy in the stereotactic biopsy of cerebral gliomas. Besides, it is likely to increase the diagnostic yield but requires further validation.

  13. Endobronchial Ultrasound-guided Transbronchial Needle Aspiration 
in the Diagnosis of Intrathoracic Metastasis from Extrapulmonary Malignancy

    Directory of Open Access Journals (Sweden)

    Jiayuan SUN

    2015-05-01

    Full Text Available Background and objective Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA has been widely applied in diagnosing mediastinal and hilar adenopathy. This study is further to evaluate value and safety of EBUS-TBNA in diagnosing intrathoracic metastasis from extrapulmonary malignancy. Methods Prospectively analysis of 41 patients suspected intrathoracic metastasis from previous diagnosed/concurrent extrapulmonary malignancies in Shanghai Chest Hospital, with radiologic findings showing mediastinal/hilar lymph node enlargement or intrapulmonary lesion requiring EBUS-TBNA examination for pathological diagnosis. Results 41 candidate patients enrolled, and 67 mediastinal/hilar lymph nodes and 5 intrapulmonary lesions were aspirated. 14 intrathoracic metastasis, 10 primary lung cancer, 9 reactive lymphadenitis, 4 sarcoid-like reactions, and 1 tuberculosis was diagnosed by EBUS-TBNA. Sensitivity and accuracy of EBUS-TBNA in diagnosing intrathoracic metastasis was 87.50% and 95.12%, respectively. Immunohistochemistry (IHC was performed in 18 malignant tumors to obtain definite type or origin, twelve intrathoracic metastasis and 6 primary lung cancer were further confirmed. Conclusion EBUS-TBNA is a safe, effective method for the diagnosis of intrathoracic metastasis from extrapulmonary malignancy. IHC can provide additional evidence for distinguishing extrapulmonary malignancy from primary lung cancer.

  14. Surgical treatment for mediastinal abscess induced by endobronchial ultrasound-guided transbronchial needle aspiration: a case report and literature review.

    Science.gov (United States)

    Yokoyama, Yujiro; Nakagomi, Takahiro; Shikata, Daichi; Higuchi, Rumi; Oyama, Toshio; Goto, Taichiro

    2017-07-14

    Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful and less invasive procedure for the definitive diagnosis of mediastinal and hilar lymph nodes. However, infectious complications can occur after EBUS-TBNA, although they are extremely rare. A 66-year-old man with necrotic and swollen lower paratracheal lymph nodes underwent EBUS-TBNA. A mediastinal abscess developed 9 days post-procedure. Surgical drainage and debridement of the abscess were performed along with lymph node biopsy followed by daily washing of the thoracic cavity. Surgical treatment was effective, leading to remission of the abscess. Biopsy revealed that the tumor was squamous cell carcinoma with no radiologically detected cancer elsewhere in the body. Mediastinal lung cancer was thus confirmed. Subsequent chemoradiotherapy led to the remission of the tumor. Mediastinitis after EBUS-TBNA is rare but should be considered, particularly if the target lymph nodes are necrotic. Mediastinitis can lead to serious and rapid deterioration of the patient's condition, for which surgical intervention is the treatment of choice.

  15. Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report.

    Science.gov (United States)

    Igarashi, Ryo; Irisawa, Atsushi; Shibukawa, Goro; Yamabe, Akane; Fujisawa, Mariko; Sato, Ai; Maki, Takumi; Arakawa, Noriyuki; Yoshida, Yoshitsugu; Yamamoto, Shogo; Ikeda, Tsunehiko

    2016-10-01

    Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed "eosinophilic esophageal myositis (EoEM)" has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient's symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.

  16. Ultrasound-Guided Fine Needle Aspiration Cytology in the Assessment of Cervical Metastasis in Patients Undergoing Elective Neck Dissection

    International Nuclear Information System (INIS)

    Dabirmoghaddam, Payman; Sharifkashany, Shervin; Mashali, Leila

    2014-01-01

    In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients’ survival. To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis. Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique. Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests. In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection

  17. Treatment of the calcific tendinopathy of the rotator cuff by ultrasound-guided percutaneous needle lavage. Two years prospective study

    Science.gov (United States)

    Castillo-González, Federico Del; Ramos-Álvarez, Juan José; Rodríguez-Fabián, Guillermo; González-Pérez, José; Calderón-Montero, Javier

    2014-01-01

    Summary Background: to evaluate the short and long term effectiveness of ultrasonography (US)-guided percutaneous needle lavage in calcific tendinopathy of the rotator cuff. To study the evolution of the size of calcifications and pain in the two years after treatment. Methods: study design: A 2 year longitudinal prospective study is carried out after applying the UGPL technique on a number of patients diagnosed with calcific tendinitis of the rotator cuff. Clinical, ultrasound and radiology follow-up controls were performed, 3 months, 6 months, one year and two years after the treatment. The Visual Analog Scale (VAS) was used to assess the pain. The degree and point of pain is selected on a 10 cm line, arranged horizontally or vertically. The “0” represents no pain and “10” represents worst pain. The population studied was made up of 121 patients that required our service as a result of suffering from a painful shoulder. Results: the pain (VAS) and the size of the calcification significantly decreased with the application of the technique (ptendinitis of the shoulder. The intervention is simple, cost-effective, does not require hospitalization, involves no complications, rehabilitation treatment is not required and it shows very few side effects without sequelae, significantly reducing the size of the calcification and pain in the majority of patients. PMID:25332939

  18. Role of endoscopic ultrasound-guided fine-needle aspiration in adrenal lesions: analysis of 32 patients

    Directory of Open Access Journals (Sweden)

    Rakesh K Gupta

    2018-01-01

    Full Text Available Objective: Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC is a precise and safe technique that provides both radiological and pathological diagnosis with a better diagnostic yield and minimal adverse events. EUS-FNAC led to the remarkable increase in the detection rate of incidentaloma found during radiologic staging or follow-up in various malignancy or unrelated conditions. Aims: We did this preliminary study with an aim to evaluate the role of EUS-FNA in diagnosing and classifying adrenal lesions, clinical impact, and compare the outcome with the previously published literature. Materials and Methods: We included 32 consecutive cases (both retrospective and prospective of EUS-guided adrenal aspirate performed over a period of 3.3 years. The indications for the aspirate in decreasing order were metastasis (most common carcinoma gall bladder > primary adrenal mass > disseminated tuberculosis > pyrexia of unknown origin. On EUS, 28 cases revealed space occupying lesion or mass (two cases bilateral and four cases revealed diffuse enlargement (two cases bilateral with a mean size of 21 mm. Results: The cytology reports were benign adrenal aspirate (43.8%, metastatic adenocarcinoma (15.6%, histoplasmosis (9.4%, tuberculosis (9.4%, round cell tumor (6.2%, adrenocortical carcinoma (3.1%, and descriptive (3.1%. Three cases (9.4% yielded inadequate sample. The TNM staging was altered in 22.23% of the cases by result of adrenal aspirate. Conclusions: EUS-FNA of the adrenal gland is a safe, quick, and sensitive and real-time diagnostic technique, which requires an integrated approach of clinician, endoscopist, and cytopathologist for high precision in diagnosis. Although the role of EUS-FNA for right adrenal is not much described, we found adequate sample yield in all the four patients that underwent the procedure.

  19. Comparison of diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration cytology and cell block in solid lesions

    Directory of Open Access Journals (Sweden)

    Avinash Bhat Balekuduru

    2017-01-01

    Full Text Available Background and Aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA is a procedure of choice for the diagnostic evaluation of submucosal and periluminal lesions. Tissue sample can be obtained by EUS-FNA cytology (FNAC or cell block (CB. The aim of the present study is to compare diagnostic yield of EUS-FNA CB and cytology in the absence of onsite pathologist following a protocol-based EUS-FNA approach in solid lesions. Patients and Methods: Participants who underwent EUS-FNA at our center for solid submucosal or periluminal lesions (pancreas, lymph node, and liver between 2014 and 2016 were included, retrospectively. The indication for the procedure along with the clinical and other investigation details and the final etiological diagnosis were recorded on uniform structured data forms. The diagnostic yield of cytology and CB were compared using McNemar's test. The P < 0.05 was considered statistically significant. Results: EUS-FNA for solid lesion was performed in 130 lesions in 101 patients during the study period. Their mean age was 52.5 ± 12 years and 42.5% were female. Pancreatic masses were the most common lesions (37.7% followed by lymph nodes (36.9%. Submucosal lesions (17.7% and liver lesions (7.7% accounted for rest of the cases. The overall diagnostic yield for EUS-FNAC (70% and CB (74.6% was not significantly different (P = 0.3 and their combined yield was 85.3%. For the 23 patients with submucosal lesion, diagnostic yield of CB (82.6% was significantly better than cytology (47.8%, P = 0.04. Conclusions: EUS-guided CB has better yield compared to cytology in gastrointestinal submucosal lesions. The combination of CB with cytology improves the overall yield of the procedure; and hence, they should be considered complimentary rather than alternatives.

  20. CT-guided thin needles percutaneous cryoablation (PCA) in patients with primary and secondary lung tumors: A preliminary experience

    Energy Technology Data Exchange (ETDEWEB)

    Pusceddu, Claudio, E-mail: clapusceddu@gmail.com [Division of Interventional Radiology, Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncologic Diseases, Cagliari, Zip code 09100 (Italy); Sotgia, Barbara, E-mail: barbara.sotgia@gmail.com [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Fele, Rosa Maria, E-mail: rosellafele@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy); Melis, Luca, E-mail: doclucamelis@tiscali.it [Department of Oncological Radiology, Businco Hospital, Regional Referral Center for Oncological Diseases, Cagliari, Zip code 09100 (Italy)

    2013-05-15

    Purpose: To report the data of our initial experience with CT-guided thin cryoprobes for percutaneous cryoablation (PCA) in patients with primary and secondary pulmonary tumors. Material and methods: CT-guided thin needles PCA was performed on 34 lung masses (11 NSCLC = 32%; 23 secondary lung malignancies = 68%) in 32 consecutive patients (24 men and 8 women; mean age 67 ± 10 years) not suitable for surgical resection. Lung masses were treated using two types of cryoprobes: IceRod and IceSeed able to obtain different size of iceball. The number of probes used ranged from 1 to 5 depending on the size of the tumor. After insertion of the cryoprobes into the lesion, the PCA were performed with two 2 (91%) or 3 (9%) cycles each of 12 min of freezing followed by a 4 min active thawing phase and a 4 min passive thawing phase for each one for all treatments. Results: All cryoablation sessions were successfully completed. All primary and metastatic lung tumors were ablated. No procedure-related deaths occurred. Morbidity consisted of 21% (7 of 34) pneumothorax and 3% (1 of 34) cases asymptomatic small pulmonary hemorrhage, respectively, all of CTCAE grade 1 (Common Terminology Criteria for Adverse Events). Low density of entire lesion, central necrosis and solid mass appearance were identify in 21 (62%), 7 (21%) and 6 (17%) of cryoablated tumors, respectively. No lymphadenopathy developed in the region of treated lesions. Technical success (complete lack of enhancement) was achieved in 82%, 97% and 91% of treated lesions at 1-, 3- and 6-months CT follow-up scan, respectively (p < .000). Comparing the tumor longest diameter between the baseline and at 6 month CT images, technical success was revealed in 92% cases (p < .000). Conclusion: Our preliminary experience suggests that PCA is a feasible treatment option. Well-designed clinical trials with a larger patient population are necessary to further investigate the long-term results and prognostic factors.

  1. CT-guided core needle biopsy of mediastinal nodes through a transpulmonary approach: retrospective analysis of the procedures conducted over six years

    Energy Technology Data Exchange (ETDEWEB)

    Yin, Zhongyuan; Liang, Zhiwen; Li, Pengcheng; Wang, Qiong [Huazhong University of Science and Technology, Cancer Center, Union Hospital, Tongji Medical College, Wuhan (China)

    2017-08-15

    To retrospectively evaluate the diagnostic performance and complications of a CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach. From January 2009 to December 2014, we used a coaxial positioning system and an 18G cutting-type biopsy device to perform CT-guided percutaneous transpulmonary needle biopsies of mediastinal nodes for 127 patients. The diagnostic performance, complication rate, influencing factors, distribution of mediastinal nodes and pathological diagnoses were investigated. Among 127 patients, pathologic analyses showed that all of the biopsies were technically successful. The sensitivity, specificity, positive predictive value, and negative predictive value were all 100%. As for complications, the ratios for pneumothorax and hemoptysis were 33.9% and 4.7%, respectively. Multivariate analyses revealed that the distance from the pleura to the target lesion (P = 0.008) and the numbers of visceral pleura injuries (P = 0.006) were the two most significant risk factors for pneumothorax, and that the distance from the pleura to the target lesion (P = 0.004) was the most significant risk factor for hemoptysis. CT-guided core needle cutting biopsy of mediastinal nodes through a transpulmonary approach is a safe and efficient diagnostic method. (orig.)

  2. Comparison tomography relocation hypocenter grid search and guided grid search method in Java island

    International Nuclear Information System (INIS)

    Nurdian, S. W.; Adu, N.; Palupi, I. R.; Raharjo, W.

    2016-01-01

    The main data in this research is earthquake data recorded from 1952 to 2012 with 9162 P wave and 2426 events are recorded by 30 stations located around Java island. Relocation hypocenter processed using grid search and guidded grid search method. Then the result of relocation hypocenter become input for tomography pseudo bending inversion process. It can be used to identification the velocity distribution in subsurface. The result of relocation hypocenter by grid search and guided grid search method after tomography process shown in locally and globally. In locally area grid search method result is better than guided grid search according to geological reseach area. But in globally area the result of guided grid search method is better for a broad area because the velocity variation is more diverse than the other one and in accordance with local geological research conditions. (paper)

  3. Ultrasound-Guided Core-Needle Versus Vacuum-Assisted Breast Biopsy: A Cost Analysis Based on the American Society of Breast Surgeons' Mastery of Breast Surgery Registry.

    Science.gov (United States)

    Grady, Ian; Vasquez, Tony; Tawfik, Sara; Grady, Sean

    2017-03-01

    To evaluate the cost-efficacy of vacuum-assisted ultrasound-guided breast biopsy instruments compared to ultrasound-guided 14-gauge spring-loaded core-needle biopsy. The American Society of Breast Surgeons' Mastery of Breast Surgery Registry was reviewed. Biopsy findings, any rebiopsy, and the instrument used were abstracted for 31,451 ultrasound-guided biopsy procedures performed between 2001 and July 2014. Rates of cancer diagnosis and rebiopsy were calculated for each instrument. A linear mathematical model was developed to calculate total cost per cancer diagnosis, including procedural costs and the costs of any additional surgical rebiopsy procedures. Mean cost per cancer diagnosis with confidence limits was then determined for 14-gauge spring-loaded core-needle biopsy and 14 different vacuum-assisted instruments. For 14-gauge spring-loaded core-needle biopsy, mean cost per cancer diagnosis was $4346 (4327-$4366). For the vacuum-assisted instruments, mean cost per cancer diagnosis ranged from a low of $3742 ($3732-$3752) to a high of $4779 ($4750-$4809). Vacuum-assisted instruments overall were more cost-effective than core with a mean cost per cancer diagnosis of $4052 ($4038-$4067) (p cancer diagnosis of $3978 ($3964-$3991) (p cancer diagnosis of $4369 ($4350-$4388), a result no better than core (p breast biopsy had a lower mean cost per cancer diagnosis than 14-gauge spring-loaded core-needle biopsy. This advantage was only seen in tethered vacuum-assisted instruments. Within device families, larger instruments tended to outperform smaller instruments.

  4. [Cost analysis of ultrasound-guided transrectal needle biopsy in prostatic carcinoma].

    Science.gov (United States)

    Bissoli, E; Fandella, A; La Torre, E; Faggiano, L; Anselmo, G; Frasson, F

    1998-04-01

    The literature mortality and morbidity rates from prostatic carcinoma prompt to the better use of some routine diagnostic tools such as transrectal ultrasound-guided biopsy. We evaluated the overall cost of transrectal ultrasound biopsy (TRUSB) of the prostate and investigated the economic impact of the procedures currently used to diagnose prostatic carcinoma. The total cost of TRUSB was calculated with reference to 247 procedures performed in 1996. The following cost factors were evaluated: personnel, materials, maintenance-equipment depreciation, energy consumption and hospital overheads. A literature review was also carried out to check if our extrapolated costs corresponded to those of other authors worldwide and to consider them in the wider framework of the cost effectiveness of the strategies for the early diagnosis of prostatic cancer. The overall cost of TRUSB was Itl. 249,000, obtained by adding together the costs of: personnel (Itl. 160,000); materials (Itl. 59,000); equipment maintenance and depreciation (Itl. 12,400); energy consumption (Itl. 100); hospital overheads (Itl. 17,500). The literature review points out TRUSB as a clinically invasive tool for diagnosing prostatic carcinoma whose cost-effectiveness is debated. Cadaver studies report the presence of cancer cells in the prostate of 50% of 70-year-old men, while extrapolations calculate a morbidity from prostatic carcinoma in 9.5% of 50-year-old men. It is therefore obvious that randomized prostatic biopsies, methods apart, are very likely to be positive. This probability varies with the patient's age, the level of prostate specific antigen (PSA), the density of PSA/cm3 of prostate volume (PSAD), and the positivity of exploration and/or transrectal ultrasound findings. Despite the strict application of all these criteria and the critical assessment of the patient's general conditions, TRUSB is indicated for 16% of the male population over 50, with obvious implications. It has been recently

  5. Endoscopic ultrasound-guided fine-needle aspiration diagnosis of secondary tumors involving the pancreas: An institution′s experience

    Directory of Open Access Journals (Sweden)

    Ahmed K Alomari

    2016-01-01

    Full Text Available Background: Pancreatic masses may seldom represent a metastasis or secondary involvement by lymphoproliferative disorders. Recognition of this uncommon occurrence may help render an accurate diagnosis and avoid diagnostic pitfalls during endoscopic ultrasound-guided fine needle aspiration (EUS-FNA. In this study, we review our experience in diagnosing secondary tumors involving the pancreas. Materials and Methods: The electronic database of cytopathology archives was searched for cases of secondary tumors involving the pancreas at our institution and a total of 31 cases were identified. The corresponding clinical presentations, imaging study findings, cytological diagnoses, the results of ancillary studies, and surgical follow-up, if available, were reviewed. Results: Nineteen of the patients were male and 12 female, with a mean age of 66 years. Twenty-three patients (74% had a prior history of malignancy, with the latency ranging from 6 months to 19 years. The secondary tumors involving the pancreas included metastatic carcinoma (24 cases, metastatic sarcoma (3 cases, diffuse large B-cell lymphoma (2 cases, and plasma cell neoplasm (2 cases. The most common metastatic tumors were renal cell carcinoma (8 cases and lung carcinoma (7 cases. Correct diagnoses were rendered in 29 cases (94%. The remaining two cases were misclassified as primary pancreatic carcinoma. In both cases, the patients had no known history of malignancy, and no ancillary studies were performed. Conclusions: Secondary tumors involving the pancreas can be accurately diagnosed by EUS-FNA. Recognizing uncommon cytomorphologic features, knowing prior history of malignancy, and performing ancillary studies are the keys to improve diagnostic performance and avoid diagnostic pitfalls.

  6. Cytological Results of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules: Emphasis on Correlation with Sonographic Findings

    Science.gov (United States)

    Lee, Mi-Jung; Hong, Soon Won; Chung, Woung Youn; Kwak, Jin Young; Kim, Min Jung

    2011-01-01

    Purpose To compare the cytological results of ultrasound-guided fine-needle aspiration (US-FNA) cytology of thyroid nodules to sonographic findings and determine whether US findings are helpful in the interpretation of cytological results. Materials and Methods Among the thyroid nodules that underwent US-FNA cytology, we included the 819 nodules which had a conclusive diagnosis. Final diagnosis was based on pathology from surgery, repeated FNA cytology or follow-up of more than one year. Cytological results were divided into five groups: benign, indeterminate (follicular or Hurthle cell neoplasm), suspicious for malignancy, malignant, and inadequate. US findings were categorized as benign or suspicious. Cytological results and US categories were analyzed. Results Final diagnosis was concluded upon in 819 nodules based on pathology (n=311), repeated FNA cytology (n=204) and follow-up (n=304), of which 634 were benign and 185 were malignant. There were 560 benign nodules, 141 malignant nodules, 49 nodules with inadequate results, 21 with indeterminate results, and 48 that were suspicious for malignancy. The positive and negative predictive values of the US categories were 59.1% and 97.0%, and those of the cytological results were 93.7% and 98.9%. The US categories were significantly correlated with final diagnosis in the benign (p=0.014) and suspicious for malignancy (pcytological result groups, but not in the inadequate and indeterminate cytological results groups. The false positive and negative rates of cytological results were 1.9% and 3.2%. Conclusion Sonographic findings can be useful when used alongside cytological results, especially in nodules with cytological results that are benign or suspicious for malignancy. PMID:21786450

  7. Clinical application of CT and CT-guided percutaneous transthoracic needle biopsy in patients with indeterminate pulmonary nodules

    Energy Technology Data Exchange (ETDEWEB)

    Cardoso, Luciana Vargas; Souza Júnior, Arthur Soares, E-mail: fabianonatividade@terra.com.br [Rio Preto-Ultra-X Radiological Diagnosis Institute, São José do Rio Preto, SP (Brazil)

    2014-07-15

    Objective: To investigate the clinical application of CT and CT-guided percutaneous transthoracic needle biopsy (CT-PTNB) in patients with indeterminate pulmonary nodules (IPNs). Methods: We retrospectively studied 113 patients with PNs undergoing CT and CT-PTNB. Variables such as gender, age at diagnosis, smoking status, CT findings, and CT-PTNB techniques were analyzed. Data analysis was performed with the Student's t-test for independent samples the chi-square test, and normal approximation test for comparison of two proportions. Results: Of the 113 patients studied, 68 (60.2%) were male and 78 (69%) were smokers. The diameter of malignant lesions ranged from 2.6 cm to 10.0 cm. Most of the IPNs (85%) were located in the peripheral region. The biopsied IPNs were found to be malignant in 88 patients (77.8%) and benign in 25 (22.2%). Adenocarcinoma was the most common malignant tumor, affecting older patients. The IPN diameter was significantly greater in patients with malignant PNs than in those with benign IPNs (p < 0.001). Having regular contour correlated significantly with an IPN being benign (p = 0.022), whereas spiculated IPNs and bosselated IPNs were more often malignant (in 50.7% and 28.7%, respectively). Homogeneous attenuation and necrosis were more common in patients with malignant lesions (51.9% and 26.9%, respectively). Conclusions: In our sample, CT and CT-PTNB were useful in distinguishing between malignant and benign IPNs. Advanced age and smoking were significantly associated with malignancy. Certain CT findings related to IPNs (larger diameter, spiculated borders, homogeneous attenuation, and necrosis) were associated with malignancy. (author)

  8. [Results of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: importance of the lymph node involvement prevalence].

    Science.gov (United States)

    De Dominicis, F; Fourdrain, A; Iquille, J; Toublanc, B; François, G; Basille, D; Monconduit, J; Merlusca, G; Jounieaux, V; Andrejak, C; Berna, P

    2015-08-01

    We studied the non-surgical invasive staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and we detailed the differences of our series, in order to understand the criteria allowing to achieve a better performance. Retrospective observational study conducted between 2007 and 2011, including all patients with proven NSCLC who underwent EBUS-TBNA. For the 92 EBUS-TBNA performed, we found a sensitivity of 78%, a specificity of 93%, a positive predictive value (PPV) of 98%, a negative predictive value (NPV) of 45%, an accuracy of 80% and a prevalence of lymph node involvement at 84%. A learning curve has been demonstrated and a significant difference was found based on the number of punctures by procedure (P=0.02) or on histological type (P=0.02). By analyzing the data of the literature, we have been able to demonstrate that the accuracy and the negative predictive value are correlated with the prevalence. If we take into account this correlation, we can consider the results of our study close to those of the literature. We highlighted a number of criteria that will influence the diagnostic yield of EBUS-TBNA. While some have already been described, other criteria such as histological type or patient selection criteria are less discussed. The key point is the correlation between the prevalence and EBUS-TBNA results. Results of the assessment of lymph node involvement techniques should be interpreted according to the prevalence of lymph node involvement. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. Safety and correlation of test results of combined ultrasound-guided fine-needle aspiration and needle core biopsy of the canine spleen.

    Science.gov (United States)

    Watson, Adam T; Penninck, Dominique; Knoll, Joyce S; Keating, John H; Sutherland-Smith, James

    2011-01-01

    The safety and diagnostic value of combined splenic fine-needle aspiration (FNA) and needle core biopsy (NCB) is unknown. Forty-one dogs with splenic lesions were studied prospectively. Safety was assessed in 38 dogs and no complications were encountered. Initially, clinical and anatomic pathologists reviewed each FNA and NCB sample, respectively, without knowledge of the other's results. Diagnoses were categorized as neoplastic, benign, inflammatory, normal, or nondiagnostic. The level of agreement between sampling methods was categorized as complete, partial, disagreement, or not available. Test correlation was performed in 40 dogs. Nondiagnostic results occurred in 5/40 NCB (12.5%) and no FNA samples. Neoplasia was diagnosed in 17/40 dogs (42.5%), benign changes in 20/40 dogs (50%), inflammatory disorders in 0/40 dogs, and normal 2/40 dogs (5%). One of the 40 dogs (2.5%) had a diagnosis that was equivocal for neoplasia on both tests and therefore was not categorized. Of the 35 dogs that had diagnostic samples, cytopathologic and histopathologic diagnoses agreed completely in 18/35 dogs (51.4%), partially in 3/35 dogs (8.6%), and were in disagreement in 14/35 dogs (40.0%). Pathologists collaboratively reviewed diagnoses that were in disagreement or partial agreement and altered their individual diagnoses in 6/17 dogs (35.3%) to be within partial or complete agreement, respectively. Percutaneous FNA and NCB can be performed safely in dogs with sonographic splenic changes. Results suggest that adding NCB to FNA provides complementary information in dogs with suspected splenic neoplasia. This combined protocol may improve detection of splenic neoplasia and provide neoplastic subclassification. © 2010 Veterinary Radiology & Ultrasound.

  10. Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids.

    Science.gov (United States)

    de Witte, Pieter Bas; Selten, Jasmijn W; Navas, Ana; Nagels, Jochem; Visser, Cornelis P J; Nelissen, Rob G H H; Reijnierse, Monique

    2013-07-01

    Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). Randomized controlled trial; Level of evidence, 1. Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. On average, there was improvement at 1-year follow

  11. Feasibility of Computed Tomography-Guided Methods for Spatial Normalization of Dopamine Transporter Positron Emission Tomography Image.

    Science.gov (United States)

    Kim, Jin Su; Cho, Hanna; Choi, Jae Yong; Lee, Seung Ha; Ryu, Young Hoon; Lyoo, Chul Hyoung; Lee, Myung Sik

    2015-01-01

    Spatial normalization is a prerequisite step for analyzing positron emission tomography (PET) images both by using volume-of-interest (VOI) template and voxel-based analysis. Magnetic resonance (MR) or ligand-specific PET templates are currently used for spatial normalization of PET images. We used computed tomography (CT) images acquired with PET/CT scanner for the spatial normalization for [18F]-N-3-fluoropropyl-2-betacarboxymethoxy-3-beta-(4-iodophenyl) nortropane (FP-CIT) PET images and compared target-to-cerebellar standardized uptake value ratio (SUVR) values with those obtained from MR- or PET-guided spatial normalization method in healthy controls and patients with Parkinson's disease (PD). We included 71 healthy controls and 56 patients with PD who underwent [18F]-FP-CIT PET scans with a PET/CT scanner and T1-weighted MR scans. Spatial normalization of MR images was done with a conventional spatial normalization tool (cvMR) and with DARTEL toolbox (dtMR) in statistical parametric mapping software. The CT images were modified in two ways, skull-stripping (ssCT) and intensity transformation (itCT). We normalized PET images with cvMR-, dtMR-, ssCT-, itCT-, and PET-guided methods by using specific templates for each modality and measured striatal SUVR with a VOI template. The SUVR values measured with FreeSurfer-generated VOIs (FSVOI) overlaid on original PET images were also used as a gold standard for comparison. The SUVR values derived from all four structure-guided spatial normalization methods were highly correlated with those measured with FSVOI (P normalization methods provided reliable striatal SUVR values comparable to those obtained with MR-guided methods. CT-guided methods can be useful for analyzing dopamine transporter PET images when MR images are unavailable.

  12. Tracheobronchial puncture-site nodular reaction (TPNR following endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA: Systematic review of case reports

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2017-01-01

    Full Text Available Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA is a minimally invasive and efficacious diagnostic modality for lung cancer staging and evaluation of undiagnosed mediastinal lymphadenopathy. Procedure-related complications are uncommon. We herein report an infrequently described phenomenon following EBUS-TBNA in which two patients developed nodular granulation tissue at the tracheobronchial puncture site. On systematic review, we found description of such phenomena by terminologies such as endobronchial inflammatory polyp, granuloma, and endobronchial mass. The endobronchial inflammatory polyp has been one of the most commonly used terminologies for these; but in most cases, the classical features of an inflammatory polyp are lacking. We propose the term, tracheobronchial puncture-site nodular reaction (TPNR with further classification into granulomatous and nongranulomatous subtypes, for standardized reporting of such reactions following transbronchial needle aspiration procedures. Knowledge of this entity and standardized nomenclature shall help in better characterization of the outcomes and risk factors for the occurrence of these reactions.

  13. Teleoperation System with Hybrid Pneumatic-Piezoelectric Actuation for MRI-Guided Needle Insertion with Haptic Feedback

    OpenAIRE

    Shang, Weijian; Su, Hao; Li, Gang; Fischer, Gregory S.

    2013-01-01

    This paper presents a surgical master-slave tele-operation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. This system consists of a piezoelectrically actuated slave robot for needle placement with integrated fiber optic force sensor utilizing Fabry-Perot interferometry (FPI) sensing principle. The sensor flexure is optimized and embedded to the slave robot for measuring needle insertion force. A novel, compact opto-mechanical FPI ...

  14. Assessment of pain score and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy of thyroid nodules

    Directory of Open Access Journals (Sweden)

    Liao LJ

    2017-12-01

    Full Text Available Li-Jen Liao,1 Wu-Chia Lo,1 Wan-Lun Hsu,2 Po-Wen Cheng,1 Cheng-Ping Wang3 1Department of Otolaryngology, Far Eastern Memorial Hospital, 2Genomics Research Center, Academia Sinica, 3Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan, Republic of China Objective: The aim of this study was to evaluate pain scores and specimen adequacy for ultrasound-guided fine-needle aspiration biopsy (US-FNAB of thyroid nodules without and with local anesthesia (LA. Materials and methods: The US-FNAB procedure was performed on 183 patients with and without LA. One puncture was made for solid nodules, and if patients could tolerate it, a two-puncture technique was used for nodules with a cystic change. Four-point verbal rating scores were assessed by a nursing assistant after completion of US-FNAB. To be an adequate specimen, at least six groups of follicular cells are required, and each group should contain at least 10 cells.Results: Immediately after US-FNAB, 92% of patients with LA and 80% without LA reported no or mild pain (p=0.01. Most patients tolerated the procedure well, with no pain (82.5% reported 5 minutes after the procedure. In univariate logistic regression, irregular boundary (odds ratio [OR]: 2.52, 95% confidence interval [CI]: 1.04–6.06, p=0.04, calcification (OR: 2.86, 95% CI: 1.06–7.76, p=0.04, and LA (OR: 0.35, 95% CI: 0.15–0.86, p=0.02 were significantly associated with immediate moderate or severe pain. Specimen adequacy was significantly associated with age (OR: 0.95, 95% CI: 0.92–0.97, p<0.01, heterogeneous echo-texture (OR: 1.76, 95% CI: 1.23–5.17, p=0.01, predominate solid architecture (OR: 2.78, 95% CI: 1.42–5.41, p<0.01, and the use of LA (OR: 3.34, 95% CI: 1.70–6.56, p<0.01. In multivariate logistic regression, patients receiving LA had lower risk of moderate or severe pain (OR: 0.25, 95% CI: 0.09–0.67, p=0.01 and higher chances of specimen adequacy (OR: 4.84, 95% CI: 2.17–10.7, p<0

  15. Computed tomography of the pancreas

    International Nuclear Information System (INIS)

    Kolmannskog, F.; Kolbenstvedt, A.; Aakhus, T.; Bergan, A.; Fausa, O.; Elgjo, K.

    1980-01-01

    The findings by computed tomography in 203 cases of suspected pancreatic tumours, pancreatitis or peripancreatic abnormalities were evaluated. The appearances of the normal and the diseased pancreas are described. Computed tomography is highly accurate in detecting pancreatic masses, but can not differentiate neoplastic from inflammatory disease. The only reliable signs of pancreatic carcinoma are a focal mass in the pancreas, together with liver metastasis. When a pancreatic mass is revealed by computed tomography, CT-guided fine-needle aspiration biopsy of the pancreas is recommended. Thus the need for more invasive diagnostic procedures and explorative laparotomy may be avoided in some patients. (Auth.)

  16. Prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy: A prospective multicenter study.

    Science.gov (United States)

    Chung, Ho Seok; Hwang, Eu Chang; Yu, Ho Song; Jung, Seung Il; Lee, Sun Ju; Lim, Dong Hoon; Cho, Won Jin; Choe, Hyun Sop; Lee, Seung-Ju; Park, Sung Woon

    2018-03-01

    To estimate the prevalence of fluoroquinolone-resistant rectal flora in patients undergoing transrectal ultrasound-guided prostate needle biopsy and to identify the high-risk groups. From January 2015 to March 2016, rectal swabs of 557 men who underwent transrectal ultrasound-guided prostate needle biopsy were obtained from five institutions. Clinical variables, including demographics, rectal swab culture results and infectious complications, were evaluated. Univariable and multivariable analyses were used to identify the risk factors for fluoroquinolone resistance of rectal flora and infectious complications. The incidence of fluoroquinolone-resistant and extended-spectrum beta-lactamase production was 48.1 and 11.8%, respectively. The most common fluoroquinolone-resistant bacteria was Escherichia coli (81% of total fluoroquinolone-resistant bacteria, 39% of total rectal flora), and 16 (2.9%) patients had infectious complications. Univariable and multivariable analysis of clinical parameters affecting fluoroquinolone resistance showed no factor associated with fluoroquinolone resistance of rectal flora. The clinical parameter related to infectious complications after prostate biopsy was a history of operation within 6 months (relative risk 6.60; 95% confidence interval 1.99-21.8, P = 0.002). These findings suggest that a risk-based approach by history taking cannot predict antibiotic resistance of rectal flora, and physicians should consider targeted antibiotic prophylaxis or extended antibiotic prophylaxis for Korean patients undergoing transrectal ultrasound-guided prostate biopsy because of high antibiotic resistance of rectal flora. © 2017 The Japanese Urological Association.

  17. Measurement of bio-impedance with a smart needle to confirm percutaneous kidney access.

    Science.gov (United States)

    Hernandez, D J; Sinkov, V A; Roberts, W W; Allaf, M E; Patriciu, A; Jarrett, T W; Kavoussi, L R; Stoianovici, D

    2001-10-01

    The traditional method of percutaneous renal access requires freehand needle placement guided by C-arm fluoroscopy, ultrasonography, or computerized tomography. This approach provides limited objective means for verifying successful access. We developed an impedance based percutaneous Smart Needle system and successfully used it to confirm collecting system access in ex vivo porcine kidneys. The Smart Needle consists of a modified 18 gauge percutaneous access needle with the inner stylet electrically insulated from the outer sheath. Impedance is measured between the exposed stylet tip and sheath using Model 4275 LCR meter (Hewlett-Packard, Sunnyvale, California). An ex vivo porcine kidney was distended by continuous gravity infusion of 100 cm. water saline from a catheter passed through the parenchyma into the collecting system. The Smart Needle was gradually inserted into the kidney to measure depth precisely using a robotic needle placement system, while impedance was measured continuously. The Smart Needle was inserted 4 times in each of 4 kidneys. When the needle penetrated the distended collecting system in 11 of 16 attempts, a characteristic sharp drop in resistivity was noted from 1.9 to 1.1 ohm m. Entry into the collecting system was confirmed by removing the stylet and observing fluid flow from the sheath. This characteristic impedance change was observed only at successful entry into the collecting system. A characteristic sharp drop in impedance signifies successful entry into the collecting system. The Smart Needle system may prove useful for percutaneous kidney access.

  18. Ultrasonography-guided fine-needle aspiration biopsy for thyroid nodules: effective technique and a peculiar smear method

    International Nuclear Information System (INIS)

    Park, Kyeong Rok; Rho, Myung Ho; Kim, Dong Wook; Koo, Yong Woon; Lee, Kyeong Hee; Kang, Tae Woo

    2006-01-01

    We wanted to evaluate the effective methods that are appropriate for an endemic area of thyroid disease and to compare the differences of cytologic diagnostic rates with and without using a peculiar smear technique. We analyzed the incidence rate of insufficient results, complications and the total procedure times of 1,126 thyroid nodules in 776 patients who underwent US-FNAB (ultrasonography-guided fine-needle aspiration biopsy) from January to December 2005. We compared the diagnostic rate between the two groups; the groups' tests were performed with a peculiar smear technique (Group A, n 313) or with a ventional smear technique (Group B, n = 250). According to the size of the thyroid nodule, the incidence rate of an insufficient result on US-FNAB and the mean total procedure time for 1126 thyroid nodules in 776 patients were measured as 16.9% (52/308) and 208 seconds for nodules under 0.5 cm, 9.8% (30/306) and 160 seconds for nodules between 0.5 cm-10 cm, and 6.0% (30/504) and 134 seconds for nodules over 1.0 cm. These 776 patients showed no significant complication, except for mild pain. In Group A, the incidence rate of an insufficient result was calculated as 15.1% (14/93) for the group with nodules under 0.5 cm, 5.3% (5/95) for the group with nodules between 0.5 cm-1.0 cm, 4.8% (6/125) for the group with nodules over 1.0 cm, and 8.0% (25/313) for the total A Group. In Group B, the incidence rate of an insufficient result was measured as 33.3% (15/45) for the group with nodules under 0.5 cm, 28.1% (25/89) for the group with nodules between 0.5 cm-1.0 cm, 21.4% (24/112) for the group with nodules over 1.0 cm, and 25.7% (63/245) for the total B group. There was a statistically significant correlation between the rate of an insufficient result and the peculiar smear technique or the size of the thyroid nodule. We consider that US-FNAB is very simple, safe and accurate diagnostic method for thyroid nodules, and US-FNAB with a peculiar smear technique is able to

  19. A rare constellation of empyema, lung abscess, and mediastinal abscess as a complication of endobronchial ultrasound-guided transbronchial needle aspiration.

    Science.gov (United States)

    Huang, Chun-Ta; Chen, Chung-Yu; Ho, Chao-Chi; Yu, Chong-Jen

    2011-07-01

    The introduction of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) brought about significant advancement in the field of bronchoscopy. The major indications for EBUS-TBNA are lung cancer staging and diagnosis of mediastinal lymphadenopathy. This procedure is minimally invasive and cost saving, and no complications have been described in large-scale studies. In this report, we present a case of empyema, lung abscess, and mediastinal abscess that developed in a patient undergoing EBUS-TBNA; the patient subsequently recovered uneventfully after aggressive surgical debridement and antimicrobial therapy. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  20. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report.

    Science.gov (United States)

    Scholten, Paul M; Massimi, Stephen; Dahmen, Nick; Diamond, Joanne; Wyss, James

    2015-01-01

    Athletic pubalgia is a syndrome of persistent groin pain due to chronic repetitive trauma or stress involving the pelvic joints and many musculotendinous structures that cross the anterior pelvis. As a result, the differential diagnosis can be complex, but insertional tendinopathies are the most common. This case report describes a novel approach to the treatment of distal rectus abdominis tendinopathies with ultrasound-guided needle tenotomy and platelet-rich plasma (PRP) injection. After injection, the patient returned to pain-free play at his previous level of intensity. This suggests that PRP may be a useful treatment for this diagnosis. Copyright © 2015. Published by Elsevier Inc.

  1. Preoperative US-guided hook-needle insertion in recurrent lymph nodes of papillary thyroid cancer: A help for the surgeon

    International Nuclear Information System (INIS)

    Duprez, Raphaelle; Lebas, Patrick; Marc, Olivier Saint; Mongeois, Elise; Emy, Philippe; Michenet, Patrick

    2010-01-01

    Objective: The objective of this study is to investigate whether preoperative ultrasound guided insertion of a hook-needle is useful in reoperations for cervical recurrent lymph node metastases of papillary thyroid cancer. Patients and methods: 8 patients with operated papillary thyroid cancer were included in this study. They all had suspicious nonpalpable cervical lymph nodes discovered during follow-up. These lymph nodes were identified by ultrasound imaging and their metastatic nature was confirmed by fine needle aspiration cytology and measurement of in situ thyroglobulin. In all cases, surgical excision of these lymph nodes was decided. All 8 patients had a hook-needle inserted in the suspicious lymph node(s) preoperatively and under ultrasound guidance. Results and conclusion: In all 8 patients, the suspicious lymph nodes were removed and their metastatic nature was confirmed by the final pathological examination. This localization technique is very helpful for the surgeon during the excision of small and nonpalpable lymph nodes, especially in previously operated area.

  2. Optical coherence tomography in guided surgery of GI cancer

    Science.gov (United States)

    Zagaynova, Elena V.; Abelevich, Alexander I.; Zagaynov, Vladimir E.; Gladkova, Natalia D.; Denisenko, Arkady N.; Feldchtein, Felix I.; Snopova, Ludmila B.; Kutis, Irina S.

    2005-04-01

    Optical Coherence Tomography (OCT) is a new high spatial resolution, real-time optical imaging modality, known from prior pilot studies for its high sensitivity to invasive cancer. We reported our results in an OCT feasibility study for accurate determination of the proximal border for esophageal carcinoma and the distal border for rectal carcinoma. The OCT study enrolled 19 patients with rectal adenocarcinoma and 24 patients with distal esophageal carcinoma (14 squamous cell carcinomas, 10 adenocarcinomas). During pre-surgery planning endoscopy we performed in vivo OCT imaging of the tumor border at four dial clock axes (12, 3, 6 and 9 o"clock). The OCT border then was marked by an electrocoagulator, or by a methylene blue tattoo. A cold biopsy (from the esophagus) was performed at visual and OCT borders and compared with visual and OCT readings. 27 post-surgery excised specimens were analyzed. OCT borders matched the histopathology in 94% cases in the rectum and 83.3% in the esophagus. In the cases of a mismatch between the OCT and histology borders, a deep tumor invasion occurred in the muscle layer (esophagus, rectum). Because of its high sensitivity to mucosal cancer, OCT can be used for pre-surgery planning and surgery guidance of the proximal border for esophageal carcinoma and the distal border for rectal carcinoma. However, deep invasion in the rectum or esophageal wall has to be controlled by alternative diagnostic modalities.

  3. Quantification of thickness loss in a liquid-loaded plate using ultrasonic guided wave tomography

    Science.gov (United States)

    Rao, Jing; Ratassepp, Madis; Fan, Zheng

    2017-12-01

    Ultrasonic guided wave tomography (GWT) provides an attractive solution to map thickness changes from remote locations. It is based on the velocity-to-thickness mapping employing the dispersive characteristics of selected guided modes. This study extends the application of GWT on a liquid-loaded plate. It is a more challenging case than the application on a free plate, due to energy of the guided waves leaking into the liquid. In order to ensure the accuracy of thickness reconstruction, advanced forward models are developed to consider attenuation effects using complex velocities. The reconstruction of the thickness map is based on the frequency-domain full waveform inversion (FWI) method, and its accuracy is discussed using different frequencies and defect dimensions. Validation experiments are carried out on a water-loaded plate with an irregularly shaped defect using S0 guided waves, showing excellent performance of the reconstruction algorithm.

  4. Comparison of a GPS needle-tracking system, multiplanar imaging and 2D imaging for real-time ultrasound-guided epidural anaesthesia: A randomized, comparative, observer-blinded study on phantoms.

    Science.gov (United States)

    Menacé, Cécilia; Choquet, Olivier; Abbal, Bertrand; Bringuier, Sophie; Capdevila, Xavier

    2017-04-01

    The real-time ultrasound-guided paramedian sagittal oblique approach for neuraxial blockade is technically demanding. Innovative technologies have been developed to improve nerve identification and the accuracy of needle placement. The aim of this study was to evaluate three types of ultrasound scans during ultrasound-guided epidural lumbar punctures in a spine phantom. Eleven sets of 20 ultrasound-guided epidural punctures were performed with 2D, GPS, and multiplanar ultrasound machines (660 punctures) on a spine phantom using an in-plane approach. For all punctures, execution time, number of attempts, bone contacts, and needle redirections were noted by an independent physician. Operator comfort and visibility of the needle (tip and shaft) were measured using a numerical scale. The use of GPS significantly decreased the number of punctures, needle repositionings, and bone contacts. Comfort of the physician was also significantly improved with the GPS system compared with the 2D and multiplanar systems. With the multiplanar system, the procedure was not facilitated and execution time was longer compared with 2D imaging after Bonferroni correction but interaction between the type of ultrasound system and mean execution time was not significant in a linear mixed model. There were no significant differences regarding needle tip and shaft visibility between the systems. Multiplanar and GPS needle-tracking systems do not reduce execution time compared with 2D imaging using a real-time ultrasound-guided paramedian sagittal oblique approach in spine phantoms. The GPS needle-tracking system can improve performance in terms of operator comfort, the number of attempts, needle redirections and bone contacts. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  5. Three-dimensional digitizer (neuronavigator): new equipment for computed tomography-guided stereotaxic surgery.

    Science.gov (United States)

    Watanabe, E; Watanabe, T; Manaka, S; Mayanagi, Y; Takakura, K

    1987-06-01

    A new device was invented as an adjunct for computed tomography (CT)-guided stereotaxic or open neurosurgery. It is composed of a multijoint three-dimensional digitizer (sensor arm) and a microcomputer, which indicates the place of the sensor arm tip on preoperative CT images. Computed tomography scan is performed preoperatively with three markers placed on the nasion and ears. At surgery, after fixing the patient's head and the sensor arm, sampling of the standard points was done to translate the position of the tip of the sensor arm onto the CT images displayed on a computer screen. In this way positional data from conventional preoperative CT scan can be directly transferred into the surgical field. This system has the unique feature of introducing CT-guided stereotaxis into conventional open neurosurgery.

  6. Cranial radiotherapy guided by computed tomography with or without fields conformation in pediatric

    International Nuclear Information System (INIS)

    Fernandez, Diego; Caussa, Lucas; Murina, Patricia; Zunino, Silvia

    2007-01-01

    Many malignancies in children can be cured by radiotherapy, acute toxicity and the significant effect of delayed treatment are worrying for the patient, family and society. Therefore, the end of the pediatric radiotherapy is to maintain or improve the cure rate of cancer, diminishing the aftermath of treatment. The goal of this study is to measure differences in doses to the healthy tissue of the central nervous system with two radiotherapy techniques, both guided by computed tomography [es

  7. Image-guided automated needle biopsy of 106 thoracic lesions: a retrospective review of diagnostic accuracy and complication rates

    International Nuclear Information System (INIS)

    Connor, S.; Dyer, J.; Guest, P.

    2000-01-01

    We reviewed the diagnostic accuracy and complication rates of transthoracic needle biopsy (TNB) with an automated 18-gauge core biopsy needle and gun, using either fluoroscopic or CT guidance. One hundred six lesions were biopsied in 103 patients between 1992 and 1998. Hard-copy images, imaging reports, pathology reports and clinical notes were reviewed. In 3 patients it was not possible to establish the lesion as either malignant or benign from the available follow-up, so these were removed from the analysis of diagnostic accuracy. Adequate samples for histological diagnosis were obtained in 104 of 106 (98 %) biopsies. There were 75 of 85 (88 %) true-positive core biopsies for malignant lesions and a specific cell type was identified in 70 of 85 (82 %) cases. A specific histological diagnosis was obtained in 12 of 18 (66 %) biopsies. There was a 19 % rate of pneumothorax with only 2.4 % requiring drainage. Minor haemoptysis occurred in 3.8 % of procedures. The TNB technique with an automated core biopsy needle provides a high level of diagnostic accuracy, effectively distinguishes cell type in malignancy and provides a definite diagnosis in benign disease more frequently than fine needle aspiration (FNA). There is no increased complication rate compared with FNA. (orig.)

  8. Teleoperation System with Hybrid Pneumatic-Piezoelectric Actuation for MRI-Guided Needle Insertion with Haptic Feedback.

    Science.gov (United States)

    Shang, Weijian; Su, Hao; Li, Gang; Fischer, Gregory S

    2013-01-01

    This paper presents a surgical master-slave tele-operation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. This system consists of a piezoelectrically actuated slave robot for needle placement with integrated fiber optic force sensor utilizing Fabry-Perot interferometry (FPI) sensing principle. The sensor flexure is optimized and embedded to the slave robot for measuring needle insertion force. A novel, compact opto-mechanical FPI sensor interface is integrated into an MRI robot control system. By leveraging the complementary features of pneumatic and piezoelectric actuation, a pneumatically actuated haptic master robot is also developed to render force associated with needle placement interventions to the clinician. An aluminum load cell is implemented and calibrated to close the impedance control loop of the master robot. A force-position control algorithm is developed to control the hybrid actuated system. Teleoperated needle insertion is demonstrated under live MR imaging, where the slave robot resides in the scanner bore and the user manipulates the master beside the patient outside the bore. Force and position tracking results of the master-slave robot are demonstrated to validate the tracking performance of the integrated system. It has a position tracking error of 0.318mm and sine wave force tracking error of 2.227N.

  9. Teleoperation System with Hybrid Pneumatic-Piezoelectric Actuation for MRI-Guided Needle Insertion with Haptic Feedback

    Science.gov (United States)

    Shang, Weijian; Su, Hao; Li, Gang; Fischer, Gregory S.

    2014-01-01

    This paper presents a surgical master-slave tele-operation system for percutaneous interventional procedures under continuous magnetic resonance imaging (MRI) guidance. This system consists of a piezoelectrically actuated slave robot for needle placement with integrated fiber optic force sensor utilizing Fabry-Perot interferometry (FPI) sensing principle. The sensor flexure is optimized and embedded to the slave robot for measuring needle insertion force. A novel, compact opto-mechanical FPI sensor interface is integrated into an MRI robot control system. By leveraging the complementary features of pneumatic and piezoelectric actuation, a pneumatically actuated haptic master robot is also developed to render force associated with needle placement interventions to the clinician. An aluminum load cell is implemented and calibrated to close the impedance control loop of the master robot. A force-position control algorithm is developed to control the hybrid actuated system. Teleoperated needle insertion is demonstrated under live MR imaging, where the slave robot resides in the scanner bore and the user manipulates the master beside the patient outside the bore. Force and position tracking results of the master-slave robot are demonstrated to validate the tracking performance of the integrated system. It has a position tracking error of 0.318mm and sine wave force tracking error of 2.227N. PMID:25126446

  10. Needle Decompression in Appalachia Do Obese Patients Need Longer Needles?

    Directory of Open Access Journals (Sweden)

    Carter, Thomas Edward

    2013-11-01

    Full Text Available Introduction: Needle decompression of a tension pneumothorax can be a lifesaving procedure. It requires an adequate needle length to reach the chest wall to rapidly remove air. With adult obesity exceeding one third of the United States population in 2010, we sought to evaluate the proper catheter length that may result in a successful needle decompression procedure. Advance Trauma Life Support (ATLS currently recommends a 51 millimeter (mm needle, while the needles stocked in our emergency department are 46 mm. Given the obesity rates of our patient population, we hypothesize these needles would not have a tolerable success rate of 90%. Methods: We retrospectively reviewed 91 patient records that had computed tomography of the chest and measured the chest wall depth at the second intercostal space bilaterally. Results: We found that 46 mm needles would only be successful in 52.7% of our patient population, yet the ATLS recommended length of 51 mm has a success rate of 64.8%. Therefore, using a 64 mm needle would be successful in 79% percent of our patient population. Conclusion: Use of longer length needles for needle thoracostomy is essential given the extent of the nation’s adult obesity population. [West J Emerg Med. 2013;14(6:650-652.

  11. Positron Emission Tomography Computed Tomography: A Guide for the General Radiologist.

    Science.gov (United States)

    Beadsmoore, Clare; Newman, David; MacIver, Duncan; Pawaroo, Davina

    2015-11-01

    Cancer remains a leading cause of death in Canada and worldwide. Whilst advances in anatomical imaging to detect and monitor malignant disease have continued over the last few decades, limitations remain. Functional imaging, such as positron emission tomography (PET), has improved the sensitivity and specificity in detecting malignant disease. In combination with computed tomography (CT), PET is now commonly used in the oncology setting and is an integral part of many cancer patients' pathways. Although initially the CT component of the study was purely for attenuation of the PET imaging and to provide anatomical coregistration, many centers now combine the PET study with a diagnostic quality contrast enhanced CT to provide one stop staging, thus refining the patient's pathway. The commonest tracer used in everyday practice is FDG (F18-fluorodeoxyglucose). There are many more tracers in routine clinical practice and those with emerging roles, such as 11C-choline, useful in the imaging of prostate cancer; 11C-methionine, useful in imaging brain tumours; C11-acetate, used in imaging hepatocellular carcinomas; 18F-FLT, which can be used as a marker of cellular proliferation in various malignancies; and F18-DOPA and various 68Ga-somatostatin analogues, used in patients with neuroendocrine tumours. In this article we concentrate on FDG PETCT as this is the most commonly available and widely utilised tracer now used to routinely stage a number of cancers. PETCT alters the stage in approximately one-third of patients compared to anatomical imaging alone. Increasingly, PETCT is being used to assess early metabolic response to treatment. Metabolic response can be seen much earlier than a change in the size/volume of the disease which is measured by standard CT imaging. This can aid treatment decisions in both in terms of modifying therapy and in addition to providing important prognostic information. Furthermore, it is helpful in patients with distorted anatomy from surgery

  12. Guided-wave tomography imaging plate defects by laser-based ultrasonic techniques

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jun Pil; Lim, Ju Young; Cho, Youn Ho [School of Mechanical Engineering, Pusan National University, Pusan (Korea, Republic of)

    2014-12-15

    Contact-guided-wave tests are impractical for investigating specimens with limited accessibility and rough surfaces or complex geometric features. A non-contact setup with a laser-ultrasonic transmitter and receiver is quite attractive for guided-wave inspection. In the present work, we developed a non-contact guided-wave tomography technique using the laser-ultrasonic technique in a plate. A method for Lamb-wave generation and detection in an aluminum plate with a pulsed laser-ultrasonic transmitter and Michelson-interferometer receiver was developed. The defect shape and area in the images obtained using laser scanning, showed good agreement with the actual defect. The proposed approach can be used as a non-contact online inspection and monitoring technique.

  13. Lesion stiffness measured by shear-wave elastography: Preoperative predictor of the histologic underestimation of US-guided core needle breast biopsy.

    Science.gov (United States)

    Park, Ah Young; Son, Eun Ju; Kim, Jeong-Ah; Han, Kyunghwa; Youk, Ji Hyun

    2015-12-01

    To determine whether lesion stiffness measured by shear-wave elastography (SWE) can be used to predict the histologic underestimation of ultrasound (US)-guided 14-gauge core needle biopsy (CNB) for breast masses. This retrospective study enrolled 99 breast masses from 93 patients, including 40 high-risk lesions and 59 ductal carcinoma in situ (DCIS), which were diagnosed by US-guided 14-gauge CNB. SWE was performed for all breast masses to measure quantitative elasticity values before US-guided CNB. To identify the preoperative factors associated with histologic underestimation, patients' age, symptoms, lesion size, B-mode US findings, and quantitative SWE parameters were compared according to the histologic upgrade after surgery using the chi-square test, Fisher's exact test, or independent t-test. The independent factors for predicting histologic upgrade were evaluated using multivariate logistic regression analysis. The underestimation rate was 28.3% (28/99) in total, 25.0% (10/40) in high-risk lesions, and 30.5% (18/59) in DCIS. All elasticity values of the upgrade group were significantly higher than those of the non-upgrade group (PBreast lesion stiffness quantitatively measured by SWE could be helpful to predict the underestimation of malignancy in US-guided 14-gauge CNB. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  14. Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients.

    Science.gov (United States)

    Akoglu, Haldun; Akoglu, Ebru Unal; Evman, Serdar; Akoglu, Tayfun; Altinok, Arzu Denizbasi; Guneysel, Ozlem; Onur, Ozge Ecmel; Eroglu, Serkan Emre

    2013-09-01

    The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX. All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients. The average CWT for men on the 2nd ICS-MCL was 38mm and for women was 52mm; on the other hand, on the 5th ICS-MAL was 33mm for men and 38mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL. This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Predictors of underestimation of malignancy after image-guided core needle biopsy diagnosis of flat epithelial atypia or atypical ductal hyperplasia.

    Science.gov (United States)

    Yu, Chi-Chang; Ueng, Shir-Hwa; Cheung, Yun-Chung; Shen, Shih-Che; Kuo, Wen-Lin; Tsai, Hsiu-Pei; Lo, Yung-Feng; Chen, Shin-Cheh

    2015-01-01

    Flat epithelial atypia (FEA) and atypical ductal hyperplasia (ADH) are precursors of breast malignancy. Management of FEA or ADH after image-guided core needle biopsy (CNB) remains controversial. The aim of this study was to evaluate malignancy underestimation rates after FEA or ADH diagnosis using image-guided CNB and to identify clinical characteristics and imaging features associated with malignancy as well as identify cases with low underestimation rates that may be treatable by observation only. We retrospectively reviewed 2,875 consecutive image-guided CNBs recorded in an electronic data base from January 2010 to December 2011 and identified 128 (4.5%) FEA and 83 (2.9%) ADH diagnoses (211 total cases). Of these, 64 (30.3%) were echo-guided CNB procedures and 147 (69.7%) mammography-guided CNBs. Twenty patients (9.5%) were upgraded to malignancy. Multivariate analysis indicated that age (OR = 1.123, p = 0.002, increase of 1 year), mass-type lesion with calcifications (OR = 8.213, p = 0.006), and ADH in CNB specimens (OR = 8.071, p = 0.003) were independent predictors of underestimation. In univariate analysis of echo-guided CNB (n = 64), mass with calcifications had the highest underestimation rate (p < 0.001). Multivariate analysis of 147 mammography-guided CNBs revealed that age (OR = 1.122, p = 0.040, increase of 1 year) and calcification distribution were significant independent predictors of underestimation. No FEA case in which, complete calcification retrieval was recorded after CNB was upgraded to malignancy. Older age at diagnosis on image-guided CNB was a predictor of malignancy underestimation. Mass with calcifications was more likely to be associated with malignancy, and in cases presenting as calcifications only, segmental distribution or linear shapes were significantly associated with upgrading. Excision after FEA or ADH diagnosis by image-guided CNB is warranted except for FEA diagnosed using mammography-guided CNB with complete calcification

  16. Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

    Science.gov (United States)

    Bento, Angela Pimenta; Fernandes, Renato Gil dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  17. CT-guided needle biopsy in the diagnosis of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue: a rare combination.

    Science.gov (United States)

    Tian, Panwen; Wang, Ye; Wan, Chun; Shen, Yongchun; Wen, Fuqiang

    2015-01-01

    We represent a rare case of lung adenocarcinoma accompanied by extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT). The patient was a 66-year-old male presented with 1 month history of recurrent cough and hemoptysis. Chest CT showed solitary ground-glass opacity (GGO) in the upper lobe of the right lung and mediastinal lymph node enlargement in station 3p. A CT-guided transthoracic needle biopsy was performed. Tissue specimens of the GGO revealed a typical adenocarcinoma. Histopathologic diagnosis of mediastinal lymph node was extranodal marginal zone lymphoma of MALT. Because of its rarity, extranodal marginal zone lymphoma of MALT should be considered in the differential diagnosis when we encounter mediastinal lymphadenopathy in patients with lung adenocarcinoma.

  18. Clinical impact of endoscopic ultrasound-guided fine needle aspiration biopsy in patients with upper gastrointestinal tract malignancies. A prospective study

    DEFF Research Database (Denmark)

    Mortensen, M B; Pless, T; Durup, J

    2001-01-01

    BACKGROUND AND STUDY AIMS: Several studies have evaluated the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) in the upper gastrointestinal tract, but so far no studies have specifically evaluated the clinical impact of EUS-FNAB in upper gastrointestinal tract......% in esophageal, gastric, and pancreatic cancer, respectively. The staging-related clinical impact was similar for all three types of cancer (11-12.5%), whereas the diagnosis-related impact was highest in pancreatic cancer patients (86%). EUS-FNAB was inadequate in 13% and gave false-negative results in 5......%. The overall sensitivity, specificity and accuracy for EUS-FNAB were 80%, 78% and 80%, respectively. No complications related to the biopsy procedure were seen. CONCLUSIONS: If EUS-FNAB was performed only in cases where a positive malignant result would change patient management, then approximately one out...

  19. Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Dhooria, Sahajal; Aggarwal, Ashutosh N; Gupta, Dheeraj; Behera, Digambar; Agarwal, Ritesh

    2015-07-01

    The use of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) has been described in the evaluation of mediastinal lymphadenopathy. Herein, we conduct a meta-analysis to estimate the overall diagnostic yield and safety of EUS-B-FNA combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in the diagnosis of mediastinal lymphadenopathy. The PubMed and EmBase databases were searched for studies reporting the outcomes of EUS-B-FNA in diagnosis of mediastinal lymphadenopathy. The study quality was assessed using the QualSyst tool. The yield of EBUS-TBNA alone and the combined procedure (EBUS-TBNA and EUS-B-FNA) were analyzed by calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each study, and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was calculated using proportion meta-analysis. Our search yielded 10 studies (1,080 subjects with mediastinal lymphadenopathy). The sensitivity of the combined procedure was significantly higher than EBUS-TBNA alone (91% vs 80%, P = .004), in staging of lung cancer (4 studies, 465 subjects). The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was 7.6% in the diagnosis of mediastinal adenopathy. No serious complication of EUS-B-FNA procedure was reported. Clinical and statistical heterogeneity was present without any evidence of publication bias. Combining EBUS-TBNA and EUS-B-FNA is an effective and safe method, superior to EBUS-TBNA alone, in the diagnosis of mediastinal lymphadenopathy. Good quality randomized controlled trials are required to confirm the results of this systematic review. Copyright © 2015 by Daedalus Enterprises.

  20. Comparison of the accuracy of cone beam computed tomography and medical computed tomography: implications for clinical diagnostics with guided surgery.

    Science.gov (United States)

    Abboud, Marcus; Calvo-Guirado, Jose Luis; Orentlicher, Gary; Wahl, Gerhard

    2013-01-01

    This study compared the accuracy of cone beam computed tomography (CBCT) and medical-grade CT in the context of evaluating the diagnostic value and accuracy of fiducial marker localization for reference marker-based guided surgery systems. Cadaver mandibles with attached radiopaque gutta-percha markers, as well as glass balls and composite cylinders of known dimensions, were measured manually with a highly accurate digital caliper. The objects were then scanned using a medical-grade CT scanner (Philips Brilliance 64) and five different CBCT scanners (Sirona Galileos, Morita 3D Accuitomo 80, Vatech PaX-Reve3D, 3M Imtech Iluma, and Planmeca ProMax 3D). The data were then imported into commercially available software, and measurements were made of the scanned markers and objects. CT and CBCT measurements were compared to each other and to the caliper measurements. The difference between the CBCT measurements and the caliper measurements was larger than the difference between the CT measurements and the caliper measurements. Measurements of the cadaver mandible and the geometric reference markers were highly accurate with CT. The average absolute errors of the human mandible measurements were 0.03 mm for CT and 0.23 mm for CBCT. The measurement errors of the geometric objects based on CT ranged between 0.00 and 0.12 mm, compared to an error range between 0.00 and 2.17 mm with the CBCT scanners. CT provided the most accurate images in this study, closely followed by one CBCT of the five tested. Although there were differences in the distance measurements of the hard tissue of the human mandible between CT and CBCT, these differences may not be of clinical significance for most diagnostic purposes. The fiducial marker localization error caused by some CBCT scanners may be a problem for guided surgery systems.

  1. Incidental finding of a left over guide wire on a positron emission tomography

    International Nuclear Information System (INIS)

    Yap, Kok Hooi; Lee, Phong Teck; Buch, Mamta; Rammohan, Kandadai Seshadri

    2012-01-01

    The Seldinger technique is commonly used cannulate vessels for radiographical procedures. Loss of a guide wire into the circulation is a rare and preventable complication. It is often noticed by chance during routine radiographs. However, there is a lack of reported cases of incidental fin dings of leftover guide wire on a PET scan. An intravascular foreign body should be retrieved as soon as the diagnosis is made, to prevent complications such as embolisation or vascular damage by fractured wires. Interventional radiology is the method of choice for retrieval. We report a rare case of the coincidental finding of a lost guide wire on a PET scan. A 37 year old man presented with psychotic episodes, thigh weakness, weight gain, increased appetite and leg cramps. He was subsequently diagnosed with cushing syndrome secondary to ectopic adrenocorticotropic secretion from a right lung tumour. He subsequently underwent a staging positron emission tomography (PET) scan. The lung tumour had no uptake on PET bit had increased activity uptake on octreotide scanning. These appearances were suggestive of with carcinoid tumour. The PET scan also revealed an incidental finding of a leftover guide wire used during peripheral inserted central catheter (PICC) recently. The wire extended from right atrium to inferior vena cava. It also showed a high uptake in the adrenal glands, indicating hyperplasia, which was most likely due to adrenocorticotropic hormone stimulation. He underwent a percutaneous wire retrieval via the right femoral vein in a cardiac catheterisation laboratory and was transferred to a thoracic surgical unit for lung tumor resection

  2. Incidental finding of a left over guide wire on a positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Yap, Kok Hooi; Lee, Phong Teck; Buch, Mamta; Rammohan, Kandadai Seshadri

    2012-12-15

    The Seldinger technique is commonly used cannulate vessels for radiographical procedures. Loss of a guide wire into the circulation is a rare and preventable complication. It is often noticed by chance during routine radiographs. However, there is a lack of reported cases of incidental fin dings of leftover guide wire on a PET scan. An intravascular foreign body should be retrieved as soon as the diagnosis is made, to prevent complications such as embolisation or vascular damage by fractured wires. Interventional radiology is the method of choice for retrieval. We report a rare case of the coincidental finding of a lost guide wire on a PET scan. A 37 year old man presented with psychotic episodes, thigh weakness, weight gain, increased appetite and leg cramps. He was subsequently diagnosed with cushing syndrome secondary to ectopic adrenocorticotropic secretion from a right lung tumour. He subsequently underwent a staging positron emission tomography (PET) scan. The lung tumour had no uptake on PET bit had increased activity uptake on octreotide scanning. These appearances were suggestive of with carcinoid tumour. The PET scan also revealed an incidental finding of a leftover guide wire used during peripheral inserted central catheter (PICC) recently. The wire extended from right atrium to inferior vena cava. It also showed a high uptake in the adrenal glands, indicating hyperplasia, which was most likely due to adrenocorticotropic hormone stimulation. He underwent a percutaneous wire retrieval via the right femoral vein in a cardiac catheterisation laboratory and was transferred to a thoracic surgical unit for lung tumor resection.

  3. The role of ultrasound guided percutaneous needle aspiration and lavage (barbotage in the treatment of calcific tendinitis

    Directory of Open Access Journals (Sweden)

    Gamal Niazi

    2015-03-01

    Conclusion: Ultrasound guided aspiration and lavage (barbotage is a highly effective, less aggressive method of treatment in cases of calcific tendinosis, especially for cases with severe pain that does not respond to other conservative methods.

  4. [Case-control study on needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding for the treatment of low back pain caused by lumbar facet osteoarthritis].

    Science.gov (United States)

    Lu, Di; Xu, Wei-xing; Ding, Wei-Guo; Guo, Qiao-Feng; Ma, Gou-ping; Zhu, Wei-min

    2013-03-01

    To study the clinical efficacy of needle-knife to cut off the medial branch of the lumbar posterior ramus under C-arm guiding to treat low back pain caused by lumbar facet osteoarthritis. From July 2009 to June 2011, 60 patients with low back pain caused by lumbar facet osteoarthritis were reviewed,including 34 males and 26 females, ranging in age from 39 to 73 years old,averaged 61.9 years old; the duration of the disease ranged from 6 to 120 months, with a mean of 18.9 months. All the patients were divided into two groups, 30 patients (18 males and 12 females, ranging in age from 39 to 71 years old, needle-knife group) were treated with needle-knife to cut off medial branch of the lumbar posterior ramus under C -arm guiding and the other 30 patients(16 males and 14 females, ranging in age from 41 to 73 years old, hormone injection group) were treated with hormone injection in lumbar facet joint under C-arm guiding. The preoperative JOA scores and the scores at the 1st, 12th and 26th weeks after treatment were analyzed. Before treatment,the JOA scores between the two groups had no significant difference (P= 0.479); after 1 week of treatment, the JOA scores between the two groups had significant difference (P= 0.040), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (58.73+/-18.20)% in needle-knife group and (71.10+/-22.19)% in hormone injection group; after 12 weeks of treatment, the JOA scores between the two groups had no significant difference(P=0.569), and the improvement rate between the two groups had no significant difference,which were (50.09+/-19.33)% in the needle-knife group and (48.70+/-18.36)%) in the hormone injection group; after 26 weeks of treatment,the JOA scores between the two groups had significant difference (P=0.000), the improvement rate of hormone injection group was superior than that of the needle-knife group,which were (48.56+/-28.24)% in needle-knife group and (15

  5. Guiding flying-spot laser transepithelial phototherapeutic keratectomy with optical coherence tomography.

    Science.gov (United States)

    Li, Yan; Yokogawa, Hideaki; Tang, Maolong; Chamberlain, Winston; Zhang, Xinbo; Huang, David

    2017-04-01

    To analyze transepithelial phototherapeutic keratectomy (PTK) results using optical coherence tomography (OCT) and develop a model to guide the laser dioptric and depth settings. Casey Eye Institute, Portland, Oregon, USA. Prospective nonrandomized case series. Patients with superficial corneal opacities and irregularities had transepithelial PTK with a flying-spot excimer laser by combining wide-zone myopic and hyperopic astigmatic ablations. Optical coherence tomography was used to calculate corneal epithelial lenticular masking effects, guide refractive laser settings, and measure opacity removal. The laser ablation efficiency and the refractive outcome were investigated using multivariate linear regression models. Twenty-six eyes of 20 patients received PTK to remove opacities and irregular astigmatism due to scar, dystrophy, radial keratotomy, or previous corneal surgeries. The uncorrected distance visual acuity and corrected distance visual acuity were significantly improved (P laser ablation depths were 31.3% (myopic ablation) and 63.0% (hyperopic ablation) deeper than the manufacturer's nomogram. The spherical equivalent of the corneal epithelial lenticular masking effect was 0.73 diopter ± 0.61 (SD). The refractive outcome highly correlated to the laser settings and epithelial lenticular masking effect (Pearson R = 0.96, P < .01). The ablation rate of granular dystrophy opacities appeared to be slower. Smoothing ablation under masking fluid was needed to prevent focal steep islands in these cases. The OCT-measured ablation depth efficiency could guide opacity removal. The corneal epithelial lenticular masking effect could refine the spherical refractive nomogram to achieve a better refractive outcome after transepithelial ablation. Copyright © 2017 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  6. Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures

    International Nuclear Information System (INIS)

    Iguchi, Toshihiro; Ogawa, Ken-Ichi; Doi, Takeshi; Munetomo, Kazuo; Miyasho, Koji; Hiraki, Takao; Kanazawa, Susumu; Ozaki, Toshifumi

    2010-01-01

    The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. Six patients (four women and two men; mean age 55.8 years; range 35-77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic ring injury (AO types B and C) was the indication for this procedure. In all the six patients except one, CT fluoroscopy-guided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9-30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6-21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk. CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures. (orig.)

  7. User-guided segmentation for volumetric retinal optical coherence tomography images

    Science.gov (United States)

    Yin, Xin; Chao, Jennifer R.; Wang, Ruikang K.

    2014-01-01

    Abstract. Despite the existence of automatic segmentation techniques, trained graders still rely on manual segmentation to provide retinal layers and features from clinical optical coherence tomography (OCT) images for accurate measurements. To bridge the gap between this time-consuming need of manual segmentation and currently available automatic segmentation techniques, this paper proposes a user-guided segmentation method to perform the segmentation of retinal layers and features in OCT images. With this method, by interactively navigating three-dimensional (3-D) OCT images, the user first manually defines user-defined (or sketched) lines at regions where the retinal layers appear very irregular for which the automatic segmentation method often fails to provide satisfactory results. The algorithm is then guided by these sketched lines to trace the entire 3-D retinal layer and anatomical features by the use of novel layer and edge detectors that are based on robust likelihood estimation. The layer and edge boundaries are finally obtained to achieve segmentation. Segmentation of retinal layers in mouse and human OCT images demonstrates the reliability and efficiency of the proposed user-guided segmentation method. PMID:25147962

  8. Ultrasound guided electrical impedance tomography for 2D free-interface reconstruction

    Science.gov (United States)

    Liang, Guanghui; Ren, Shangjie; Dong, Feng

    2017-07-01

    The free-interface detection problem is normally seen in industrial or biological processes. Electrical impedance tomography (EIT) is a non-invasive technique with advantages of high-speed and low cost, and is a promising solution for free-interface detection problems. However, due to the ill-posed and nonlinear characteristics, the spatial resolution of EIT is low. To deal with the issue, an ultrasound guided EIT is proposed to directly reconstruct the geometric configuration of the target free-interface. In the method, the position of the central point of the target interface is measured by a pair of ultrasound transducers mounted at the opposite side of the objective domain, and then the position measurement is used as the prior information for guiding the EIT-based free-interface reconstruction. During the process, a constrained least squares framework is used to fuse the information from different measurement modalities, and the Lagrange multiplier-based Levenberg-Marquardt method is adopted to provide the iterative solution of the constraint optimization problem. The numerical results show that the proposed ultrasound guided EIT method for the free-interface reconstruction is more accurate than the single modality method, especially when the number of valid electrodes is limited.

  9. Ultrasound guided electrical impedance tomography for 2D free-interface reconstruction

    International Nuclear Information System (INIS)

    Liang, Guanghui; Ren, Shangjie; Dong, Feng

    2017-01-01

    The free-interface detection problem is normally seen in industrial or biological processes. Electrical impedance tomography (EIT) is a non-invasive technique with advantages of high-speed and low cost, and is a promising solution for free-interface detection problems. However, due to the ill-posed and nonlinear characteristics, the spatial resolution of EIT is low. To deal with the issue, an ultrasound guided EIT is proposed to directly reconstruct the geometric configuration of the target free-interface. In the method, the position of the central point of the target interface is measured by a pair of ultrasound transducers mounted at the opposite side of the objective domain, and then the position measurement is used as the prior information for guiding the EIT-based free-interface reconstruction. During the process, a constrained least squares framework is used to fuse the information from different measurement modalities, and the Lagrange multiplier-based Levenberg–Marquardt method is adopted to provide the iterative solution of the constraint optimization problem. The numerical results show that the proposed ultrasound guided EIT method for the free-interface reconstruction is more accurate than the single modality method, especially when the number of valid electrodes is limited. (paper)

  10. Image-guided fine needle cytology with aspiration versus non-aspiration in retroperitoneal masses: is aspiration necessary?

    Science.gov (United States)

    Misra, Rajiv Kumar; Mitra, Shaila; Jain, Rishav Kumar; Vahikar, Shilpa; Bundela, Archana; Misra, Purak

    2015-03-01

    Although using fine needle cytology with aspiration (FNC-A) for establishing diagnoses in the retroperitoneal region has shown promise, there is scant literature supporting a role of non-aspiration cytology (FNC-NA) for this region. We assessed the accuracy and reliability of FNC-A and FNC-NA as tools for preoperative diagnosis of retroperitoneal masses and compared the results of both techniques with each other and with histopathology. Fifty-seven patients with retroperitoneal masses were subjected to FNC-A and FNC-NA. Smears were stained with May-Grunwald Giemsa and hematoxylin and eosin stain. An individual slide was objectively analysed using a point scoring system to enable comparison between FNC-A and FNC-NA. By FNC-A, 91.7% accuracy was obtained in cases of retroperitoneal lymph node lesions followed by renal masses (83.3%). The diagnostic accuracy of other sites by FNC-A varied from 75.0%-81.9%. By FNC-NA, 93.4% diagnostically accurate results were obtained in the kidney, followed by 75.0% in adrenal masses. The diagnostic accuracy of other sites by FNC-NA varied from 66.7%-72.8%. Although both techniques have their own advantages and disadvantages, FNC-NA may be a more efficient adjuvant method of sampling in retroperitoneal lesions.

  11. CT guided transthoracic fine needle aspiration biopsy (TFNAB) of the chest tumours; Transtorakalna biopsja aspiracyjna cienkoiglowa (TBAC) guzow umiejscowionych w klatce piersiowej pod kontrola obrazu tomografii komputerowej

    Energy Technology Data Exchange (ETDEWEB)

    Glowacki, J; Legaszewski, T; Skrzelewski, S; Sraga, W [Katedra i Zaklad Radiologii Lekarskiej i Radiodiagnostyki, Zabrze (Poland); Slaska Akademia Medyczna, Katowice [Poland; Zajecki, W [Katedra i Klinika Chirurgii Klatki Piersiowej, Zabrze (Poland); Slaska Akademia Medyczna, Katowice [Poland; Harasim, J [Katedra i Zaklad Patomorfologii, Zabrze (Poland); Slaska Akademia Medyczna, Katowice [Poland; Polonska, A [Katedra i Klinika Fizjopneumonologii, Zabrze (Poland); Slaska Akademia Medyczna, Katowice [Poland

    2003-07-01

    Tumours spreading within the chest are nowadays diagnosed based on computed tomography (CT). The aim of this paper is to present a few years experience in transthoracic fine needle aspiration biopsy of lung tumours and tumour-like lesions in adjacent tissues and organs during CT examination. To make an accurate diagnosis, the authors performed 124 TFNAB in 116 patients. About 2/3 of the biopsies were performed in patients with a tumour size from 1 to 5 cm in diameter, adjacent or located peripherally to the chest wall. The valuable cellular material, which enabled us to define a type of a disease and to make a final clinical diagnosis, was obtained in nearly 80% of cases. The complications were found in 10 patients (8.6% of all patients). Pneumothorax was found in eight cases and pulmonary bleeding (bleeding into pulmonary parenchyma and bleeding from respiratory duct) in two cases. The authors emphasized the significance of TFNAB in obtaining valuable material for fine spectrum study and discussed the problem of safety related to this procedure. (author)

  12. Image-Guided Radiotherapy for Liver Cancer Using Respiratory-Correlated Computed Tomography and Cone-Beam Computed Tomography

    International Nuclear Information System (INIS)

    Guckenberger, Matthias; Sweeney, Reinhart A.; Wilbert, Juergen; Krieger, Thomas; Richter, Anne; Baier, Kurt; Mueller, Gerd; Sauer, Otto; Flentje, Michael

    2008-01-01

    Purpose: To evaluate a novel four-dimensional (4D) image-guided radiotherapy (IGRT) technique in stereotactic body RT for liver tumors. Methods and Materials: For 11 patients with 13 intrahepatic tumors, a respiratory-correlated 4D computed tomography (CT) scan was acquired at treatment planning. The target was defined using CT series reconstructed at end-inhalation and end-exhalation. The liver was delineated on these two CT series and served as a reference for image guidance. A cone-beam CT scan was acquired after patient positioning; the blurred diaphragm dome was interpreted as a probability density function showing the motion range of the liver. Manual contour matching of the liver structures from the planning 4D CT scan with the cone-beam CT scan was performed. Inter- and intrafractional uncertainties of target position and motion range were evaluated, and interobserver variability of the 4D-IGRT technique was tested. Results: The workflow of 4D-IGRT was successfully practiced in all patients. The absolute error in the liver position and error in relation to the bony anatomy was 8 ± 4 mm and 5 ± 2 mm (three-dimensional vector), respectively. Margins of 4-6 mm were calculated for compensation of the intrafractional drifts of the liver. The motion range of the diaphragm dome was reproducible within 5 mm for 11 of 13 lesions, and the interobserver variability of the 4D-IGRT technique was small (standard deviation, 1.5 mm). In 4 patients, the position of the intrahepatic lesion was directly verified using a mobile in-room CT scanner after application of intravenous contrast. Conclusion: The results of our study have shown that 4D image guidance using liver contour matching between respiratory-correlated CT and cone-beam CT scans increased the accuracy compared with stereotactic positioning and compared with IGRT without consideration of breathing motion

  13. Enhancing early bladder cancer detection with fluorescence-guided endoscopic optical coherence tomography

    Science.gov (United States)

    Pan, Y. T.; Xie, T. Q.; Du, C. W.; Bastacky, S.; Meyers, S.; Zeidel, M. L.

    2003-12-01

    We report an experimental study of the possibility of enhancing early bladder cancer diagnosis with fluorescence-image-guided endoscopic optical coherence tomography (OCT). After the intravesical instillation of a 10% solution of 5-aminolevulinic acid, simultaneous fluorescence imaging (excitation of 380-420 nm, emission of 620-700 nm) and OCT are performed on rat bladders to identify the photochemical and morphological changes associated with uroepithelial tumorigenesis. The preliminary results of our ex vivo study reveal that both fluorescence and OCT can identify early uroepithelial cancers, and OCT can detect precancerous lesions (e.g., hyperplasia) that fluorescence may miss. This suggests that a cystoscope combining 5-aminolevulinic acid fluorescence and OCT imaging has the potential to enhance the efficiency and sensitivity of early bladder cancer diagnosis.

  14. Imaging osteoarthritis in the knee joints using x-ray guided diffuse optical tomography

    Science.gov (United States)

    Zhang, Qizhi; Yuan, Zhen; Sobel, Eric S.; Jiang, Huabei

    2010-02-01

    In our previous studies, near-infrared (NIR) diffuse optical tomography (DOT) had been successfully applied to imaging osteoarthritis (OA) in the finger joints where significant difference in optical properties of the joint tissues was evident between healthy and OA finger joints. Here we report for the first time that large joints such as the knee can also be optically imaged especially when DOT is combined with x-ray tomosynthesis where the 3D image of the bones from x-ray is incorporated into the DOT reconstruction as spatial a priori structural information. This study demonstrates that NIR light can image large joints such as the knee in addition to finger joints, which will drastically broaden the clinical utility of our x-ray guided DOT technique for OA diagnosis.

  15. Novel Double-Needle System That Can Prevent Intravascular Injection of Any Filler

    Directory of Open Access Journals (Sweden)

    Hsiang Huang, MD

    2017-09-01

    Full Text Available Summary:. A new type of needle system combines 2 parts, an inner needle and an outer needle. The inner needle is used for filler injection and the outer needle acts as a guiding needle that can observe blood reflow when inserting into the vessel lumen during injection process. This new needle system can be used for all kinds of filler, providing real time monitoring for physician and preventing intravascular injection of any filler.

  16. Guided access cavity preparation using cone-beam computed tomography and optical surface scans - an ex vivo study

    DEFF Research Database (Denmark)

    Buchgreitz, J; Buchgreitz, M; Mortensen, D

    2016-01-01

    AIM: To evaluate ex vivo, the accuracy of a preparation procedure planned for teeth with pulp canal obliteration (PCO) using a guide rail concept based on a cone-beam computed tomography (CBCT) scan merged with an optical surface scan. METHODOLOGY: A total of 48 teeth were mounted in acrylic bloc...

  17. The using of megavoltage computed tomography in image-guided brachytherapy for cervical cancer: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Tharavichitkul, Ekkasit; Janla-or, Suwapim; Wanwilairat, Somsak; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Supawongwattana, Bongkot; Chitapanarux, Imjai [Division of Therapeutic Radiology and Oncology, Dept. of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai (Thailand); Galalae, Razvan M. [Faculty of Medicine, Christian-Albrecht University (Campus Kiel), Kiel (Germany)

    2015-06-15

    We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.

  18. Prior image constrained scatter correction in cone-beam computed tomography image-guided radiation therapy.

    Science.gov (United States)

    Brunner, Stephen; Nett, Brian E; Tolakanahalli, Ranjini; Chen, Guang-Hong

    2011-02-21

    X-ray scatter is a significant problem in cone-beam computed tomography when thicker objects and larger cone angles are used, as scattered radiation can lead to reduced contrast and CT number inaccuracy. Advances have been made in x-ray computed tomography (CT) by incorporating a high quality prior image into the image reconstruction process. In this paper, we extend this idea to correct scatter-induced shading artifacts in cone-beam CT image-guided radiation therapy. Specifically, this paper presents a new scatter correction algorithm which uses a prior image with low scatter artifacts to reduce shading artifacts in cone-beam CT images acquired under conditions of high scatter. The proposed correction algorithm begins with an empirical hypothesis that the target image can be written as a weighted summation of a series of basis images that are generated by raising the raw cone-beam projection data to different powers, and then, reconstructing using the standard filtered backprojection algorithm. The weight for each basis image is calculated by minimizing the difference between the target image and the prior image. The performance of the scatter correction algorithm is qualitatively and quantitatively evaluated through phantom studies using a Varian 2100 EX System with an on-board imager. Results show that the proposed scatter correction algorithm using a prior image with low scatter artifacts can substantially mitigate scatter-induced shading artifacts in both full-fan and half-fan modes.

  19. Contrast-Enhanced Ultrasound Improves the Pathological Outcomes of US-Guided Core Needle Biopsy That Targets the Viable Area of Anterior Mediastinal Masses

    Directory of Open Access Journals (Sweden)

    Jian-hua Zhou

    2018-01-01

    Full Text Available Based on the option that ultrasound-guided core needle biopsy (US-CNB of the enhanced portion of anterior mediastinal masses (AMMs identified by contrast-enhanced ultrasound (CEUS would harvest viable tissue and benefit the histological diagnoses, a retrospective study was performed to elucidate the correlation between the prebiopsy CEUS and diagnostic yield of AMMs and found that CEUS potentially improved the diagnostic yield of AMMs compared with conventional US with a significant increase in the cellularity of samples. Furthermore, the marginal blood flow signals and absence of necrosis can predict the diagnostic yield of AMM. It was concluded that US-CNB of the viable part of AMMs, as verified by CEUS, was able to harvest sufficient tissue with more cellularity that could be used for ancillary studies and improve the diagnostic yield. And CEUS was recommended to those patients with AMMs undergoing repeated US-CNB, with the absence of marginal blood signals or presence of necrosis.

  20. Computer tomography urography assisted real-time ultrasound-guided percutaneous nephrolithotomy on renal calculus.

    Science.gov (United States)

    Fang, You-Qiang; Wu, Jie-Ying; Li, Teng-Cheng; Zheng, Hao-Feng; Liang, Guan-Can; Chen, Yan-Xiong; Hong, Xiao-Bin; Cai, Wei-Zhong; Zang, Zhi-Jun; Di, Jin-Ming

    2017-06-01

    This study aimed to assess the role of pre-designed route on computer tomography urography (CTU) in the ultrasound-guided percutaneous nephrolithotomy (PCNL) for renal calculus.From August 2013 to May 2016, a total of 100 patients diagnosed with complex renal calculus in our hospital were randomly divided into CTU group and control group (without CTU assistance). CTU was used to design a rational route for puncturing in CTU group. Ultrasound was used in both groups to establish a working trace in the operation areas. Patients' perioperative parameters and postoperative complications were recorded.All operations were successfully performed, without transferring to open surgery. Time of channel establishment in CTU group (6.5 ± 4.3 minutes) was shorter than the control group (10.0 ± 6.7 minutes) (P = .002). In addition, there was shorter operation time, lower rates of blood transfusion, secondary operation, and less establishing channels. The incidence of postoperative complications including residual stones, sepsis, severe hemorrhage, and perirenal hematoma was lower in CTU group than in control group.Pre-designing puncture route on CTU images would improve the puncturing accuracy, lessen establishing channels as well as improve the security in the ultrasound-guided PCNL for complex renal calculus, but at the cost of increased radiation exposure.

  1. Efficacy of computed tomography guided radiofrequency ablation forosteoid osteomas in 31 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Ahn, Joong Mo; Lee, Joon Woo; Lee, Guen Young; Lee, Eu Gene; Oh, Joo Han; Cho, Hwan Seong; Kang, Heung Sik [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2015-04-15

    To present the clinical outcome of computed tomography (CT) guided radiofrequency ablation (RFA) for osteoid osteoma. Thirty-one patients (M:F = 23:8, mean age: 20 years, range: 4-54 years) who underwent RFA for clinically suspected osteoid osteoma from May 2004 to December 2013 were retrospectively reviewed. RFA was done in all cases under CT guidance by one of three radiologists in our department. Electronic medical records and images were retrospectively reviewed in all patients. Lesions were located in femur (n = 20), tibia (n = 5), fibula (n = 2), humerus (n = 3), talus (n = 2), and calcaneus (n = 1). On discharge, 27 of 33 cases showed complete remission of pain (82%). One major complication (compartment syndrome) and 2 minor complications (reactive synovitis, minimal skin burn at electrode insertion site) were observed. On the last follow-up (0-78 months, mean: 12.6 months) 27 of 33 cases were successfully treated (82%) and had no more complaints. 3 cases presented remaining pain (9%). In 3 cases relapse occurred (9%) and RFA was repeated in 1 case. The repeated treatment was successful. CT-guided RFA is an effective method for the treatment of osteoid osteoma.

  2. Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Pang, G; Rowlands, J A [Toronto-Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, Toronto M4N 3M5 (Canada); Imaging Research, Sunnybrook and Women' s College Health Sciences Centre, Departments of Radiation Oncology and Medical Biophysics, University of Toronto, Toronto (Canada)

    2005-11-07

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy-just-in-time tomography (JiTT)-is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment. (note)

  3. Just-in-time tomography (JiTT): a new concept for image-guided radiation therapy

    International Nuclear Information System (INIS)

    Pang, G; Rowlands, J A

    2005-01-01

    Soft-tissue target motion is one of the main concerns in high-precision radiation therapy. Cone beam computed tomography (CBCT) has been developed recently to image soft-tissue targets in the treatment room and guide the radiation therapy treatment. However, due to its relatively long image acquisition time the CBCT approach cannot provide images of the target at the instant of the treatment and thus it is not adequate for imaging targets with intrafraction motion. In this note, a new approach for image-guided radiation therapy-just-in-time tomography (JiTT)-is proposed. Differing from CBCT, JiTT takes much less time to generate the needed tomographical, beam's-eye-view images of the treatment target at the right moment to guide the radiation therapy treatment. (note)

  4. Tomography

    International Nuclear Information System (INIS)

    1985-01-01

    Already widely accepted in medicine, tomography can also be useful in industry. The theory behind tomography and a demonstration of the technique to inspect a motorcycle carburetor is presented. To demonstrate the potential of computer assisted tomography (CAT) to accurately locate defects in three dimensions, a sectioned 5 cm gate valve with a shrink cavity made visible by the sectioning was tomographically imaged using a Co-60 source. The tomographic images revealed a larger cavity below the sectioned surface. The position of this cavity was located with an in-plane and axial precision of approximately +-1 mm. The volume of the cavity was estimated to be approximately 40 mm 3

  5. CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure.

    Science.gov (United States)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

    2018-01-01

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

  6. Accuracy of Core Needle Biopsy Versus Fine Needle Aspiration Cytology for Diagnosing Salivary Gland Tumors

    Directory of Open Access Journals (Sweden)

    In Hye Song

    2015-03-01

    Full Text Available Background: Core needle biopsy is a relatively new technique used to diagnose salivary gland lesions, and its role in comparison with fine needle aspiration cytology needs to be refined. Methods: We compared the results of 228 ultrasound-guided core needle biopsy and 371 fine needle aspiration procedures performed on major salivary gland tumors with their postoperative histological diagnoses. Results: Core needle biopsy resulted in significantly higher sensitivity and more accurate tumor subtyping, especially for malignant tumors, than fine needle aspiration. No patient developed major complications after core needle biopsy. Conclusions: We recommend ultrasoundguided core needle biopsy as the primary diagnostic tool for the preoperative evaluation of patients with salivary gland lesions, especially when malignancy is suspected.

  7. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies

    International Nuclear Information System (INIS)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Torriani, Martin; Rosenthal, Daniel I.; Halpern, Elkan F.; Springfield, Dempsey S.

    2015-01-01

    To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate ?This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ 2 test or Fisher's exact test. In all, 140 of 963 (15 %) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96 %). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8 %), POC cytology (25 %), or neither (24 %) were significantly different (P < 0.0001). Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a benign

  8. Percutaneous CT-guided needle biopsies of musculoskeletal tumors: a 5-year analysis of non-diagnostic biopsies

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Connie Y.; Huang, Ambrose J.; Bredella, Miriam A.; Torriani, Martin; Rosenthal, Daniel I. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Halpern, Elkan F. [Massachusetts General Hospital, Institute for Technology Assessment, Department of Radiology, Boston, MA (United States); Springfield, Dempsey S. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2015-12-15

    To study non-diagnostic CT-guided musculoskeletal biopsies and take steps to minimize them. Specifically we asked: (1) What malignant diagnoses have a higher non-diagnostic rate? (2) What factors of a non-diagnostic biopsy may warrant more aggressive pursuit? (3) Do intra-procedural frozen pathology (FP) or point-of-care (POC) cytology reduce the non-diagnostic biopsy rate ?This study was IRB-approved and HIPAA-compliant. We retrospectively reviewed 963 consecutive CT-guided musculoskeletal biopsies. We categorized pathology results as malignant, benign, or non-diagnostic and recorded use of FP or POC cytology. Initial biopsy indication, final diagnosis, method of obtaining the final diagnosis of non-diagnostic biopsies, age of the patient, and years of biopsy attending experience were recorded. Groups were compared using Pearson's χ{sup 2} test or Fisher's exact test. In all, 140 of 963 (15 %) biopsies were non-diagnostic. Lymphoma resulted in more non-diagnostic biopsies (P < 0.0001). While 67% of non-diagnostic biopsies yielded benign diagnoses, 33% yielded malignant diagnoses. Patients whose percutaneous biopsy was indicated due to the clinical context without malignancy history almost always generated benign results (96 %). Whereas 56% of biopsies whose indication was an imaging finding of a treatable lesion were malignant, 20% of biopsies whose indication was a history of malignancy were malignant. There was no statistically significant difference in the nondiagnostic biopsy rates of pediatric versus adult patients (P = 0.8) and of biopsy attendings with fewer versus more years of experience (P = 0.5). The non-diagnostic rates of biopsies with FP (8 %), POC cytology (25 %), or neither (24 %) were significantly different (P < 0.0001). Lymphoma is the malignant diagnosis most likely to result in a non-diagnostic biopsy. If the clinical and radiologic suspicion for malignancy is high, repeat biopsy is warranted. If the clinical context suggests a

  9. Non-real-time computed tomography-guided percutaneous ethanol injection therapy for heapocellular carcinoma undetectable by ultrasonography

    International Nuclear Information System (INIS)

    Ueda, Kazushige; Ohkawara, Tohru; Minami, Masahito; Sawa, Yoshihiko; Morinaga, Osamu; Kohli, Yoshihiro; Ohkawara, Yasuo

    1998-01-01

    The purpose of this study was to evaluate the feasibility of non-real-time CT-guided percutaneous ethanol injection therapy (PEIT) for hepatocellular carcinoma (HCC, 37 lesions) untreatable by ultrasonography-guided (US)-PEIT. The HCC lesion was localized on the lipiodol CT image with a graduated grid system. We advanced a 21 G or 22 G needle in a stepwise fashion with intermittent localization scans using a tandem method to position the tip of the needle in the lesion. Ethanol containing contrast medium was injected with monitoring scans obtained after incremental volumes of injection, until perfusion of the lesion was judged to be complete. A total of 44 CT-PEIT procedures were performed. The average number of needle passes from the skin to the liver in each CT-PEIT procedure was 2.3, the average amount of ethanol injected was 14.4 ml, and the average time required was 49.3 minutes. Complete perfusion of the lesion by ethanol on monitoring CT images was achieved in all lesions with only a single or double CT-PEIT procedure without severe complication. Local recurrence was detected only in 5 lesions. At present, it is more time-consuming to perform CT-PEIT than US-PEIT because conventional CT guidance is not real-time imaging. However, it is expected that this limitation of CT-PEIT will be overcome in the near future with the introduction of CT fluoroscopy. In conclusion, CT-PEIT should prove to be a feasible, acceptable treatment for challenging cases of HCC undetectable by US. (author)

  10. Transrectal ultrasound: Diagnosis of prostate cancer by a new biplane US-guided biopsy technique. Comparison of thin-needle cytology and histology with large-core biopsy

    International Nuclear Information System (INIS)

    Lee, F.; Littrup, P.; McLeary, R.; Kumasaka, G.; Borlaza, G.; McHugh, T.; Soiderer, M.; Roi, L.

    1986-01-01

    A new transperineal biopsy technique was developed that uses biplane transrectal US guidance for needle placement into anechoic-hypoechoic lesions thought to indicate prostate cancer (n = 83). The results of histologic studies on biopsy material obtained with a 22-gauge needle and of aspiration histologic studies on biopsy material obtained with a 19-gauge needle were compared with results of histologic studies on material obtained with a 14-gauge needle. When sufficient tissue was obtained, the positive biopsy yield was 61% by cytology and 58% by histology; the combined yield was 61%. A limited study ( n = 21) of histologic findings in biopsy material obtained with 19-gauge and 14-gauge needles showed equivalent diagnostic results. Sixty-seven percent of the biopsies were of lesions less than 1.5 cm in diameter, and 57% (13 of 23) of the biopsy-proved cancers in this group were either nonpalpable or only mildly suspicious on digital rectal examination

  11. Dual source and dual detector arrays tetrahedron beam computed tomography for image guided radiotherapy

    International Nuclear Information System (INIS)

    Kim, Joshua; Zhang, Tiezhi; Lu, Weiguo

    2014-01-01

    Cone-beam computed tomography (CBCT) is an important online imaging modality for image guided radiotherapy. But suboptimal image quality and the lack of a real-time stereoscopic imaging function limit its implementation in advanced treatment techniques, such as online adaptive and 4D radiotherapy. Tetrahedron beam computed tomography (TBCT) is a novel online imaging modality designed to improve on the image quality provided by CBCT. TBCT geometry is flexible, and multiple detector and source arrays can be used for different applications. In this paper, we describe a novel dual source–dual detector TBCT system that is specially designed for LINAC radiation treatment machines. The imaging system is positioned in-line with the MV beam and is composed of two linear array x-ray sources mounted aside the electrical portal imaging device and two linear arrays of x-ray detectors mounted below the machine head. The detector and x-ray source arrays are orthogonal to each other, and each pair of source and detector arrays forms a tetrahedral volume. Four planer images can be obtained from different view angles at each gantry position at a frame rate as high as 20 frames per second. The overlapped regions provide a stereoscopic field of view of approximately 10–15 cm. With a half gantry rotation, a volumetric CT image can be reconstructed having a 45 cm field of view. Due to the scatter rejecting design of the TBCT geometry, the system can potentially produce high quality 2D and 3D images with less radiation exposure. The design of the dual source–dual detector system is described, and preliminary results of studies performed on numerical phantoms and simulated patient data are presented. (paper)

  12. Dual source and dual detector arrays tetrahedron beam computed tomography for image guided radiotherapy

    Science.gov (United States)

    Kim, Joshua; Lu, Weiguo; Zhang, Tiezhi

    2014-02-01

    Cone-beam computed tomography (CBCT) is an important online imaging modality for image guided radiotherapy. But suboptimal image quality and the lack of a real-time stereoscopic imaging function limit its implementation in advanced treatment techniques, such as online adaptive and 4D radiotherapy. Tetrahedron beam computed tomography (TBCT) is a novel online imaging modality designed to improve on the image quality provided by CBCT. TBCT geometry is flexible, and multiple detector and source arrays can be used for different applications. In this paper, we describe a novel dual source-dual detector TBCT system that is specially designed for LINAC radiation treatment machines. The imaging system is positioned in-line with the MV beam and is composed of two linear array x-ray sources mounted aside the electrical portal imaging device and two linear arrays of x-ray detectors mounted below the machine head. The detector and x-ray source arrays are orthogonal to each other, and each pair of source and detector arrays forms a tetrahedral volume. Four planer images can be obtained from different view angles at each gantry position at a frame rate as high as 20 frames per second. The overlapped regions provide a stereoscopic field of view of approximately 10-15 cm. With a half gantry rotation, a volumetric CT image can be reconstructed having a 45 cm field of view. Due to the scatter rejecting design of the TBCT geometry, the system can potentially produce high quality 2D and 3D images with less radiation exposure. The design of the dual source-dual detector system is described, and preliminary results of studies performed on numerical phantoms and simulated patient data are presented.

  13. US-guided diffuse optical tomography for breast lesions: the reliability of clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Jung; Kim, Ji Youn; Youn, Jung Hyun; Kim, Myung Hyun; Koo, Hye Ryoung; Kim, Soo Jin; Sohn, Yu-Mee; Moon, Hee Jung; Kim, Eun-Kyung [Yonsei University College of Medicine, Institute of Radiological Science, Seoul (Korea, Republic of); Yonsei University College of Medicine, Department of Radiology, Seoul (Korea, Republic of)

    2011-07-15

    To prospectively assess the reliability of US-guided diffuse optical tomography (US-DOT) using interobserver agreement for the diagnosis of breast lesions with individual real-time imaging and to assess the interobserver agreement of conventional sonography (US) combined with US-DOT for differentiation between benignity and malignancy breast lesions. An Institutional Review Board approved this study, and all subjects provided written informed consent. 122 breast lesions in 111 patients evaluated with US-guided core biopsy were included. Assessments with US and US-DOT for cases subjected to biopsy were obtained by two radiologists using individual real-time imaging prior to biopsy and were prospectively recorded by each performer. With DOT, the total haemoglobin concentration (THC) for each breast lesion was measured. Histopathological results from US-guided biopsies were used as a reference standard. To assess measurement interobserver agreement, the intraclass correlation coefficient (ICC) and the Bland-Altman plot were used for THC in US-DOT and the kappa values and ROC analysis were used to evaluate the diagnostic performances of the US BI-RADS final assessment in US and combined US and US-DOT. Of 122 US-guided core biopsied lesions, 83 (68.0%) were diagnosed as benign, and 39 (32.0%) as malignant. Excellent correlation was seen in the THC in US-DOT (ICC score 0.796; 95% confidence interval, 0.708-0.857). The interobserver agreement in BI-RADS final assessment with US and US-DOT (almost perfect; {kappa} = 0.8618) was improved compared with that of US (substantial agreement, {kappa} = 0.6574). However, the overall areas under the ROC curve did not show significant differences between US and combined US and US-DOT, 0.8894 and 0.8975, respectively (P = 0.981). The reliability of THC in US-DOT showed excellent correlation in overall real-time performance. Although the inter-observer agreement for BI-RADS final assessment of US was improved by using US-DOT, the

  14. Computed-tomography-guided anatomic standardization for quantitative assessment of dopamine transporter SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Yokoyama, Kota [National Center of Neurology and Psychiatry, Department of Radiology, Tokyo (Japan); National Center of Neurology and Psychiatry, Integrative Brain Imaging Center, Tokyo (Japan); Imabayashi, Etsuko; Matsuda, Hiroshi [National Center of Neurology and Psychiatry, Integrative Brain Imaging Center, Tokyo (Japan); Sumida, Kaoru; Sone, Daichi; Kimura, Yukio; Sato, Noriko [National Center of Neurology and Psychiatry, Department of Radiology, Tokyo (Japan); Mukai, Youhei; Murata, Miho [National Center of Neurology and Psychiatry, Department of Neurology, Tokyo (Japan)

    2017-03-15

    For the quantitative assessment of dopamine transporter (DAT) using [{sup 123}I]FP-CIT single-photon emission computed tomography (SPECT) (DaTscan), anatomic standardization is preferable for achieving objective and user-independent quantification of striatal binding using a volume-of-interest (VOI) template. However, low accumulation of DAT in Parkinson's disease (PD) would lead to a deformation error when using a DaTscan-specific template without any structural information. To avoid this deformation error, we applied computed tomography (CT) data obtained using SPECT/CT equipment to anatomic standardization. We retrospectively analyzed DaTscan images of 130 patients with parkinsonian syndromes (PS), including 80 PD and 50 non-PD patients. First we segmented gray matter from CT images using statistical parametric mapping 12 (SPM12). These gray-matter images were then anatomically standardized using the diffeomorphic anatomical registration using exponentiated Lie algebra (DARTEL) algorithm. Next, DaTscan images were warped with the same parameters used in the CT anatomic standardization. The target striatal VOIs for decreased DAT in PD were generated from the SPM12 group comparison of 20 DaTscan images from each group. We applied these VOIs to DaTscan images of the remaining patients in both groups and calculated the specific binding ratios (SBRs) using nonspecific counts in a reference area. In terms of the differential diagnosis of PD and non-PD groups using SBR, we compared the present method with two other methods, DaTQUANT and DaTView, which have already been released as software programs for the quantitative assessment of DaTscan images. The SPM12 group comparison showed a significant DAT decrease in PD patients in the bilateral whole striatum. Of the three methods assessed, the present CT-guided method showed the greatest power for discriminating PD and non-PD groups, as it completely separated the two groups. CT-guided anatomic standardization using

  15. CT fluoroscopy-guided renal tumour cutting needle biopsy. Retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

    International Nuclear Information System (INIS)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

    2018-01-01

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. (orig.)

  16. CT fluoroscopy-guided renal tumour cutting needle biopsy. Retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu [Okayama University Medical School, Department of Radiology, Okayama (Japan)

    2018-01-15

    To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. (orig.)

  17. Needle counter

    International Nuclear Information System (INIS)

    Fujita, Yuzo

    1977-01-01

    Needle counter had been devised by Geiger about 60 years ago before the present GM counter appeared. It is suitable for the detection of weak radiation because it is limited in effective volume, if the background due to mainly cosmic ray is proportional to the effective volume of the counter. Recently the very low β detector having a needle counter as the main detector has been developed. It showed highly excellent performance in the measurements of small area samples, about ten times sensitive as compared with other detectors. The counter is installed in the very low radiation measuring well at Nokogiriyama, Chiba Prefecture, using a NaI scintillator as its guard counter. D. H. Wilkinson first treated a gas amplification counter theoretically and quantitatively. The authors have obtained good results in the comparison with the experiments of the counter using a generalized form of Wilkinson theory. The findings obtained through this study seem to be applicable to the electrode arrangement which is important for the counter design. It was found that the excellent rise time of induced pulses in a gas amplification counter was achieved in larger amplification factor and smaller convolution effect. In the detection of charged particles with small obstructing capability such as γ ray, faster rise time and higher pulses can be obtained with needle counters than wire counters. (Wakatsuki, Y.)

  18. Design and evaluation of a computed tomography (CT)-compatible needle insertion device using an electromagnetic tracking system and CT images

    NARCIS (Netherlands)

    Shahriari, Navid; Hekman, Edsko; Oudkerk, Matthijs; Misra, Sarthak

    2015-01-01

    Percutaneous needle insertion procedures are commonly used for diagnostic and therapeutic purposes. Although current technology allows accurate localization of lesions, they cannot yet be precisely targeted. Lung cancer is the most common cause of cancer-related death, and early detection reduces

  19. Design and evaluation of a computed tomography (CT)-compatible needle insertion device using an electromagnetic tracking system and CT images

    NARCIS (Netherlands)

    Shahriari, Navid; Hekman, Edsko E.G.; Oudkerk, Matthijs; Misra, Sarthak

    2015-01-01

    Purpose Percutaneous needle insertion procedures are commonly used for diagnostic and therapeutic purposes. Although current technology allows accurate localization of lesions, they cannot yet be precisely targeted. Lung cancer is the most common cause of cancer-related death, and early detection

  20. Efficacy of Lower-Body Shielding in Computed Tomography Fluoroscopy-Guided Interventions

    International Nuclear Information System (INIS)

    Mahnken, Andreas H.; Sedlmair, Martin; Ritter, Christine; Banckwitz, Rosemarie; Flohr, Thomas

    2012-01-01

    Purpose: Computed tomography (CT) fluoroscopy-guided interventions pose relevant radiation exposure to the interventionalist. The goal of this study was to analyze the efficacy of lower-body shielding as a simple structural method for decreasing radiation dose to the interventionalist without limiting access to the patient. Material and Methods: All examinations were performed with a 128-slice dual source CT scanner (12 × 1.2-mm collimation; 120 kV; and 20, 40, 60, and 80 mAs) and an Alderson-Rando phantom. Scatter radiation was measured with an ionization chamber and a digital dosimeter at standardized positions and heights with and without a lower-body lead shield (0.5-mm lead equivalent; Kenex, Harlow, UK). Dose decreases were computed for the different points of measurement. Results: On average, lower-body shielding decreased scatter radiation by 38.2% within a 150-cm radius around the shielding. This decrease is most significant close to the gantry opening and at low heights of 50 and 100 cm above the floor with a maximum decrease of scatter radiation of 95.9% close to the scanner’s isocentre. With increasing distance to the gantry opening, the effect decreased. There is almost no dose decrease effect at ≥150 above the floor. Scatter radiation and its decrease were linearly correlated with the tube current-time product (r 2 = 0.99), whereas percent scatter radiation decrease was independent of the tube current-time product. Conclusion: Lower-body shielding is an effective way to decrease radiation exposure to the interventionalist and should routinely be used in CT fluoroscopy-guided interventions.

  1. Magnetic resonance imaging-targeted, 3D transrectal ultrasound-guided fusion biopsy for prostate cancer: Quantifying the impact of needle delivery error on diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Peter R., E-mail: pmarti46@uwo.ca [Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Cool, Derek W. [Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada and Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Romagnoli, Cesare [Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Fenster, Aaron [Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Ward, Aaron D. [Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7 (Canada); Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7 (Canada)

    2014-07-15

    Purpose: Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided “fusion” prostate biopsy intends to reduce the ∼23% false negative rate of clinical two-dimensional TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsies continue to yield false negatives. Therefore, the authors propose to investigate how biopsy system needle delivery error affects the probability of sampling each tumor, by accounting for uncertainties due to guidance system error, image registration error, and irregular tumor shapes. Methods: T2-weighted, dynamic contrast-enhanced T1-weighted, and diffusion-weighted prostate MRI and 3D TRUS images were obtained from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D tumor surfaces that were registered to the 3D TRUS images using an iterative closest point prostate surface-based method to yield 3D binary images of the suspicious regions in the TRUS context. The probabilityP of obtaining a sample of tumor tissue in one biopsy core was calculated by integrating a 3D Gaussian distribution over each suspicious region domain. Next, the authors performed an exhaustive search to determine the maximum root mean squared error (RMSE, in mm) of a biopsy system that gives P ≥ 95% for each tumor sample, and then repeated this procedure for equal-volume spheres corresponding to each tumor sample. Finally, the authors investigated the effect of probe-axis-direction error on measured tumor burden by studying the relationship between the error and estimated percentage of core involvement. Results: Given a 3.5 mm RMSE for contemporary fusion biopsy systems,P ≥ 95% for 21 out of 81 tumors. The authors determined that for a biopsy system with 3.5 mm RMSE, one cannot expect to sample tumors of approximately 1 cm{sup 3} or smaller with 95% probability with only one biopsy core. The predicted maximum RMSE giving P ≥ 95% for each

  2. Magnetic resonance imaging-targeted, 3D transrectal ultrasound-guided fusion biopsy for prostate cancer: Quantifying the impact of needle delivery error on diagnosis.

    Science.gov (United States)

    Martin, Peter R; Cool, Derek W; Romagnoli, Cesare; Fenster, Aaron; Ward, Aaron D

    2014-07-01

    Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided "fusion" prostate biopsy intends to reduce the ∼23% false negative rate of clinical two-dimensional TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsies continue to yield false negatives. Therefore, the authors propose to investigate how biopsy system needle delivery error affects the probability of sampling each tumor, by accounting for uncertainties due to guidance system error, image registration error, and irregular tumor shapes. T2-weighted, dynamic contrast-enhanced T1-weighted, and diffusion-weighted prostate MRI and 3D TRUS images were obtained from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D tumor surfaces that were registered to the 3D TRUS images using an iterative closest point prostate surface-based method to yield 3D binary images of the suspicious regions in the TRUS context. The probabilityP of obtaining a sample of tumor tissue in one biopsy core was calculated by integrating a 3D Gaussian distribution over each suspicious region domain. Next, the authors performed an exhaustive search to determine the maximum root mean squared error (RMSE, in mm) of a biopsy system that gives P ≥ 95% for each tumor sample, and then repeated this procedure for equal-volume spheres corresponding to each tumor sample. Finally, the authors investigated the effect of probe-axis-direction error on measured tumor burden by studying the relationship between the error and estimated percentage of core involvement. Given a 3.5 mm RMSE for contemporary fusion biopsy systems,P ≥ 95% for 21 out of 81 tumors. The authors determined that for a biopsy system with 3.5 mm RMSE, one cannot expect to sample tumors of approximately 1 cm(3) or smaller with 95% probability with only one biopsy core. The predicted maximum RMSE giving P ≥ 95% for each tumor was consistently greater when using

  3. Magnetic resonance imaging-targeted, 3D transrectal ultrasound-guided fusion biopsy for prostate cancer: Quantifying the impact of needle delivery error on diagnosis

    International Nuclear Information System (INIS)

    Martin, Peter R.; Cool, Derek W.; Romagnoli, Cesare; Fenster, Aaron; Ward, Aaron D.

    2014-01-01

    Purpose: Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided “fusion” prostate biopsy intends to reduce the ∼23% false negative rate of clinical two-dimensional TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsies continue to yield false negatives. Therefore, the authors propose to investigate how biopsy system needle delivery error affects the probability of sampling each tumor, by accounting for uncertainties due to guidance system error, image registration error, and irregular tumor shapes. Methods: T2-weighted, dynamic contrast-enhanced T1-weighted, and diffusion-weighted prostate MRI and 3D TRUS images were obtained from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D tumor surfaces that were registered to the 3D TRUS images using an iterative closest point prostate surface-based method to yield 3D binary images of the suspicious regions in the TRUS context. The probabilityP of obtaining a sample of tumor tissue in one biopsy core was calculated by integrating a 3D Gaussian distribution over each suspicious region domain. Next, the authors performed an exhaustive search to determine the maximum root mean squared error (RMSE, in mm) of a biopsy system that gives P ≥ 95% for each tumor sample, and then repeated this procedure for equal-volume spheres corresponding to each tumor sample. Finally, the authors investigated the effect of probe-axis-direction error on measured tumor burden by studying the relationship between the error and estimated percentage of core involvement. Results: Given a 3.5 mm RMSE for contemporary fusion biopsy systems,P ≥ 95% for 21 out of 81 tumors. The authors determined that for a biopsy system with 3.5 mm RMSE, one cannot expect to sample tumors of approximately 1 cm 3 or smaller with 95% probability with only one biopsy core. The predicted maximum RMSE giving P ≥ 95% for each tumor was

  4. Genomic characterisation of small cell lung cancer patient-derived xenografts generated from endobronchial ultrasound-guided transbronchial needle aspiration specimens.

    Directory of Open Access Journals (Sweden)

    Tracy L Leong

    Full Text Available Patient-derived xenograft (PDX models generated from surgical specimens are gaining popularity as preclinical models of cancer. However, establishment of PDX lines from small cell lung cancer (SCLC patients is difficult due to very limited amount of available biopsy material. We asked whether SCLC cells obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA could generate PDX lines that maintained the phenotypic and genetic characteristics of the primary tumor. Following successful EBUS-TBNA sampling for diagnostic purposes, we obtained an extra sample for cytologic analysis and implantation into the flanks of immunodeficient mice. Animals were monitored for engraftment for up to 6 months. Histopathologic and immunohistochemical analysis, and targeted next-generation re-sequencing, were then performed in both the primary sample and the derivative PDX line. A total of 12 patients were enrolled in the study. EBUS-TBNA aspirates yielded large numbers of viable tumor cells sufficient to inject between 18,750 and 1,487,000 cells per flank, and to yield microgram quantities of high-quality DNA. Of these, samples from 10 patients generated xenografts (engraftment rate 83% with a mean latency of 104 days (range 63-188. All but one maintained a typical SCLC phenotype that closely matched the original sample. Identical mutations that are characteristic of SCLC were identified in both the primary sample and xenograft line. EBUS-TBNA has the potential to be a powerful tool in the development of new targeting strategies for SCLC patients by providing large numbers of viable tumor cells suitable for both xenografting and complex genomic analysis.

  5. Diagnostic value of sonography, ultrasound-guided fine-needle aspiration cytology, and diffusion-weighted MRI in the characterization of cold thyroid nodules

    Energy Technology Data Exchange (ETDEWEB)

    Schueller-Weidekamm, Claudia [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)], E-mail: claudia.schueller-weidekamm@meduniwien.ac.at; Schueller, Gerd [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Kaserer, Klaus [Department of Pathology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Scheuba, Christian [Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria); Ringl, Helmut; Weber, Michael; Czerny, Christian; Herneth, Andreas M. [Department of Diagnostic Radiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna (Austria)

    2010-03-15

    Introduction: The purpose of this prospective study was to assess the diagnostic value of different modalities for the characterization of cold thyroid nodules. Methods: In 35 patients with cold nodules, thyroid carcinoma was suspected on scintigraphy. These patients were prospectively investigated with sonography, ultrasound-guided fine-needle aspiration (USgFNA), and quantitative diffusion-weighted imaging magnetic resonance imaging (DWI) (navigated echo-planar imaging; maximum b-value 800 s/mm{sup 2}) prior to surgery. The sonographic findings, USgFNA cytology, and the apparent diffusion coefficient (ADC) values of DWI were correlated with the postoperative histology of benign and malignant lesions. Statistical analysis was performed with the Kruskal-Wallis test and the Fisher's exact test. P < .05 denoted statistical significance. Results: The accuracy of sonography and USgFNA was 64% and 68.8%, respectively. The sensitivity was 86.7% and 80%, respectively. Specificity was only 57.2% and 50%, respectively. The median ADC values for carcinoma and adenoma were 2.73 x 10{sup -3} mm{sup 2}/s and 1.93 x 10{sup -3} mm{sup 2}/s, respectively (P < .001). There was no significant difference between the median ADC value for Hashimoto thyroiditis (3.46 x 10{sup -3} mm{sup 2}/s) and carcinoma. An ADC value of 2.25 x 10{sup -3} mm{sup 2}/s or higher was proven to be the cut-off value for differentiating between benign and malignant cold thyroid nodules, with an accuracy of 88%, a sensitivity of 85%, and a specificity of 100%. Conclusions: These results show that quantitative DWI is a more reliable diagnostic method for differentiation between benign and malignant thyroid lesions than sonography or USgFNA. However, further studies including a larger study population are necessary to confirm our study results.

  6. Surgical positioning of orthodontic mini-implants with guides fabricated on models replicated with cone-beam computed tomography.

    Science.gov (United States)

    Kim, Seong-Hun; Choi, Yong-Suk; Hwang, Eui-Hwan; Chung, Kyu-Rhim; Kook, Yoon-Ah; Nelson, Gerald

    2007-04-01

    This article illustrates a new surgical guide system that uses cone-beam computed tomography (CBCT) images to replicate dental models; surgical guides for the proper positioning of orthodontic mini-implants were fabricated on the replicas, and the guides were used for precise placement. The indications, efficacy, and possible complications of this method are discussed. Patients who were planning to have orthodontic mini-implant treatment were recruited for this study. A CBCT system (PSR 9000N, Asahi Roentgen, Kyoto, Japan) was used to acquire virtual slices of the posterior maxilla that were 0.1 to 0.15 mm thick. Color 3-dimensional rapid prototyping was used to differentiate teeth, alveolus, and maxillary sinus wall. A surgical guide for the mini-implant was fabricated on the replica model. Proper positioning for mini-implants on the posterior maxilla was determined by viewing the CBCT images. The surgical guide was placed on the clinical site, and it allowed precise pilot drilling and accurate placement of the mini-implant. CBCT imaging allows remarkably lower radiation doses and thinner acquisition slices compared with medical computed tomography. Virtually reproduced replica models enable precise planning for mini-implant positions in anatomically complex sites.

  7. Creating vascular models by postprocessing computed tomography angiography images: a guide for anatomical education.

    Science.gov (United States)

    Govsa, Figen; Ozer, Mehmet Asim; Sirinturk, Suzan; Eraslan, Cenk; Alagoz, Ahmet Kemal

    2017-08-01

    A new application of teaching anatomy includes the use of computed tomography angiography (CTA) images to create clinically relevant three-dimensional (3D) printed models. The purpose of this article is to review recent innovations on the process and the application of 3D printed models as a tool for using under and post-graduate medical education. Images of aortic arch pattern received by CTA were converted into 3D images using the Google SketchUp free software and were saved in stereolithography format. Using a 3D printer (Makerbot), a model mode polylactic acid material was printed. A two-vessel left aortic arch was identified consisting of the brachiocephalic trunk and left subclavian artery. The life-like 3D models were rotated 360° in all axes in hand. The early adopters in education and clinical practices have embraced the medical imaging-guided 3D printed anatomical models for their ability to provide tactile feedback and a superior appreciation of visuospatial relationship between the anatomical structures. Printed vascular models are used to assist in preoperative planning, develop intraoperative guidance tools, and to teach patients surgical trainees in surgical practice.

  8. Percutaneous computed tomography-guided ethanol injection in aldosterone-producing adrenocortical adenoma

    International Nuclear Information System (INIS)

    Rossi, R.; Savastano, S.; Tommaselli, A.P.

    1995-01-01

    The feasibility, safety and effectiveness of percutaneous computed tomography-guided ethanol injection (PEI-CT) was investigated in a patient affected by aldosterone-producing adenoma (APA). A 42-year-old male patient with typical features of hyperaldosteronism presented a solitary left adrenal adenoma measuring 2 cm, with a normal contralateral gland, evidenced by both CT scan and adrenal [ 75 Se-19]-nor-cholesterol scintigraphy. After normalization of potassium plasma levels, 4 ml of sterile 95% ethanol with 0.5 ml of 80% iothalamate sodium was injected. The procedure was completed in about 30 min. No severe pain or local complication was noted. Five hour after PEI, a fourfold and a twofold increase in aldosterone and cortisol plasma levels were observed, respectively. After 11 days on a normal sodium and potassium diet, normal potassium plasma levels and reduced aldosterone plasma levels were present, with reappearance of an aldosterone postural response. Plasma renin activity and aldosterone plasma levels normalized 1 month later, with reappearance also of a plasma renin activity postural response and maintenance of normal potassium plasma levels on a high sodium and normal potassium diet. The patient has remained hypertensive, although lower antihypertensive drug dosages have been employed. After 17 months, normal biochemical, hormonal and morphological findings were present. The authors suggested PEI-CT as a further alternative approach to surgery in the management of carefully selected patients with APA. 15 refs., 2 figs., 1 tab

  9. Artifact reduction method in ultrasound-guided diffuse optical tomography using exogenous contrast agents

    Science.gov (United States)

    Ardeshirpour, Yasaman; Biswal, Nrusingh; Aguirre, Andres; Zhu, Quing

    2011-04-01

    In diffuse optical tomography (DOT), a typical perturbation approach requires two sets of measurements obtained at the lesion breast (lesion or target site) and a contra-lateral location of the normal breast (reference site) for image reconstruction. For patients who have a small amount of breast tissue, the chest-wall underneath the breast tissue at both sites affects the imaging results. In this group of patients, the perturbation, which is the difference between measurements obtained at the lesion and reference sites, may include the information of background mismatch which can generate artifacts or affect the reconstructed quantitative absorption coefficient of the lesion. Also, for patients who have a single breast due to prior surgery, the contra-lateral reference is not available. To improve the DOT performance or overcome its limitation, we introduced a new method based on an exogenous contrast agent and demonstrate its performance using animal models. Co-registered ultrasound was used to guide the lesion localization. The results have shown that artifacts caused by background mismatch can be reduced significantly by using this new method.

  10. A study of MRI-guided diffuse fluorescence molecular tomography for monitoring PDT effects in pancreas cancer

    Science.gov (United States)

    Samkoe, Kimberley S.; Davis, Scott C.; Srinivasan, Subhadra; O'Hara, Julia A.; Hasan, Tayyaba; Pogue, Brian W.

    2009-06-01

    Over the last several decades little progress has been made in the therapy and treatment monitoring of pancreas adenocarcinoma, a devastating and aggressive form of cancer that has a 5-year patient survival rate of 3%. Currently, investigations for the use of interstitial Verteporfin photodynamic therapy (PDT) are being undertaken in both orthotopic xenograft mouse models and in human clinical trials. In the mouse models, magnetic resonance (MR) imaging has been used as a measure of surrogate response to Verteporfin PDT; however, MR imaging alone lacks the molecular information required to assess the metabolic function and growth rates of the tumor immediately after treatment. We propose the implementation of MR-guided fluorescence tomography in conjunction with a fluorescently labeled (IR-Dye 800 CW, LI-COR) epidermal growth factor (EGF) as a molecular measure of surrogate response. To demonstrate the effectiveness of MR-guided diffuse fluorescence tomography for molecular imaging, we have used the AsPC-1 (+EGFR) human pancreatic adenocarcinoma in an orthotopic mouse model. EGF IRDye 800CW was injected 48 hours prior to imaging. MR image sequences were collected simultaneously with the fluorescence data using a MR-coupled diffuse optical tomography system. Image reconstruction was performed multiple times with varying abdominal organ segmentation in order to obtain a optimal tomographic image. It is shown that diffuse fluorescence tomography of the orthotopic pancreas model is feasible, with consideration of confounding fluorescence signals from the multiple organs and tissues surrounding the pancreas. MR-guided diffuse fluorescence tomography will be used to monitor EGF response after photodynamic therapy. Additionally, it provide the opportunity to individualize subsequent therapies based on response to PDT as well as to evaluate the success of combination therapies, such as PDT with chemotherapy, antibody therapy or even radiation.

  11. Tomography

    International Nuclear Information System (INIS)

    Barrett, H.H.; Gordon, S.; Swindell, W.

    1980-01-01

    Apparatus is described for generating a two-dimensional back-projected image of a slice of an object in tomography. The apparatus uses optical techniques to perform the functions of filtering and back projection. Central to the technique is a cylindrical drum which rotates at a fast rate and whose rotational axis tilts at a slower rate. The novel method overcomes the problem of image blurring due to motion which occurs in many tomographic techniques. It also has the advantages of being less expensive and simpler compared to tomography using digital processing techniques which require fast computers. (UK)

  12. EUS needle identification comparison and evaluation (NICE) study (with videos)

    Science.gov (United States)

    Tang, Shou-jiang; Vilmann, Andreas S.; Saftoiu, Adrian; Wang, Wanmei; Streba, Costin; Fink, Peter P.; Griswold, Michael; Wu, Ruonan; Dietrich, Christoph F.; Jenssen, Christian; Hocke, Michael; Kantowski, Marcus; Pohl, Jürgen; Fockens, Paul; Annema, Jouke T.; van der Heijden, Erik H.F.M.; Havre, Roald Flesland; Pham, Khanh Do-Cong; Kunda, Rastislav; Deprez, Pierre H.; Mariana, Jinga; Vazquez-Sequeiros, Enrique; Larghi, Alberto; Buscarini, Elisabetta; Fusaroli, Pietro; Lahav, Maor; Puri, Rajesh; Garg, Pramod Kumar; Sharma, Malay; Maluf-Filho, Fauze; Sahai, Anand; Brugge, William R.; Lee, Linda S.; Aslanian, Harry R.; Wang, Andrew Y.; Shami, Vanessa M.; Markowitz, Arnold; Siddiqui, Ali A.; Mishra, Girish; Scheiman, James M.; Isenberg, Gerard; Siddiqui, Uzma D.; Shah, Raj J.; Buxbaum, James; Watson, Rabindra R.; Willingham, Field F.; Bhutani, Manoop S.; Levy, Michael J.; Harris, Cynthia; Wallace, Michael B.; Nolsøe, Christian Pállson; Lorentzen, Torben; Bang, Niels; Sørensen, Sten Mellerup; Gilja, Odd Helge; D’Onofrio, Mirko; Piscaglia, Fabio; Gritzmann, Norbert; Radzina, Maija; Sparchez, Zeno Adrian; Sidhu, Paul S.; Freeman, Simon; McCowan, Timothy C.; de Araujo, Cyrillo Rodrigues; Patel, Akash; del Ali, Mohammad A; Campbell, Garth; Chen, Edward; Vilmann, Peter

    2017-01-01

    Background and Aims Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) or biopsy is widely practiced. Optimal sonographic visualization of the needle is critical for image guided interventions. There are several commercially available needles but no bench-top testing and direct comparison of these needles to reveal their inherent echogenicity. The aims are to provide bench-top data that can be used to guide clinical applications and to promote future device research and development. Methods Descriptive bench-top testing and comparison. Bench-top testing of 8 commonly used EUS-FNA needles (all of 22 gauge in size): SonoTip Pro Control (Medi-Globe); Expect Slimline (Boston Scientific); EchoTip, EchoTip Ultra, EchoTip ProCore High Definition, (Cook Medical); ClearView (Conmed); EZ Shot2 (Olympus); BNX (Beacon Endoscopic); and 2 new prototype needles that are coated by echogenic polymers by Medi-Globe. Blinded evaluation of standardized and unedited videos by 43 EUS endoscopists and 17 radiologists specialized in gastrointestinal ultrasound examination that is unfamiliar with EUS needle devices. Results There was no significant difference in the ratings and rankings of these needles between endosonographers and radiologists. Overall, one prototype needle was rated as the best, ranking 10% to 40% higher than all other needles (p<0.01). Among the commercially available needles, the EchoTip Ultra needle and the ClearView needle were top choices. The EZ Shot 2 needle was ranked statistically lower than other needles (30%–75% worse, p<0.001). Conclusions All FNA needles have their inherent and different echogenicity, and these differences are similarly recognized by EUS endoscopists and radiologists. Needles with polymeric coating from the entire shaft to the needle tip may offer better echogenicity. PMID:26873530

  13. Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ogo, Takeshi, E-mail: ogo.takeshi.hp@mail.ncvc.go.jp [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Department of Advanced Mediccal Research for Pulmonary Hypertension, National Cerebral and Cardiovascular Centre, Osaka (Japan); Fukuda, Tetsuya [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Sanda, Yoshihiro [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Morita, Yoshiaki [Department of Radiology, National Cerebral and Cardiovascular Centre, Osaka (Japan); Asano, Ryotaro; Konagai, Nao [Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan); Yasuda, Satoshi [Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Centre, Osaka (Japan)

    2017-04-15

    Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

  14. Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography

    International Nuclear Information System (INIS)

    Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

    2017-01-01

    Highlights: • Recent advancement in CT enables distal CTEpH lesions to be visualized. • We investigated the efficacy and safety of BPA guided by CBCT or ECG-gated area detector CT. • BPA guided by CBCT or ECG-gated area detector CT is effective and safe in patients with CTEpH . • These new advanced CT techniques may be useful in pre-BPA target lesion assessment. - Abstract: Background: Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. Methods: We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1 year after BPA. Results: Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1 year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. Conclusions: BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment.

  15. Percutaneous needle-biopsy of the adrenal glands

    International Nuclear Information System (INIS)

    Wernecke, K.; Galanski, M.

    1986-01-01

    This account of techniques, range of indications and results of percutaneous adrenal biopsy refers to communications in the literature and to the authors' own experience. Lateral, transhepatic aspiration of adrenal material guided by sonographic control is more easy in the right adrenal gland. Punctation of the left adrenal gland ought to be done from the back and guided by computerized tomography, also in order to leave spleen, kidney, pancreas and stomach as unaffected as possible. The most frequent problem indicating adrenal biopsy still is differentiation between metastases or encretorily non-active adenomas in tumor patients. Experienced examiners will achieve an 80 to 90% sensitivity of adrenal biopsy. Clinically established, suspected phaeochromocytoma is an absolute contra-indication to fine-needle biopsy. (orig./MG) [de

  16. Tomography

    International Nuclear Information System (INIS)

    Allan, C.J.; Keller, N.A.; Lupton, L.R.; Taylor, T.; Tonner, P.D.

    1984-10-01

    Tomography is a non-intrusive imaging technique being developed at CRNL as an industrial tool for generating quantitative cross-sectional density maps of objects. Of most interest is tomography's ability to: distinguish features within complex geometries where other NDT techniques fail because of the complexity of the geometry; detect/locate small density changes/defects within objects, e.g. void fraction measurements within thick-walled vessels, shrink cavities in castings, etc.; provide quantitative data that can be used in analyses, e.g. of complex processes, or fracture mechanics; and provide objective quantitative data that can be used for (computer-based) quality assurance decisions, thereby reducing and in some cases eliminating the present subjectivity often encountered in NDT. The CRNL program is reviewed and examples are presented to illustrate the potential and the limitations of the technology

  17. Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography.

    Science.gov (United States)

    Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

    2017-04-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1year after BPA. Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Value of computed tomography for evaluating the injection site in endosonography-guided celiac plexus neurolysis

    International Nuclear Information System (INIS)

    Sakamoto, Hiroki; Kitano, Masayuki; Nishio, Takeshi; Takeyama, Yoshifumi; Yasuda, Chikao; Kudo, Masatoshi

    2006-01-01

    Endosonography-guided celiac plexus neurolysis (EUS-CPN) safely and effectively relieves pain associated with intra-abdominal malignancies when the neurolytic is accurately injected. We applied contrast medium to evaluate the ethanol injection sites in patients who received EUS-CPN due to abdominal pain caused by malignancies. We injected, under the guidance of endoscopic ultrasonography (EUS), ethanol containing 10% contrast medium into the celiac plexus of patients with intra-abdominal pain due to malignancies. Immediately after the endoscopic therapy, patients underwent computed tomography (CT) to confirm the injection site. Images of distribution of injected solutions were classified into three groups. Injected solution dispersed in unilateral and bilateral anterocrural space was defined as ''unilateral injection'' or bilateral injection'', respectively. Injected solution located out of the anterocrural space was defined as ''inappropriate injection''. Pre- and postprocedure pain was assessed using a standard analog scale. Before and 2, 4, 8, 12, and 16 weeks after the procedure, pain scores were evaluated. From April 2003 to May 2005, 13 patients were enrolled in this study. Improvement of pain score in the ''bilateral injection'' and ''unilateral injection'' groups was significantly superior to the change in the ''inappropriate injection'' group. Although EUS-CPN was effective in eight of 13 patients (61.5%), additional EUS-CPN to the ''inappropriate injection group'' increased the response rate to 84.6%. Injection of ethanol to the anterocrural space by EUS-CPN produced adequate pain relief. Immediate examination by CT for confirmation of injection sites after EUS-CPN would increase the likelihood of induction of pain relief. (author)

  19. Evaluation of a cone beam computed tomography geometry for image guided small animal irradiation

    International Nuclear Information System (INIS)

    Yang, Yidong; Armour, Michael; Wang, Ken Kang-Hsin; Gandhi, Nishant; Wong, John; Iordachita, Iulian; Siewerdsen, Jeffrey

    2015-01-01

    The conventional imaging geometry for small animal cone beam computed tomography (CBCT) is that a detector panel rotates around the head-to-tail axis of an imaged animal (‘tubular’ geometry). Another unusual but possible imaging geometry is that the detector panel rotates around the anterior-to-posterior axis of the animal (‘pancake’ geometry). The small animal radiation research platform developed at Johns Hopkins University employs the pancake geometry where a prone-positioned animal is rotated horizontally between an x-ray source and detector panel. This study is to assess the CBCT image quality in the pancake geometry and investigate potential methods for improvement. We compared CBCT images acquired in the pancake geometry with those acquired in the tubular geometry when the phantom/animal was placed upright simulating the conventional CBCT geometry. Results showed signal-to-noise and contrast-to-noise ratios in the pancake geometry were reduced in comparison to the tubular geometry at the same dose level. But the overall spatial resolution within the transverse plane of the imaged cylinder/animal was better in the pancake geometry. A modest exposure increase to two folds in the pancake geometry can improve image quality to a level close to the tubular geometry. Image quality can also be improved by inclining the animal, which reduces streak artifacts caused by bony structures. The major factor resulting in the inferior image quality in the pancake geometry is the elevated beam attenuation along the long axis of the phantom/animal and consequently increased scatter-to-primary ratio in that orientation. Not withstanding, the image quality in the pancake-geometry CBCT is adequate to support image guided animal positioning, while providing unique advantages of non-coplanar and multiple mice irradiation. This study also provides useful knowledge about the image quality in the two very different imaging geometries, i.e. pancake and tubular geometry

  20. Evaluation of a cone beam computed tomography geometry for image guided small animal irradiation.

    Science.gov (United States)

    Yang, Yidong; Armour, Michael; Wang, Ken Kang-Hsin; Gandhi, Nishant; Iordachita, Iulian; Siewerdsen, Jeffrey; Wong, John

    2015-07-07

    The conventional imaging geometry for small animal cone beam computed tomography (CBCT) is that a detector panel rotates around the head-to-tail axis of an imaged animal ('tubular' geometry). Another unusual but possible imaging geometry is that the detector panel rotates around the anterior-to-posterior axis of the animal ('pancake' geometry). The small animal radiation research platform developed at Johns Hopkins University employs the pancake geometry where a prone-positioned animal is rotated horizontally between an x-ray source and detector panel. This study is to assess the CBCT image quality in the pancake geometry and investigate potential methods for improvement. We compared CBCT images acquired in the pancake geometry with those acquired in the tubular geometry when the phantom/animal was placed upright simulating the conventional CBCT geometry. Results showed signal-to-noise and contrast-to-noise ratios in the pancake geometry were reduced in comparison to the tubular geometry at the same dose level. But the overall spatial resolution within the transverse plane of the imaged cylinder/animal was better in the pancake geometry. A modest exposure increase to two folds in the pancake geometry can improve image quality to a level close to the tubular geometry. Image quality can also be improved by inclining the animal, which reduces streak artifacts caused by bony structures. The major factor resulting in the inferior image quality in the pancake geometry is the elevated beam attenuation along the long axis of the phantom/animal and consequently increased scatter-to-primary ratio in that orientation. Not withstanding, the image quality in the pancake-geometry CBCT is adequate to support image guided animal positioning, while providing unique advantages of non-coplanar and multiple mice irradiation. This study also provides useful knowledge about the image quality in the two very different imaging geometries, i.e. pancake and tubular geometry, respectively.

  1. MRI-guided trephine biopsy and fine-needle aspiration in the diagnosis of bone lesions in low-field (0.23 T) MRI system using optical instrument tracking

    International Nuclear Information System (INIS)

    Blanco Sequeiros, Roberto; Klemola, Rauli; Ojala, Risto; Jyrkinen, Lasse; Tervonen, Osmo; Lappi-Blanco, Elisa; Soini, Ylermi

    2002-01-01

    The purpose of this study was to evaluate the feasibility of MRI-guided bone biopsy with optical instrument tracking and evaluate advantage of combined fine-needle aspiration (FNA) with trephine biopsy. Twenty trephine bone biopsies and 13 FNAs were performed under MRI and CT guidance in 14 patients. Informed consent was obtained from all patients. The evaluation of diagnostic accuracy was achieved by comparing the histopathological and cytological diagnosis with current or final diagnosis made during 6-month clinical follow-up. A 0.23-T open MRI scanner with interventional tools (Outlook Proview, Marconi Medical Systems, Cleveland, Ohio) was used. A surface coil was used. For trephine biopsy MRI-compatible bone biopsy set (Daum medical, Schwerin, Germany) was used. The FNA was performed with MRI compatible 20-G needle (Cook, Bloomington, Ind.). The diagnostic accuracy of MRI-guided trephine biopsy was 95%. The FNA sample diagnosis concurred with the histological in 54%. Our results show that MRI guidance in bone biopsies is accurate and safe. It is comparable to CT-guided or open biopsy. The role of combined FNA with bone biopsies remains controversial. (orig.)

  2. Surgeon-Performed Ultrasound-Guided Fine-Needle Aspiration Cytology (SP-US-FNAC) Shortens Time for Diagnosis of Thyroid Nodules.

    Science.gov (United States)

    Gu, Wei Xiang; Tan, Chuen Seng; Ho, Thomas W T

    2014-06-01

    Ultrasound-guided fine-needle aspiration cytology (US-FNAC) of thyroid nodules is an important diagnostic procedure. In most hospitals, patients are referred to radiologists for US-FNAC, but this often results in a long waiting time before results are available. Surgeon-performed US-FNAC (SP-US-FNAC) during the initial patient consultation attempts to reduce the waiting time but it is not known whether this is as accurate as radiologist-performed US-FNAC (RP-US-FNAC). The aim of this study is to compare the clinical efficiency between SP-US-FNAC and RP-US-FNAC. A retrospective study was performed on patients from the Department of General Surgery, Tan Tock Seng Hospital (TTSH) who underwent an US-FNAC from August 2011 to May 2012. All cases of SP-US-FNAC were performed by a single surgeon. This study compared the rates of positive diagnoses achieved by SP-US-FNAC and RPUS- FNAC as well as the time interval to reach a cytological diagnosis by each group. A total of 40 cases of SP-US-FNAC and 72 cases of RP-US-FNAC were included in the study. SP-US-FNAC resulted in 28 (70%) positive diagnoses and 12 (30%) nondiagnoses while RP-US-FNAC resulted in 47 (65.3%) positive diagnoses and 25 (34.7%) non-diagnoses. These results were comparable (P=0.678). The median time taken to reach a cytological diagnosis was 1 working day for SP-US-FNAC and 29.5 working days for RP-US-FNAC resulting in a shorter interval to reaching a cytological diagnosis for SP-US-FNAC (P<0.001). In the workup of thyroid nodules, SP-US-FNAC is as accurate as RP-US-FNAC but significantly reduces the time taken to reach a cytological diagnosis. This leads to greater clinical efficiency in the management of patients with thyroid nodules, which in turn leads to other benefits such as decreased patient anxiety and increased patient satisfaction.

  3. Needle autopsy

    Directory of Open Access Journals (Sweden)

    Philip Davis Marsden

    1997-04-01

    Full Text Available Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clariffy organ histology. In this way the clinician may resolve puzzling fatal disease.Muitas vezes, em clínicas de países tropicais, não há tempo nem condições para se realizar uma necropsia adequada em um paciente que foi a óbito. Um técnica de biópsia por punção é descrita para fins de exame em necropsia limitadamente fechada, para esclarecimento da histologia do órgão. Dessa maneira, o clínico pode resolver enigmas de doenças fatais.

  4. Systematic study of target localization for bioluminescence tomography guided radiation therapy

    Science.gov (United States)

    Yu, Jingjing; Zhang, Bin; Iordachita, Iulian I.; Reyes, Juvenal; Lu, Zhihao; Brock, Malcolm V.; Patterson, Michael S.; Wong, John W.

    2016-01-01

    Purpose: To overcome the limitation of CT/cone-beam CT (CBCT) in guiding radiation for soft tissue targets, the authors developed a spectrally resolved bioluminescence tomography (BLT) system for the small animal radiation research platform. The authors systematically assessed the performance of the BLT system in terms of target localization and the ability to resolve two neighboring sources in simulations, tissue-mimicking phantom, and in vivo environments. Methods: Multispectral measurements acquired in a single projection were used for the BLT reconstruction. The incomplete variables truncated conjugate gradient algorithm with an iterative permissible region shrinking strategy was employed as the optimization scheme to reconstruct source distributions. Simulation studies were conducted for single spherical sources with sizes from 0.5 to 3 mm radius at depth of 3–12 mm. The same configuration was also applied for the double source simulation with source separations varying from 3 to 9 mm. Experiments were performed in a standalone BLT/CBCT system. Two self-illuminated sources with 3 and 4.7 mm separations placed inside a tissue-mimicking phantom were chosen as the test cases. Live mice implanted with single-source at 6 and 9 mm depth, two sources at 3 and 5 mm separation at depth of 5 mm, or three sources in the abdomen were also used to illustrate the localization capability of the BLT system for multiple targets in vivo. Results: For simulation study, approximate 1 mm accuracy can be achieved at localizing center of mass (CoM) for single-source and grouped CoM for double source cases. For the case of 1.5 mm radius source, a common tumor size used in preclinical study, their simulation shows that for all the source separations considered, except for the 3 mm separation at 9 and 12 mm depth, the two neighboring sources can be resolved at depths from 3 to 12 mm. Phantom experiments illustrated that 2D bioluminescence imaging failed to distinguish two sources

  5. Systematic study of target localization for bioluminescence tomography guided radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Yu, Jingjing [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 and School of Physics and Information Technology, Shaanxi Normal University, Shaanxi 710119 (China); Zhang, Bin; Reyes, Juvenal; Wong, John W.; Wang, Ken Kang-Hsin, E-mail: kwang27@jhmi.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Iordachita, Iulian I. [Laboratory for Computational Sensing and Robotics, Johns Hopkins University, Baltimore, Maryland 21218 (United States); Lu, Zhihao [Department of Oncology and Department of Surgery, Johns Hopkins University, Baltimore, Maryland 21231 and Key laboratory of Carcinogenesis and Translational Research, Department of GI Oncology, Peking University, Beijing Cancer Hospital and Institute, Beijing 100142 (China); Brock, Malcolm V. [Department of Oncology and Department of Surgery, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Patterson, Michael S. [Department of Medical Physics and Applied Radiation Sciences, McMaster University, Hamilton, Ontario L8S 4L8 (Canada)

    2016-05-15

    Purpose: To overcome the limitation of CT/cone-beam CT (CBCT) in guiding radiation for soft tissue targets, the authors developed a spectrally resolved bioluminescence tomography (BLT) system for the small animal radiation research platform. The authors systematically assessed the performance of the BLT system in terms of target localization and the ability to resolve two neighboring sources in simulations, tissue-mimicking phantom, and in vivo environments. Methods: Multispectral measurements acquired in a single projection were used for the BLT reconstruction. The incomplete variables truncated conjugate gradient algorithm with an iterative permissible region shrinking strategy was employed as the optimization scheme to reconstruct source distributions. Simulation studies were conducted for single spherical sources with sizes from 0.5 to 3 mm radius at depth of 3–12 mm. The same configuration was also applied for the double source simulation with source separations varying from 3 to 9 mm. Experiments were performed in a standalone BLT/CBCT system. Two self-illuminated sources with 3 and 4.7 mm separations placed inside a tissue-mimicking phantom were chosen as the test cases. Live mice implanted with single-source at 6 and 9 mm depth, two sources at 3 and 5 mm separation at depth of 5 mm, or three sources in the abdomen were also used to illustrate the localization capability of the BLT system for multiple targets in vivo. Results: For simulation study, approximate 1 mm accuracy can be achieved at localizing center of mass (CoM) for single-source and grouped CoM for double source cases. For the case of 1.5 mm radius source, a common tumor size used in preclinical study, their simulation shows that for all the source separations considered, except for the 3 mm separation at 9 and 12 mm depth, the two neighboring sources can be resolved at depths from 3 to 12 mm. Phantom experiments illustrated that 2D bioluminescence imaging failed to distinguish two sources

  6. Preliminary Results of Emergency Computed Tomography-Guided Ventricular Drain Placement-Precision for the Most Difficult Cases.

    Science.gov (United States)

    Nowacki, Andreas; Wagner, Franca; Söll, Nicole; Hakim, Arsany; Beck, Jürgen; Raabe, Andreas; Z'Graggen, Werner J

    2018-04-05

    External ventricular drainage (EVD) catheter placement is one of the most commonly performed neurosurgical procedures. The study's objective was to compare a computed tomography (CT) bolt scan-guided approach for the placement of EVDs with conventional landmark-based insertion. In this retrospective case-control study, we analyzed patients undergoing bolt-kit EVD catheter placement, either CT-guided or landmark-based, between 2013 and 2016. The CT bolt scan-guided approach was based on a dose-reduced CT scan after bolt fixation with immediate image reconstruction along the axis of the bolt to evaluate the putative insertion axis. If needed, angulation of the bolt was corrected and the procedure repeated before the catheter was inserted. Primary endpoint was the accuracy of insertion. Secondary endpoints were the overall number of attempts, duration of intervention, complication rates, and cumulative radiation dose. In total, 34 patients were included in the final analysis. In the group undergoing CT-guided placement, the average ventricle width was significantly smaller (P = 0.04) and average midline shift significantly more pronounced (P = 0.01). CT-guided placement resulted in correct positioning of the catheter in the ipsilateral frontal horn in all 100% of the cases compared with landmark-guided insertion (63%; P = 0.01). Application of the CT-guided approach increased the number of total CT scans (3.6 ± 1.9) and the overall radiation dose (3.34 ± 1.61 mSv) compared with the freehand insertion group (1.84 ± 2.0 mSv and 1.55 ± 1.66 mSv). No differences were found for the other secondary outcome parameters. CT-guided bolt-kit EVD catheter placement is feasible and accurate in the most difficult cases. Copyright © 2018 Elsevier Inc. All rights reserved.

  7. Rotator Cuff Calcific Tendinitis: Ultrasound-Guided Needling and Lavage Versus Subacromial Corticosteroids: Five-Year Outcomes of a Randomized Controlled Trial.

    Science.gov (United States)

    de Witte, Pieter Bas; Kolk, Arjen; Overes, Ferdinand; Nelissen, Rob G H H; Reijnierse, Monique

    2017-12-01

    Barbotage (needling and lavage) is often applied in the treatment of calcific tendinitis of the rotator cuff (RCCT). In a previously published randomized controlled trial, we reported superior clinical and radiological 1-year outcomes for barbotage combined with a corticosteroid injection in the subacromial bursa (SAIC) compared with an isolated SAIC. There are no trials with a midterm or long-term follow-up of barbotage available. To compare the 5-year results of 2 regularly applied treatments of RCCT: ultrasound (US)-guided barbotage combined with a SAIC (group 1) versus an isolated US-guided SAIC (group 2). Randomized controlled trial; Level of evidence, 1. Patients were randomly assigned to group 1 or 2 and evaluated before and after treatment at regular time points until 12 months and also at 5 years using the Constant score (CS), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand (DASH). The calcification location and size and Gärtner classification were assessed on radiographs. The rotator cuff condition was evaluated with US. Results were analyzed using t tests, linear regression, and a mixed model for repeated measures. Forty-eight patients were included (mean age, 52.0 ± 7.3 years; 25 [52%] female) with a mean baseline CS of 68.7 ± 11.9. After a mean follow-up of 5.1 ± 0.5 years, the mean CS was 90 (95% CI, 83.0-95.9) in group 1 versus 87 (95% CI, 80.5-93.5) in group 2 ( P = .58). The mean improvement in the CS in group 1 was 18 (95% CI, 12.3-23.0) versus 21 (95% CI, 16.2-26.2) in group 2 ( P = .32). There was total resorption in 62% of group 1 and 73% of group 2 ( P = .45). The US evaluation of the rotator cuff condition showed no significant differences between the groups. With the mixed model for repeated measures, taking into account the baseline CS and Gärtner classification, the mean treatment effect for barbotage was 6 (95% CI, -8.9 to 21.5), but without statistical significance. Follow-up scores

  8. Ultrasound-guided image fusion with computed tomography and magnetic resonance imaging. Clinical utility for imaging and interventional diagnostics of hepatic lesions

    International Nuclear Information System (INIS)

    Clevert, D.A.; Helck, A.; Paprottka, P.M.; Trumm, C.; Reiser, M.F.; Zengel, P.

    2012-01-01

    Abdominal ultrasound is often the first-line imaging modality for assessing focal liver lesions. Due to various new ultrasound techniques, such as image fusion, global positioning system (GPS) tracking and needle tracking guided biopsy, abdominal ultrasound now has great potential regarding detection, characterization and treatment of focal liver lesions. Furthermore, these new techniques will help to improve the clinical management of patients before and during interventional procedures. This article presents the principle and clinical impact of recently developed techniques in the field of ultrasound, e.g. image fusion, GPS tracking and needle tracking guided biopsy and discusses the results based on a feasibility study on 20 patients with focal hepatic lesions. (orig.) [de

  9. Imaging breast adipose and fibroglandular tissue molecular signatures by using hybrid MRI-guided near-infrared spectral tomography

    Science.gov (United States)

    Brooksby, Ben; Pogue, Brian W.; Jiang, Shudong; Dehghani, Hamid; Srinivasan, Subhadra; Kogel, Christine; Tosteson, Tor D.; Weaver, John; Poplack, Steven P.; Paulsen, Keith D.

    2006-06-01

    Magnetic resonance (MR)-guided near-infrared spectral tomography was developed and used to image adipose and fibroglandular breast tissue of 11 normal female subjects, recruited under an institutional review board-approved protocol. Images of hemoglobin, oxygen saturation, water fraction, and subcellular scattering were reconstructed and show that fibroglandular fractions of both blood and water are higher than in adipose tissue. Variation in adipose and fibroglandular tissue composition between individuals was not significantly different across the scattered and dense breast categories. Combined MR and near-infrared tomography provides fundamental molecular information about these tissue types with resolution governed by MR T1 images. hemoglobin | magnetic resonance imaging | water | fat | oxygen saturation

  10. Development of a guidance guide for dosimetry in computed tomography; Desenvolvimento de um guia orientativo para dosimetria em tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Fontes, Ladyjane Pereira

    2016-07-01

    Due to frequent questions from users of ionization chambers pencil type calibrated in the Instrument Calibration Laboratory of the Institute of Energy and Nuclear Research (LCI - IPEN), on how to properly apply the factors indicated in their calibration certificates, a guide was prepared guidance for dosimetry in computed tomography. The guide includes guidance prior knowledge of half value layer (HVL), as it is necessary to know the effective beam energy for application quality for correction factor (kq). The evaluation of HVL in TC scanners becomes a difficult task due to system geometry and therefore a survey was conducted of existing methodologies for the determination of HVL in clinical beams Computed Tomography, taking into account technical, practical and economic factors. In this work it was decided to test a Tandem System consists of absorbing covers made in the workshop of IPEN, based on preliminary studies due to low cost and good response. The Tandem system consists of five cylindrical absorbing layers of 1mm, 3mm, 5mm, 7mm and 10mm aluminum and 3 cylindrical absorbing covers 15mm, 25mm and acrylic 35mm (PMMA) coupled to the ionization chamber of commercial pencil type widely used in quality control tests in dosimetry in clinical beams Computed tomography. Through Tandem curves it was possible to assess HVL values and from the standard curve pencil-type ionization chamber, Kq find the appropriate beam. The elaborate Guide provides information on how to build the calibration curve on the basis of CSR, to find the Kq and information for construction Tandem curve, to find values close to CSR. (author)

  11. Predictors of Malignancy and Recommended Follow-Up for Patients with Negative Endoscopic Ultrasound-Guided Fine-Needle Aspiration of Suspected Pancreatic Lesions

    Directory of Open Access Journals (Sweden)

    Bret J Spier

    2009-01-01

    Full Text Available BACKGROUND: Endoscopic ultrasound (EUS with fine-needle aspiration (FNA can characterize and diagnose pancreatic lesions as malignant, but cannot definitively rule out the presence of malignancy. Outcome data regarding the length of follow-up in patients with negative or nondiagnostic EUS-FNA of pancreatic lesions are not well-established.

  12. [Discussion on needling sensation, arrival of qi and needling response (Deqi)].

    Science.gov (United States)

    Zhang, Fang; Wang, Hong-Du

    2012-12-01

    The current appointed teaching material of Science of Acupuncture and Moxibustion holds that there is no difference among the needling sensation, arrival of qi and needling response. However, the author has a different understanding. Therefore, Neijing (Internal Classic), its annotation, exposition and understandings of ancient and modern famous experts are cited to analyze their meanings. And the result indicates that the needling sensation is subjective feelings and perceived responses of doctors and patients. Arrival of qi is the healing process of the organ through activating the anti-pathogenic qi to expel the pathogens. The needling response is the final aim of acupuncture therapy. Thus, the meaning of needling sensation, arrival of qi, and needling response are different. And an accurate understanding can better guide acupuncture treatment.

  13. Removal of calcium hydroxide from Weine Type II systems using photon-induced photoacoustic streaming, passive ultrasonic, and needle irrigation: a microcomputed tomography study

    Directory of Open Access Journals (Sweden)

    Adam LLOYD

    Full Text Available ABSTRACT Objective This study compared the effectiveness of Er:YAG laser-activated irrigation (PIPS, passive ultrasonic irrigation (PUI with EndoUltra and standard needle irrigation (SNI in the removal of calcium hydroxide [Ca(OH2] from the mesial roots of Weine Type II mandibular molars. Material and Methods Thirty mandibular molars were screened by µCT for the presence of mesial roots with complex intra-canal anatomy and a common apical foramen. The teeth were enlarged to a standardized 25/.06 preparation and filled with Ca(OH2 paste. Specimens were divided into three groups (n=10 according to the technique used for Ca(OH2 removal: PIPS, at 15 Hz and 20 mJ using a 9 mm long, 600 µm diameter tip; PUI using a 15/.02 tip; and SNI (30 Ga. side-vented needle. Equal volumes of 8.25% NaOCl and 17% EDTA were used in all groups. µCT was used to measure the initial amount of Ca(OH2 present and to assess the residual volume of Ca(OH2 following each irrigation protocol. Data were analyzed using Tukey HSD and Kruskal-Wallis tests (α=5%. Results The mean volume of Ca(OH2 before removal was significantly higher in the coronal third than in the middle and apical third (p0.05. PIPS (median 0%; IQR: 0-0 showed significant higher Ca(OH2 removal in the apical third than PUI (median 100%, IQR: 85-100 and SNI (median 47%; IQR: 16-72 (p<0.001. Conclusions PIPS laser-activation was more effective for the removal of Ca(OH2 from mesial roots of mandibular molars with Weine Type II canal configurations than PUI with EndoUltra and SNI.

  14. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle – a perspective on a new tool to avoid stent migration of Dumon stents

    Directory of Open Access Journals (Sweden)

    Hohenforst-Schmidt W

    2015-05-01

    fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level, it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.Keywords: stent, airway, cone-beam computer tomography, Berci

  15. Tomography

    International Nuclear Information System (INIS)

    Brown, B.H.; Barber, D.C.; Freeston, I.L.

    1983-01-01

    Tomography images of a body are constructed by placing a plurality of surface electrodes at spaced intervals on the body, causing currents to flow in the body (e.g. by applying a potential between each pair of electrodes in turn, or by induction), and measuring the potential between pairs of electrodes, calculating the potential expected in each case on the assumption that the body consists of a medium of uniform impedance, plotting the isopotentials corresponding to the calculated results to create a uniform image of the body, obtaining the ratio between the measured potential and the calculated potential in each case, and modifying the image in accordance with the respective ratios by increasing the assumed impedance along an isopotential in proportion to a ratio greater than unity or decreasing the assumed impedance in proportion to a ratio less than unity. The modified impedances along the isopotentials for each pair of electrodes are superimposed. The calculations are carried out using a computer and the plotting is carried out by a visual display unit and/or a print-out unit. (author)

  16. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents.

    Science.gov (United States)

    Hohenforst-Schmidt, Wolfgang; Linsmeier, Bernd; Zarogoulidis, Paul; Freitag, Lutz; Darwiche, Kaid; Browning, Robert; Turner, J Francis; Huang, Haidong; Li, Qiang; Vogl, Thomas; Zarogoulidis, Konstantinos; Brachmann, Johannes; Rittger, Harald

    2015-01-01

    Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson's disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50-60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although

  17. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle – a perspective on a new tool to avoid stent migration of Dumon stents

    Science.gov (United States)

    Hohenforst-Schmidt, Wolfgang; Linsmeier, Bernd; Zarogoulidis, Paul; Freitag, Lutz; Darwiche, Kaid; Browning, Robert; Turner, J Francis; Huang, Haidong; Li, Qiang; Vogl, Thomas; Zarogoulidis, Konstantinos; Brachmann, Johannes; Rittger, Harald

    2015-01-01

    Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6

  18. Ultrasound-guided percutaneous treatment of hepatocellular carcinoma by radiofrequency hyperthermia with a 'cooled-tip needle'. A preliminary clinical experience.

    Science.gov (United States)

    Francica, G; Marone, G

    1999-05-01

    Radiofrequency hyperthermia using the newly-developed 'cooled-tip' needle has recently been proposed as a therapeutic modality for hepatocellular carcinoma (HCC). Herein we report our preliminary results on feasibility and effectiveness of the thermal ablation of mono- or pauci-focal hepatocellular carcinoma with the cooled-tip needle. We treated 15 cirrhotic patients (mean age 68.8 years; 12 males; 14 HCV-positive; 13 in Child's Class A and 2 in Class B) with 20 hepatocellular carcinoma nodules (mean diameter 28.1 mm; range 10-43 mm; nine lesions with diameter greater than 3 cm). None of the patients had portal thrombosis and/or extrahepatic spread. We used a radiofrequency generator (100 W of power) connected to a 18 g perfusion electrode needle with an exposed tip of 2-3 cm. The circuit was closed through a dispersive electrode positioned under the patient's thighs. A peristaltic pump infused a chilled (2-5 degrees C) saline solution to guarantee the continuous cooling of the needle tip. The needle was placed into target lesions under US guidance. The interventional procedure was carried out in general anesthesia without intubation. Dynamic helical CT was carried out 15-20 days after thermal ablation to assess therapeutic efficacy. In all, 38 areas of coagulation necrosis (at 1000-1200 mA for 10-15 min) were generated in 24 sessions in the 20 hepatocellular carcinoma nodules (mean 1.9 lesions per nodule and 1.2 sessions per nodule). Complete necrosis as assessed at dynamic CT (lack of enhancement during the arteriographic phase) was achieved in 75% of cases in a single session; after a second RF session success rate was 90% (18 out of 20 nodules). A self-limited pleurisy along with a 5-fold increase in transaminases occurred in one patient; a 3-fold elevation of transaminases was encountered in three other patients. During the follow-up (median 15 months) five patients had recurrent hepatocellular carcinoma with a 1-year disease free interval of 64%. Of the

  19. Image Guided Radiation Therapy Using Synthetic Computed Tomography Images in Brain Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Price, Ryan G. [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States); Kim, Joshua P.; Zheng, Weili [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Chetty, Indrin J. [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States); Glide-Hurst, Carri, E-mail: churst2@hfhs.org [Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan (United States); Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, Michigan (United States)

    2016-07-15

    Purpose: The development of synthetic computed tomography (CT) (synCT) derived from magnetic resonance (MR) images supports MR-only treatment planning. We evaluated the accuracy of synCT and synCT-generated digitally reconstructed radiographs (DRRs) relative to CT and determined their performance for image guided radiation therapy (IGRT). Methods and Materials: Magnetic resonance simulation (MR-SIM) and CT simulation (CT-SIM) images were acquired of an anthropomorphic skull phantom and 12 patient brain cancer cases. SynCTs were generated using fluid attenuation inversion recovery, ultrashort echo time, and Dixon data sets through a voxel-based weighted summation of 5 tissue classifications. The DRRs were generated from the phantom synCT, and geometric fidelity was assessed relative to CT-generated DRRs through bounding box and landmark analysis. An offline retrospective analysis was conducted to register cone beam CTs (n=34) to synCTs and CTs using automated rigid registration in the treatment planning system. Planar MV and KV images (n=37) were rigidly registered to synCT and CT DRRs using an in-house script. Planar and volumetric registration reproducibility was assessed and margin differences were characterized by the van Herk formalism. Results: Bounding box and landmark analysis of phantom synCT DRRs were within 1 mm of CT DRRs. Absolute planar registration shift differences ranged from 0.0 to 0.7 mm for phantom DRRs on all treatment platforms and from 0.0 to 0.4 mm for volumetric registrations. For patient planar registrations, the mean shift differences were 0.4 ± 0.5 mm (range, −0.6 to 1.6 mm), 0.0 ± 0.5 mm (range, −0.9 to 1.2 mm), and 0.1 ± 0.3 mm (range, −0.7 to 0.6 mm) for the superior-inferior (S-I), left-right (L-R), and anterior-posterior (A-P) axes, respectively. The mean shift differences in volumetric registrations were 0.6 ± 0.4 mm (range, −0.2 to 1.6 mm), 0.2 ± 0.4 mm (range, −0.3 to 1.2 mm), and 0.2 ± 0

  20. Image Guided Radiation Therapy Using Synthetic Computed Tomography Images in Brain Cancer

    International Nuclear Information System (INIS)

    Price, Ryan G.; Kim, Joshua P.; Zheng, Weili; Chetty, Indrin J.; Glide-Hurst, Carri

    2016-01-01

    Purpose: The development of synthetic computed tomography (CT) (synCT) derived from magnetic resonance (MR) images supports MR-only treatment planning. We evaluated the accuracy of synCT and synCT-generated digitally reconstructed radiographs (DRRs) relative to CT and determined their performance for image guided radiation therapy (IGRT). Methods and Materials: Magnetic resonance simulation (MR-SIM) and CT simulation (CT-SIM) images were acquired of an anthropomorphic skull phantom and 12 patient brain cancer cases. SynCTs were generated using fluid attenuation inversion recovery, ultrashort echo time, and Dixon data sets through a voxel-based weighted summation of 5 tissue classifications. The DRRs were generated from the phantom synCT, and geometric fidelity was assessed relative to CT-generated DRRs through bounding box and landmark analysis. An offline retrospective analysis was conducted to register cone beam CTs (n=34) to synCTs and CTs using automated rigid registration in the treatment planning system. Planar MV and KV images (n=37) were rigidly registered to synCT and CT DRRs using an in-house script. Planar and volumetric registration reproducibility was assessed and margin differences were characterized by the van Herk formalism. Results: Bounding box and landmark analysis of phantom synCT DRRs were within 1 mm of CT DRRs. Absolute planar registration shift differences ranged from 0.0 to 0.7 mm for phantom DRRs on all treatment platforms and from 0.0 to 0.4 mm for volumetric registrations. For patient planar registrations, the mean shift differences were 0.4 ± 0.5 mm (range, −0.6 to 1.6 mm), 0.0 ± 0.5 mm (range, −0.9 to 1.2 mm), and 0.1 ± 0.3 mm (range, −0.7 to 0.6 mm) for the superior-inferior (S-I), left-right (L-R), and anterior-posterior (A-P) axes, respectively. The mean shift differences in volumetric registrations were 0.6 ± 0.4 mm (range, −0.2 to 1.6 mm), 0.2 ± 0.4 mm (range, −0.3 to 1.2 mm), and 0.2 ± 0

  1. The research of knitting needle status monitoring setup

    Science.gov (United States)

    Liu, Lu; Liao, Xiao-qing; Zhu, Yong-kang; Yang, Wei; Zhang, Pei; Zhao, Yong-kai; Huang, Hui-jie

    2013-09-01

    In textile production, quality control and testing is the key to ensure the process and improve the efficiency. Defect of the knitting needles is the main factor affecting the quality of the appearance of textiles. Defect detection method based on machine vision and image processing technology is universal. This approach does not effectively identify the defect generated by damaged knitting needles and raise the alarm. We developed a knitting needle status monitoring setup using optical imaging, photoelectric detection and weak signal processing technology to achieve real-time monitoring of weaving needles' position. Depending on the shape of the knitting needle, we designed a kind of Glass Optical Fiber (GOF) light guides with a rectangular port used for transmission of the signal light. To be able to capture the signal of knitting needles accurately, we adopt a optical 4F system which has better imaging quality and simple structure and there is a rectangle image on the focal plane after the system. When a knitting needle passes through position of the rectangle image, the reflected light from needle surface will back to the GOF light guides along the same optical system. According to the intensity of signals, the computer control unit distinguish that the knitting needle is broken or curving. The experimental results show that this system can accurately detect the broken needles and the curving needles on the knitting machine in operating condition.

  2. Percutaneous transthoracic computed tomography-guided AICD insertion in a patient with extracardiac Fontan conduit.

    LENUS (Irish Health Repository)

    Murphy, Darra T

    2011-02-01

    Percutaneous pulmonary venous atrial puncture was performed under computed tomography guidance to successfully place an automated implantable cardiac defibrillator into a 26-year-old patient with extracardiac Fontan conduit who had presented with two out-of-hospital cardiac arrests. The procedure avoided the need for lead placement at thoracotomy.

  3. Osteoid osteomas in common and in technically challenging locations treated with computed tomography-guided percutaneous radiofrequency ablation

    International Nuclear Information System (INIS)

    Mylona, Sophia; Patsoura, Sofia; Karapostolakis, Georgios; Galani, Panagiota; Pomoni, Anastasia; Thanos, Loukas

    2010-01-01

    To evaluate the efficacy of computed tomography (CT)-guided radiofrequency (RF) ablation for the treatment of osteoid osteomas in common and in technically challenging locations. Twenty-three patients with osteoid osteomas in common (nine cases) and technically challenging [14 cases: intra-articular (n = 7), spinal (n = 5), metaphyseal (n = 2)] positions were treated with CT-guided RF ablation. Therapy was performed under conscious sedation with a seven-array expandable RF electrode for 8-10 min at 80-110 C and power of 90-110 W. The patients went home under instruction. A brief pain inventory (BPI) score was calculated before and after (1 day, 4 weeks, 6 months and 1 year) treatment. All procedures were technically successful. Primary clinical success was 91.3% (21 of total 23 patients), despite the lesions' locations. BPI score was dramatically reduced after the procedure, and the decrease in BPI score was significant (P < 0.001, paired t-test; n - 1 = 22) for all periods during follow up. Two patients had persistent pain after 1 month and were treated successfully with a second procedure (secondary success rate 100%). No immediate or delayed complications were observed. CT-guided RF ablation is safe and highly effective for treatment of osteoid osteomas, even in technically difficult positions. (orig.)

  4. Computed tomography-guided interstitial high dose rate brachytherapy for centrally located liver tumours: a single institution study

    Energy Technology Data Exchange (ETDEWEB)

    Tselis, Nikolaos; Chatzikonstantinou, Georgios; Zamboglou, Nikolaos [Klinikum Offenbach, Department of Radiation Oncology, Offenbach am Main (Germany); Kolotas, Christos [Hirslanden Medical Center, Institute for Radiotherapy, Aarau (Switzerland); Milickovic, Natasa; Baltas, Dimos [Klinikum Offenbach, Department of Medical Physics and Engineering, Offenbach am Main (Germany)

    2013-08-15

    To evaluate the clinical outcome of computed tomography (CT)-guided interstitial (IRT) high-dose-rate (HDR) brachytherapy (BRT) in the treatment of unresectable primary and secondary liver malignancies. This report updates and expands our previously described experience with this treatment technique. Forty-one patients with 50 tumours adjacent to the liver hilum and bile duct bifurcation were treated in 59 interventions of CT-guided IRT HDR BRT. The tumours were larger than 4 cm with a median volume of 84 cm{sup 3} (38-1,348 cm{sup 3}). The IRT HDR BRT delivered a median total physical dose of 20.0 Gy (7.0-32.0 Gy) in twice daily fractions of median 7.0 Gy (4.0-10.0 Gy) in 19 patients and in once daily fractions of median 8.0 Gy (7.0-14.0 Gy) in 22 patients. With a median follow-up of 12.4 months, the local control for metastatic hepatic tumours was 89 %, 73 % and 63 % at 6, 12 and 18 months respectively. The local control for primary hepatic tumours was 90 %, 81 % and 50 % at 6, 12 and 18 months respectively. Severe side effects occurred in 5.0 % of interventions with no treatment-related deaths. CT-guided IRT HDR BRT is a promising procedure for the radiation treatment of centrally located liver malignancies. (orig.)

  5. 3D artificial bones for bone repair prepared by computed tomography-guided fused deposition modeling for bone repair.

    Science.gov (United States)

    Xu, Ning; Ye, Xiaojian; Wei, Daixu; Zhong, Jian; Chen, Yuyun; Xu, Guohua; He, Dannong

    2014-09-10

    The medical community has expressed significant interest in the development of new types of artificial bones that mimic natural bones. In this study, computed tomography (CT)-guided fused deposition modeling (FDM) was employed to fabricate polycaprolactone (PCL)/hydroxyapatite (HA) and PCL 3D artificial bones to mimic natural goat femurs. The in vitro mechanical properties, in vitro cell biocompatibility, and in vivo performance of the artificial bones in a long load-bearing goat femur bone segmental defect model were studied. All of the results indicate that CT-guided FDM is a simple, convenient, relatively low-cost method that is suitable for fabricating natural bonelike artificial bones. Moreover, PCL/HA 3D artificial bones prepared by CT-guided FDM have more close mechanics to natural bone, good in vitro cell biocompatibility, biodegradation ability, and appropriate in vivo new bone formation ability. Therefore, PCL/HA 3D artificial bones could be potentially be of use in the treatment of patients with clinical bone defects.

  6. A novel needle-type sampling device for flexible ultrathin bronchoscopy

    International Nuclear Information System (INIS)

    Suda, Yuji; Hayashi, Katsutoshi; Shindoh, Yuriko; Iijima, Hideya; Tanaka, Akiko

    2008-01-01

    Diagnosis of suspected cancer in the periphery of the lung is difficult. A flexible ultrathin bronchoscope has been developed for the diagnosis of peripherally located pulmonary lesions that cannot be reached with the sampling devices for standard flexible bronchoscopes. The diagnostic yield with forceps and a brush for ultrathin bronchoscopes, however, is not adequate, especially when a lesion is not exposed to the bronchial lumen. We have thus developed a novel needle-type sampling device and tested its yield in transbronchial cytology. The device consists of an elongated dental H-file (0.4 mm in diameter and 110 cm in length), a housing sheath (1.0 mm in outer diameter), and a novel handle, which enables rapid out-and-in motion of the needle. Ten consecutive patients with a peripheral pulmonary lesion who had an indication for diagnostic procedure with a flexible ultrathin bronchoscope were enrolled. The optimal bronchial route to the lesion was analyzed with virtual bronchoscopy in a data set obtained with high-resolution computed tomography, and a novel bronchial route labeling system (prior-ridge-based relative orientation nomenclature) was employed to guide insertion of the bronchoscope. Sampling with the novel needle was performed prior to use of the forceps and brush under conventional fluoroscopy. In all the cases, sampling with the needle was successful and the amount of the specimen was sufficient for cytology. Our novel sampling system with flexible ultrathin bronchoscopes may contribute to accurate and minimally invasive diagnosis of peripheral pulmonary lesions. (author)

  7. Automatic entry point planning for robotic post-mortem CT-based needle placement.

    Science.gov (United States)

    Ebert, Lars C; Fürst, Martin; Ptacek, Wolfgang; Ruder, Thomas D; Gascho, Dominic; Schweitzer, Wolf; Thali, Michael J; Flach, Patricia M

    2016-09-01

    Post-mortem computed tomography guided placement of co-axial introducer needles allows for the extraction of tissue and liquid samples for histological and toxicological analyses. Automation of this process can increase the accuracy and speed of the needle placement, thereby making it more feasible for routine examinations. To speed up the planning process and increase safety, we developed an algorithm that calculates an optimal entry point and end-effector orientation for a given target point, while taking constraints such as accessibility or bone collisions into account. The algorithm identifies the best entry point for needle trajectories in three steps. First, the source CT data is prepared and bone as well as surface data are extracted and optimized. All vertices of the generated surface polygon are considered to be potential entry points. Second, all surface points are tested for validity within the defined hard constraints (reachability, bone collision as well as collision with other needles) and removed if invalid. All remaining vertices are reachable entry points and are rated with respect to needle insertion angle. Third, the vertex with the highest rating is selected as the final entry point, and the best end-effector rotation is calculated to avoid collisions with the body and already set needles. In most cases, the algorithm is sufficiently fast with approximately 5-6 s per entry point. This is the case if there is no collision between the end-effector and the body. If the end-effector has to be rotated to avoid collision, calculation times can increase up to 24 s due to the inefficient collision detection used here. In conclusion, the algorithm allows for fast and facilitated trajectory planning in forensic imaging.

  8. Feasibility of optimizing the dose distribution in lung tumors using fluorine-18-fluorodeoxyglucose positron emission tomography and single photon emission computed tomography guided dose prescriptions

    International Nuclear Information System (INIS)

    Das, S.K.; Miften, M.M.; Zhou, S.; Bell, M.; Munley, M.T.; Whiddon, C.S.; Craciunescu, O.; Baydush, A.H.; Wong, T.; Rosenman, J.G.; Dewhirst, M.W.; Marks, L.B.

    2004-01-01

    The information provided by functional images may be used to guide radiotherapy planning by identifying regions that require higher radiation dose. In this work we investigate the dosimetric feasibility of delivering dose to lung tumors in proportion to the fluorine-18-fluorodeoxyglucose activity distribution from positron emission tomography (FDG-PET). The rationale for delivering dose in proportion to the tumor FDG-PET activity distribution is based on studies showing that FDG uptake is correlated to tumor cell proliferation rate, which is shown to imply that this dose delivery strategy is theoretically capable of providing the same duration of local control at all voxels in tumor. Target dose delivery was constrained by single photon emission computed tomography (SPECT) maps of normal lung perfusion, which restricted irradiation of highly perfused lung and imposed dose-function constraints. Dose-volume constraints were imposed on all other critical structures. All dose-volume/function constraints were considered to be soft, i.e., critical structure doses corresponding to volume/function constraint levels were minimized while satisfying the target prescription, thus permitting critical structure doses to minimally exceed dose constraint levels. An intensity modulation optimization methodology was developed to deliver this radiation, and applied to two lung cancer patients. Dosimetric feasibility was assessed by comparing spatially normalized dose-volume histograms from the nonuniform dose prescription (FDG-PET proportional) to those from a uniform dose prescription with equivalent tumor integral dose. In both patients, the optimization was capable of delivering the nonuniform target prescription with the same ease as the uniform target prescription, despite SPECT restrictions that effectively diverted dose from high to low perfused normal lung. In one patient, both prescriptions incurred similar critical structure dosages, below dose-volume/function limits

  9. Reliability of implant placement with stereolithographic surgical guides generated from computed tomography: clinical data from 94 implants.

    Science.gov (United States)

    Ersoy, Ahmet Ersan; Turkyilmaz, Ilser; Ozan, Oguz; McGlumphy, Edwin A

    2008-08-01

    Dental implant placement requires precise planning with regard to anatomic limitations and restorative goals. The aim of this study was to evaluate the match between the positions and axes of the planned and placed implants using stereolithographic (SLA) surgical guides. Ninety-four implants were placed using SLA surgical guides generated from computed tomography (CT) between 2005 and 2006. Radiographic templates were used for all subjects during CT imaging. After obtaining three-dimensional CT images, each implant was virtually placed on the CT images. SLA surgical guides, fabricated using an SLA machine with a laser beam to polymerize the liquid photo-polymerized resin, were used during implant placement. A new CT scan was taken for each subject following implant placement. Special software