CT Image Guidance of Minimally Invasive Procedures and Micro-therapy
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Since the beginning of computed
tomography, radiologists have used CAT/CT to guide simple interventional procedures such as
tissue biopsy. Conventional CT guidance of biopsy and other
simple procedures is well established. However, conventional CT can be painstakingly slow
since it often requires a new image to be acquired each time the doctor advances the
needle or surgical instrument in order to verify the updated position. In many cases the
radiologist repeatedly leaves the scan room each time a new image is acquired, extending
the length of the procedure.
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The radiologist performs a CT
guided biopsy using "Fluoro CT" |
New fluoroscopic CT procedures
allow radiologists to better guide tissue biopsy and allows the guidance of minimally invasive surgery or micro-therapy.
Conventional CT can only acquires one image at a time, like a pocket camera or simple radiograph. Fluoro CT is more like a video camera (or x-ray fluoroscope) and allows acquisition and immediate display of up to 9
images per second. Thus Fluoro CT allows the physician to continuously monitor the
trajectory of the needle or surgical instrument as it is inserted, eliminating the slow
slice by slice process and allowing a significant streamlining of CT guided interventional
procedures.
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| The radiologist delivers a
therapeutic agent into the thoracic vertebrae under fluoro CT guidance |
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This fluoro CT image is used
to guide needle placement. A therapeutic agent is then injected into the thoracic
vertebrae to alleviate pain |
Many open surgical
procedures can now be replaced with minimally invasive procedures under CT guidance. For
example, Fluoro CT can be used to guide micro therapy to repair prolapsed or burst disks
in the spinal canal without surgery. Until recently, the repair of a "bad disk"
was primarily an open surgical procedure.
Fluoro CT imaging is now used to guide a number of minimally invasive,
micro-therapy procedures:
- Drainage of fluid collections such as cysts,
abscesses (pus), lymphoceles (lymph fluid), bilioma (bile), hematomas (blood), for
example, to remove fluid from an infection or wound
- Diagnostic biopsy to
remove a tissue sample for pathologic or cytologic lab testing
- Pain therapy, for example, the injection of
therapeutic agents into a spinal disk space to alleviate pain (see above images)
- Minimally invasive operation, for example, cyst
removal or ablation (cutting away) of tumors (such as brain tumors)
- Dynamic study of knee or elbow motion, swallowing
or study of the larynx
- CT arthrogram:
injection of contrast into joint space for easier diagnosis of injury
- Guidance of embolization to stop bleeding, for
example, in liver and spleen trauma
- Monitor difficult endoscope placement, for example
in the gastrointestinal tract
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Updated: September 13, 2007
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