Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain

2021 ◽  
Vol 2021 (9) ◽  
Author(s):  
Joshua Zadro ◽  
Adam Rischin ◽  
Renea V Johnston ◽  
Rachelle Buchbinder
Keyword(s):  
Shoulder Pain ◽  
Image Guidance ◽  
Image Guided

397 Intra-tumor immunotherapy injections utilizing image guidance in interventional radiology: clinical trial experience at a tertiary care cancer center

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A422-A422
Author(s):  
Ravi Murthy ◽  
Rahul Sheth ◽  
Alda Tam ◽  
Sanjay Gupta ◽  
Vivek Subbiah ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Interventional Radiology ◽  
Real Time ◽  
Image Guidance ◽  
Tertiary Care ◽  
Cancer Center ◽  
Imaging Guidance ◽  
Image Guided ◽  
Real Time Image ◽  
Time Image

BackgroundImage guided intra-tumor administration of investigational immunotherapeutic agents represents an expanding field of interest. We present a retrospective review of the safety, feasibility & technical nuances of real-time image guidance for injection & biopsy across a spectrum of extracranial solid malignancies utilizing the discipline of Interventional Radiology.MethodsPatients who were enrolled in image guided intratumoral immunotherapy injection (ITITI) clinical trials over a 6 year period (2013–19) at a single tertiary care cancer center were included in this analysis. Malignancy, location, imaging guidance utilized for ITITI & biopsy for injected (adscopal) & non-injected (abscopal) lesions were determined and categorized. Peri-procedural adverse events were noted.Results262 pts (146 female, 61 yrs median) participating in 29 immunotherapeutic clinical trials (TLR & STING agonists, gene therapy, anti CD-40, viral/bacterial/metabolic oncolytics) met study criteria. Malignancies included melanoma 88, sarcoma 32, colorectal 29, breast 23, lung 17, head & neck 15, ovarian 8, neuroendocrine 7, pancreatic adenocarcinoma 6, 3 each (cholangioCA, endometrial, bladder, GI tract), 2 each (RCC, thymicCA, lymphoma, merkel cell, prostate) & others 1 each (CUP, GIST, dermatofibrosarcoma, DSRT, neuroblastoma, thyroid). All 169 & 93 patients received the intended 1371 ITITI in parietal (abdominal/chest wall, extremity, neck, pelvis) or visceral (liver, lung, peritoneum, adrenal) locations respectively; 83 patients received lymph node injections within either location. Imaging guidance was US in 68% of the cohort (US 161, CT+US 19); CT was used in 30% (81) & MRI in 1 patient. Median diameter of the ITITI lesion was 32 mm (8–230 mm). Median volume of the ITITI therapeutic material/session was 2 ml (1–6.9 ml). Lesions were accessed using a coaxial technique. ITITI delivery needles used at operator preference & tailored to lesion characteristics were either a 21G/22G Chiba, 21G Profusion (Cook Medical), 22G Morrison (AprioMed), 25G hypodermic (BD) & 18G Quadrafuse (Rex Medical). 2840 core biopsies (>18G Tru-cut core, Mission, Bard Medical) were performed in 237 patients during 690 procedures; biopsy sessions were often concurrent & of the ITITI site. 137 patients also underwent biopsy of a non-ITITI site (89 parietal location). Dimensions of the non-ITITI lesion were median 10 mm (7–113 mm); US image guidance was used in 97 patients (72%) to obtain a total of 1257, >18G Tru-core samples. 1.3% of injections resulted in SAE (NCI CTC AE >3) and 0.5% of 4097 biopsies developed major complications (SIR Criteria); both categories were manageable.ConclusionsUtilizing real time image guidance, ITITI to the administration of a myriad of investigational immunotherapeutic agents with concomitant biopsy procedures to date are associated with a high technical success rate & favorable safety profile.AcknowledgementsJoshua Hein, Mara Castaneda, Jyotsna Pera, Yunfang Jiang,Shuang Liu, Holly Liu and Anna LuiTrial RegistrationN/AEthics ApprovalThe study was approved by Institution’s Ethics Board, approval number 2020-0536: A retrospective study to determine the safety, feasibility and technical challenges of real-time image guidance for intra-tumor injection and biopsy across multiple solid tumors.Consent2020-0536 Waiver of Informed ConsentReferenceSheth RA, Murthy R, Hong DS, et al. Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Netw Open 2020;3(7):e207911. doi:10.1001/jamanetworkopen.2020.7911

Optimal Fiducial Configuration in Image-Guided Neurosurgery Using a Genetic Algorithm

2010 ◽  
Vol 4 (4) ◽  
Author(s):  
Laura Gastaldi ◽  
Alessandro Battezzato ◽  
Claudio Bernucci ◽  
Marco Mannino ◽  
Stefano Pastorelli
Keyword(s):  
Genetic Algorithm ◽  
Image Guidance ◽  
3D Model ◽  
Magnetic Resonance Images ◽  
Optimal Placement ◽  
Fiducial Markers ◽  
Virtual Spaces ◽  
Target Registration Error ◽  
Image Guided ◽  
Localize Lesion

Image-guided neurosurgery allows surgeons to navigate and localize lesion through the patient’s cranium with a 3D image guidance. The model of the head is reconstructed using preoperative computed tomography or magnetic resonance images and real and virtual spaces are aligned by means of fiducial markers placed on the patient. In this paper, a new method for the optimal placement of the fiducial markers in order to reduce misalignment is presented. Using routine diagnostic images, a customized 3D model of the patient’s cranium is reconstructed. A genetic algorithm calculates optimal positions of the marker in order to minimize the target registration error. The fiducial set is shown to the surgeons on the 3D model to help him/her in placement of them.

Image-guided intensity modulated radiation therapy (IG-IMRT) affords increased survival for biliary tract tumors: Results from preliminary analysis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4131-4131
Author(s):  
G. Starling ◽  
C. D. Fuller ◽  
C. R. Thomas ◽  
M. Fuss
Keyword(s):  
Median Survival ◽  
Biliary Tract ◽  
Survival Data ◽  
Image Guidance ◽  
Radiation Treatment ◽  
Bile Duct Neoplasms ◽  
Ultrasound Images ◽  
Image Guided Radiotherapy ◽  
Image Guided ◽  
Safety Margins

4131 Background: The purpose of this study is to determine the effect of image-guided radiotherapy on survival in adenocarcinoma of the biliary tract. Methods: Between 1995 and 2005, 43 pts with primary biliary tract (gallbladder or bile duct) neoplasms were treated with radiotherapy. 26 of the pts were female and 17 were male. Their average age at registration was 64, and ranged from 25 to 86. Twenty-five pts (58%) were Hispanic, while 18 (42%) were white. 31 pts (72%) underwent surgical treatment, most having cholecystecomy (50%). 29 pts (67%) had chemotherapy: 21 (72%) were given fluorouracil-based drugs, 2 (7%) received gemcitabine, and 6 (21%) received other agents. 23 pts (53%) received conventional radiation treatment using AP/PA, AP/PA with opposing lateral, or AP with opposing lateral fields. 20 pts (47%) received IG-IMRT using Nomos Peacock and daily ultrasound image guidance (BAT, Nomos, Cranberry, PA). For daily ultrasound-based image-guidance, sagittal and axial ultrasound images were acquired, and used to align pt anatomy through superimposition of CT derived organ and vascular guidance structures. Pts were treated using a boost technique to a reduced volume at gross disease after an initial dose to gross tumor and clinically evident microscopic disease. Results: Median dose to target was 54 Gy, with median conventional and IG-IMRT total doses of 48.6 and 60 Gy respectively (p=0.05). Treatment was well tolerated, with only two patients reporting RTOG grade 3 toxicity. All other patients exhibited Grade ≤2, with 23/43 reporting Grade ≤1 The median survival time from the date of registration for all patients was 8.7 months; conventional RT pts had a median survival of 6.1 months, while the IG-IMRT cohort had a median survival of 11.4 months (p = .02). Conclusions: Ultrasound-based image-guided IMRT is a feasible mechanism of delivering moderate dose escalation in conjunction with tighter safety margins, resulting in acceptable acute toxicities. Early survival data with this novel technique are encouraging and demonstrate a notable survival differential using image guided radiotherapy as component of multi-modaility regimens. No significant financial relationships to disclose.

Image-Guided Lateral Suboccipital Approach: Part 2—Impact on Complication Rates and Operation Times

2008 ◽  
Vol 62 (suppl_1) ◽  
pp. ONS24-ONS29 ◽  
Author(s):  
Alireza Gharabaghi ◽  
Steffen K. Rosahl ◽  
Günther C. Feigl ◽  
Sam Safavi-Abbasi ◽  
Javad M. Mirzayan ◽  
...  
Keyword(s):  
Image Guidance ◽  
Postoperative Morbidity ◽  
Three Dimensional ◽  
Air Embolism ◽  
Venous Sinus ◽  
Complication Rates ◽  
Venous Air Embolism ◽  
Image Guided ◽  
Neurosurgical Planning ◽  
The Impact

Abstract Objective: Image-guidance systems are widely available for surgical planning and intraoperative navigation. Recently, three-dimensional volumetric image rendering technology that increasingly applies in navigation systems to assist neurosurgical planning, e.g., for cranial base approaches. However, there is no systematic clinical study available that focuses on the impact of this image-guidance technology on outcome parameters in suboccipital craniotomies. Methods: A total of 200 patients with pathologies located in the cerebellopontine angle were reviewed, 100 of whom underwent volumetric neuronavigation and 100 of whom underwent treatment without intraoperative image guidance. This retrospective study analyzed the impact of image guidance on complication rates (venous sinus injury, venous air embolism, postoperative morbidity caused by venous air embolism) and operation times for the lateral suboccipital craniotomies performed with the patient in the semi-sitting position. Result: This study demonstrated a 4% incidence of injury to the transverse-sigmoid sinus complex in the image-guided group compared with a 15% incidence in the non-image-guided group. Venous air embolisms were detected in 8% of the image-guided patients and in 19% of the non-image-guided patients. These differences in terms of complication rates were significant for both venous sinus injury and venous air embolism (P < 0.05). There was no difference in postoperative morbidity secondary to venous air embolism between both groups. The mean time for craniotomy was 21 minutes in the image-guided group and 39 minutes in non-image-guided group (P = 0.036). Conclusion: Volumetric image guidance provides fast and reliable three-dimensional visualization of sinus anatomy in the posterior fossa, thereby significantly increasing speed and safety in lateral suboccipital approaches.

scholarly journals Psychoakustische Sonifikation zur Navigation in bildgeführter Chirurgie

2020 ◽  
Author(s):  
Tim Ziemer ◽  
Holger Schultheis
Keyword(s):  
High Resolution ◽  
Cognitive Load ◽  
Operating Room ◽  
Image Guidance ◽  
Visual Channel ◽  
Research Project ◽  
Image Guided ◽  
Linear Dimensions

Sonification is the systematic transformation of data to sound. Sonification is a means to communicate information, to support navigation, or to explore data. In a multi-disciplinary research project we develop a psychoacoustically-motivated sonification that supports surgeons’ orientation in image-guided interventions. One drawback of image-guidance is that neither the location of monitors nor the displayed view on the patient’s anatomy coincides with the actual viewpoint of the surgeon. Surgeons need to mentally scale, rotate, and translate the displayed graphics. These operations are cognitively demanding. Sonification can reduce cognitive load and relieve the visual channel to improve the ergonomic situation in the operating room by communicating the location of the target, relative to the tool tip, like the center of a tumor relative to the ablation needle. By means of psychoacoustic sonification we ensure that the sounds are readily interpretable in terms of orthogonal and linear dimensions with a high resolution.

scholarly journals Cost-Effectiveness of Image-Guided Spine Surgery

2010 ◽  
Vol 4 (1) ◽  
pp. 228-233 ◽  
Author(s):  
Robert Green Watkins ◽  
Akash Gupta ◽  
Robert Green Watkins
Keyword(s):  
Pedicle Screw ◽  
Spine Surgery ◽  
Image Guidance ◽  
Pedicle Screws ◽  
Cost Savings ◽  
Cost Effective ◽  
Guidance System ◽  
Screw Placement ◽  
Image Guided ◽  
Time Required

Objective: To determine if image-guided spine surgery is cost effective. Methods: A prospective case series of the first 100 patients undergoing thoracolumbar pedicle screw instrumentation under image-guidance was compared to a retrospective control group of the last 100 patients who underwent screw placement prior to the use of image-guidance. The image-guidance system was NaviVision (Vector Vision-BrainLAB) and Arcadis Orbic (Siemens). Results: The rate of revision surgery was reduced from 3% to 0% with the use of image guidance (p=0.08). The cost savings of image guidance for the placement of pedicle screws was $71,286 per 100 cases. Time required for pedicle screw placement with image guidance was 20 minutes for 2 screws, 29 minutes for 4 screws, 38 minutes for 6 screws, and 50 min for 8 screws. Cost savings for the time required for placement of pedicle screws with image guidance can be estimated by subtracting the time required with currently used techniques without image guidance from the above averages, then multiplying by $93 per minute. The approximate costs of the navigation system is $475,000 ( $225,000 for Vector Vision-BrainLAB and $250,000 for Arcadis Orbic-Siemens). Conclusion: Image guidance for the placement of pedicle screws may be cost effective in spine practices with heavy volume, that perform surgery in difficult cases, and that require long surgical times for the placement of pedicle screws.

Operating room radiation exposure in cone beam computed tomography–based, image-guided spinal surgery

2013 ◽  
Vol 19 (2) ◽  
pp. 226-231 ◽  
Author(s):  
Eric W. Nottmeier ◽  
Stephen M. Pirris ◽  
Steven Edwards ◽  
Sherri Kimes ◽  
Cammi Bowman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Radiation Exposure ◽  
Operating Room ◽  
Cone Beam Computed Tomography ◽  
Spinal Surgery ◽  
Image Guidance ◽  
Cone Beam ◽  
3D Image ◽  
Image Guided ◽  
Radiation Scatter

Object Surgeon and operating room (OR) staff radiation exposure during spinal surgery is a concern, especially with the increasing use of multiplanar fluoroscopy in minimally invasive spinal surgery procedures. Cone beam computed tomography (cbCT)–based, 3D image guidance does not involve the use of active fluoroscopy during instrumentation placement and therefore decreases radiation exposure for the surgeon and OR staff during spinal fusion procedures. However, the radiation scatter of a cbCT device can be similar to that of a standard 64-slice CT scanner and thus could expose the surgeon and OR staff to radiation during image acquisition. The purpose of the present study was to measure radiation exposure at several unshielded locations in the OR when using cbCT in conjunction with 3D image-guided spinal surgery in 25 spinal surgery cases. Methods Five unshielded badge dosimeters were placed at set locations in the OR during 25 spinal surgery cases in which cbCT-based, 3D image guidance was used. The cbCT device (O-ARM) was used in conjunction with the Stealth S7 image-guided platform. The radiology department analyzed the badge dosimeters after completion of the last case. Results Fifty high-definition O-ARM spins were performed in 25 patients for spinal registration and to check instrumentation placement. Image-guided placement of 124 screws from C-2 to the ileum was accomplished without complication. Badge dosimetry analysis revealed minimal radiation exposure for the badges 6 feet from the gantry in the area of the anesthesiology equipment, as well as for the badges located 10–13 feet from the gantry on each side of the room (mean 0.7–3.6 mrem/spin). The greatest radiation exposure occurred on the badge attached to the OR table within the gantry (mean 176.9 mrem/spin), as well as on the control panel adjacent to the gantry (mean 128.0 mrem/spin). Conclusions Radiation scatter from the O-ARM was minimal at various distances outside of and not adjacent to the gantry. Although the average radiation exposure at these locations was low, an earlier study, undertaken in a similar fashion, revealed no radiation exposure when the surgeon stood behind a lead shield. This simple precaution can eliminate the small amount of radiation exposure to OR staff in cases in which the O-ARM is used.

Preliminary results of a prospective trial of image-guided 3D conformal accelerated partial breast irradiation (APBI).

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 125-125
Author(s):  
H. T. Pham ◽  
M. Yao ◽  
G. Song ◽  
K. R. Badiozamani ◽  
C. Salcedo - Wasicek ◽  
...  
Keyword(s):  
Adverse Events ◽  
Image Guidance ◽  
Prospective Trial ◽  
Surgical Margin ◽  
Target Volume ◽  
Accelerated Partial Breast Irradiation ◽  
Partial Mastectomy ◽  
Partial Breast Irradiation ◽  
Image Guided ◽  
Whole Breast Radiotherapy

125 Background: External beam APBI is noninvasive and may offer better coverage of tumor sites in proximity to skin or chest wall than brachytherapy. To improve conformality and accuracy of treatment, we conducted a prospective IRB-approved clinical trial of APBI with implanted gold markers for image guidance. Cosmetic assessments through patient and physician questionnaires were collected. Adverse events were graded according to Common Terminology Criteria for Adverse Events v3.0. This is our preliminary report on toxicity and cosmetic outcomes. Methods: Thirty-four pts were enrolled from 12/06 to 4/10. Eligibility criteria included age > 40, unifocal disease, ductal histology, tumor ≤ 3 cm, surgical margin ≥ 2 mm, and planning target volume: breast volume ratio < 0.2. Vascular invasion, positive axillary nodes, high-grade ductal carcinoma in situ, and extensive intraductal component were excluded. Three gold fiducials were sutured into the operative site at the time of partial mastectomy. The clinical target volume comprised the surgical cavity including all surgical clips and gold fiducials + 10-15 mm. Prescribed dose was 3.85 Gy b.i.d. to 38.5 Gy, using 4–5 non-coplanar beams. Special breathing technique and image guidance with electronic portal imaging were used. Results: Median follow-up is 18 months (range 7-47 months). Most pts had mild acute reactions with only 6% grade 2 erythema. Late toxicities include hyperpigmentation (71% grade 1), fibrosis (26% grade 1, 32% grade 2), skin dimpling or indentation (38% grade 1, 3% grade 2), telangiectasias (12% grade 1), rib fractures in the treatment area (3% grade 2). The only grade 3 toxicity was a seroma requiring surgical excision in one pt. Cosmesis was rated by the pt versus (v.) physician as excellent/good in 85% v. 94%, 80% v. 90%, and 84% v. 85% of the pts at prior to treatment, 6 months, and one year respectively. Ninety-one percent of patients were “totally satisfied with the treatment and results.” No breast recurrences have been observed. Conclusions: Image-guided APBI is well-tolerated, with high patient satisfaction. Early cosmesis results, as assessed by both pts and physicians, are comparable to whole-breast radiotherapy.

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