MA02.04 Initial Experience of Hybrid Operating Room Cone-Beam CT Guided Bronchoscopic Microwave Thermal Ablation of Peripheral Small Lung Lesions

Background: The aim of this study was to evaluate the diagnostic capacity of Cone-Beam computed tomography (CT)-guided transthoracic percutaneous biopsies on lung lesions in our setting and to detect risk factors for possible complications. Methods: Retrospective study of 98 biopsies in 94 patients, performed between May 2017 and January 2020. To obtain them, a 17G coaxial puncture system and a Siemens Artis Zee Floor vc21 archwire were used. Descriptive data of the patients, their position at the time of puncture, location and size of the lesions, number of cylinders extracted, and complications were recorded. Additionally, the fluoroscopy time used in each case, the doses/area and the estimated total doses received by the patients were recorded. Results: Technical success was 96.8%. A total of 87 (92.5%) malignant lesions and 3 (3.1%) benign lesions were diagnosed. The sensitivity was 91.5% and the specificity was 100%. We registered three technical failures and three false negatives initially. Complications included 38 (38.8%) pneumothorax and 2 (2%) hemoptysis cases. Fluoroscopy time used in each case was 4.99 min and the product of the dose area is 11,722.4 microGy/m2. Conclusion: The transthoracic biopsy performed with Cone-Beam CT is accurate and safe in expert hands for the diagnosis of lung lesions. Complications are rare and the radiation dose used was not excessive.

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Intraoperative cone beam CT in hybrid operating room set-up as an alternative to postoperative CT for pedicle screw breach detection

10.21203/rs.3.rs-256928/v1 ◽

2021 ◽

Author(s):

Simon Peh ◽

Julian Pfarr ◽

Jost Philipp Schäfer ◽

Jan-Hendrik Christensen ◽

Anindita Chatterjea ◽

...

Keyword(s):

Radiation Dose ◽

Pedicle Screw ◽

Operating Room ◽

Cone Beam Ct ◽

Pedicle Screws ◽

Roc Curves ◽

Cone Beam ◽

Screw Placement ◽

Hybrid Operating Room ◽

Effective Radiation Dose

Abstract Background CT is considered the gold standard for detecting pedicle breach. However, CBCT may be a viable and low radiation dose alternative, to provide intraoperative feedback to surgeons to permit in-room revisions of misplaced screws Methods To assess the ability and reliability of intraoperative cone-beam CT (CBCT) from a robotic C-arm in a hybrid operating room (OR) two hundred forty-one pedicle screws were inserted in cervical, thoracic and lumbar spine of 7 cadavers, followed by CBCT and CT imaging. The CT images served as the standard of reference. Agreement on screw placement between both imaging systems was assessed using Cohen’s Kappa coefficient (κ). Sensitivity, Specificity, Receiver operating characteristic (ROC), area under the empirical and fitted ROC curves (AUC) were computed to assess CBCT as a diagnostic tool compared to CT. The patient effective radiation dose (ED) was calculated for comparison. A systematic literature review was performed to provide perspective to the obtained results. Results Almost perfect agreement in assessing pedicle screw grading between CBCT and CT was observed (κ = 0.84). The sensitivity and specificity of CBCT were 0.84 and 0.98, respectively. The AUC derived from the empirical and fitted ROC curves were 0.95 and 0.96, respectively. Conclusion Intraoperative CBCT by C-arm in a hybrid OR is highly reliable in identification of screw placement at significant dose reduction.

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Ciliated muconodular papillary tumor with a growing cavity shadow that mimicked colorectal metastasis to the lung: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01012-7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Kotaro Murakami ◽

Yojiro Yutaka ◽

Naoki Nakajima ◽

Akihiko Yoshizawa ◽

Hiroshi Date

Keyword(s):

Colorectal Cancer ◽

Operating Room ◽

Lung Tumor ◽

Cone Beam Ct ◽

Cone Beam ◽

Small Lesion ◽

Hybrid Operating Room ◽

Papillary Tumor ◽

Preoperative Marking ◽

Dye Marking

Abstract Background Ciliated muconodular papillary tumor (CMPT) is a rare papillary nodule tumor with benign and malignant characteristics that occurs in the peripheral lung. Case presentation A 70-year-old woman who underwent right hemicolectomy for colorectal cancer (CRC; pT3N0M0, p-stage II) 2 years prior, presented with a sub-centimeter growing cavity shadow on chest computed tomography (CT), which was suspected to be a CRC metastasis. Because positron emission tomography CT suggested there was no other site suspicious of recurrence, thoracoscopic resection with preoperative pleural dye marking was planned to remove the small lesion, which seemed to be hardly palpable on CT. Immediately after pleural dye marking adjacent to the lesion using cone beam CT in the hybrid operating room, thoracoscopic wedge resection was performed and the tumor was finally diagnosed as CMPT, characterized by the papillary growth of mucus-producing cells in the alveoli. Conclusion We resected the non-palpable small lung lesions following preoperative marking using cone-beam CT in the hybrid operating room. This case highlights a rare cavitary CT image of a CMPT mimicking a metastatic lung tumor from colorectal cancer.

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