Pre‐Procedural Computed Tomography to Guide Needle Insertion During Percutaneous Epicardial Access: “Measure Twice, Stick Once”

Objective: Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques. Methods: During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study. Results: A total of 111 subjects (77 males) with median age 64 (range, 18–86) years and body mass index 25.4 (range, 15.9–50.7) were included. In unit A, tracheal wall was directly exposed; in unit B, limited dissection to enable tracheal palpation was made. In both units, bronchoscopy was used to check the location of an already inserted guiding needle; needle position required correction in 8% and 12% of cases, respectively. In unit C, in tracheostomies without pretracheal tissue dissection, bronchoscopy was used to guide needle insertion; needle position required correction in 66% of cases. Median duration of operations performed by thoracic surgeons and residents was 10 (range, 3–37) min and by intensive care doctors and residents was 16.5 (range, 3–63) min (p < 0.001). Time from the beginning of preparations for tracheostomy until the end of the whole procedure was median 32 min for bedside tracheostomies and 64 min for operations in the operating theatre (p < 0.001). Conclusion: Limited pretracheal tissue dissection enabled proper guiding needle insertion and bronchoscopy was rarely needed. Percutaneous tracheostomies performed by thoracic surgeons took less time, and duration of the whole procedure was remarkably shorter when performed at bedside.

Download Full-text

Vertebral Stenting and Vertebroplasty Guided by an Angiographic 3D Rotational Unit

Case Reports in Orthopedics ◽

10.1155/2015/260240 ◽

2015 ◽

Vol 2015 ◽

pp. 1-7

Author(s):

Escobar-de la Garma Víctor Hugo ◽

Jorge-Barroso Henry Luis ◽

Padilla-Vázquez Felipe ◽

Balderrama-Bañares Jorge Luis

Keyword(s):

Imaging System ◽

Three Dimensional ◽

Compression Fracture ◽

Needle Insertion ◽

Lumbar Pain ◽

High Quality ◽

Interventional Imaging ◽

Flat Panel Detectors ◽

High Resolution Images ◽

Guide Needle

Introduction. Use of interventional imaging systems in minimally invasion procedures such as kyphoplasty and vertebroplasty gives the advantage of high-resolution images, various zoom levels, different working angles, and intraprocedure image processing such as three-dimensional reconstructions to minimize complication rate. Due to the recent technological improvement of rotational angiographic units (RAU) with flat-panel detectors, the useful interventional features of CT have been combined with high-quality fluoroscopy into one single machine. Intraprocedural 3D images offer an alternative way to guide needle insertion and the safe injection of cement to avoid leakages.Case Report. We present the case of a 72-year-old female patient with insidious lumbar pain. Computed tomography revealed a wedge-shaped osteoporotic compression fracture of T10 vertebrae, which was treated successfully with the installation of vertebral stenting system and vertebroplasty with methacrylate guided with a rotational interventional imaging system.Conclusion. Rotational angiographic technology may provide a suitable place for the realization of high-quality minimally invasive spinal procedures, such as kyphoplasty, vertebroplasty, and vertebral stenting. New software programs available nowadays offer the option to make three-dimensional reconstructions with no need of CT scans with the same degree of specificity.

Download Full-text

Robotic needle insertion during computed tomography fluoroscopy–guided biopsy: prospective first-in-human feasibility trial

European Radiology ◽

10.1007/s00330-019-06409-z ◽

2019 ◽

Vol 30 (2) ◽

pp. 927-933 ◽

Cited By ~ 2

Author(s):

Takao Hiraki ◽

Tetsushi Kamegawa ◽

Takayuki Matsuno ◽

Jun Sakurai ◽

Toshiyuki Komaki ◽

...

Keyword(s):

Computed Tomography ◽

Needle Insertion ◽

Feasibility Trial ◽

Guided Biopsy ◽

Computed Tomography Fluoroscopy

Download Full-text

Post-Anesthesia Hookwire Localization of Pulmonary Ground Glass Nodules Guided by Computed-Tomography Three-Dimensional Reconstruction: A Feasibility Study

10.21203/rs.3.rs-332644/v1 ◽

2021 ◽

Author(s):

Chong Wang ◽

Yang Liu ◽

Bo Xiao ◽

Shuku Liu

Keyword(s):

Computed Tomography ◽

Three Dimensional ◽

Effective Rate ◽

Needle Insertion ◽

Ground Glass ◽

Pain Patient ◽

Three Dimensional Reconstruction ◽

Ct Guided ◽

Dimensional Reconstruction ◽

Ground Glass Nodules

Abstract Background: Computed-tomography(CT) guided hookwire localization has disadvantages, such as pain, patient transport risk and increased radiation exposure. In order to overcome the above shortcomings, our method is post-anesthesia hookwire localization guided by preoperative CT three-dimensional reconstruction. The effectiveness and safety of this method will be studied.Methods: A total of 36 patients(36 nodules) with ground glass nodules were consecutively included in this study. Three dimensional reconstruction of chest CT was performed to simulate the puncture path. The puncture point, the depth and angle of needle insertion were recorded. After anesthesia, the puncture point was marked on the patient's body surface. Hookwire was placed according to the previous planned puncture direction and depth. The effectiveness and complications of the localization were evaluated during the operation.Results: Hookwire dislocation was found in 1 patient in operation. The other 35 nodules were successfully positioned. The median distance between hookwire and lesion was 14mm(3-25mm). The effective rate was 97.2%(35/36). Only one patient found a small amount of blood in the chest. There was no pulmonary hematoma, blood pressure or oxygen decreasing in all patients. The complication rate was 2.8% (1/36) and the severe complication was 0. The median time for localization was 3 minutes. Conclusion: Post-anesthesia hookwire localization guided by preoperative three-dimensional reconstruction is a simple, safe and effective localization method, which is suitable for appropriate nodules, and is an important supplement to CT guided localization.Trial registration: ChiCTR1900023853. Registered in Chinese Clinical Trail Registry on 14 June 2019, http://www.chictr.org.cn/showprojen.aspx?proj=40060

Download Full-text

Celiac plexus block: an anatomical study and simulation using computed tomography

Radiologia Brasileira ◽

10.1590/0100-3984.2013.1881 ◽

2014 ◽

Vol 47 (5) ◽

pp. 283-287 ◽

Cited By ~ 4

Author(s):

Gabriela Augusta Mateus Pereira ◽

Paulo Tadeu Campos Lopes ◽

Ana Maria Pujol Vieira dos Santos ◽

Adriane Pozzobon ◽

Rodrigo Dias Duarte ◽

...

Keyword(s):

Computed Tomography ◽

Celiac Trunk ◽

Anatomical Variations ◽

Needle Insertion ◽

Celiac Plexus ◽

Organ Injury ◽

Celiac Plexus Block ◽

Computed Tomography Images ◽

Wide Range ◽

Plexus Block

Objective: To analyze anatomical variations associated with celiac plexus complex by means of computed tomography simulation, assessing the risk for organ injury as the transcrural technique is utilized. Materials and Methods: One hundred eight transaxial computed tomography images of abdomen were analyzed. The aortic-vertebral, celiac trunk (CeT)-vertebral, CeT-aortic and celiac-aortic-vertebral topographical relationships were recorded. Two needle insertion pathways were drawn on each of the images, at right and left, 9 cm and 4.5 cm away from the midline. Transfixed vital organs and gender-related associations were recorded. Results: Aortic-vertebral - 45.37% at left and 54.62% in the middle; CeT-vertebral - T12, 36.11%; T12-L1, 32.4%; L1, 27.77%; T11-T12, 2.77%; CeT-aortic - 53.7% at left and 46.3% in the middle; celiac-aortic-vertebral - L-l, 22.22%; M-m, 23.15%; L-m, 31.48%; M-l, 23.15%. Neither correspondence on the right side nor significant gender-related associations were observed. Conclusion: Considering the wide range of abdominal anatomical variations and the characteristics of needle insertion pathways, celiac plexus block should not be standardized. Imaging should be performed prior to the procedure in order to reduce the risks for injuries or for negative outcomes to patients. Gender-related anatomical variations involved in celiac plexus block should be more deeply investigated, since few studies have addressed the subject.

Download Full-text

Development of a Gripper with Variable Stiffness for a CT-Guided Needle Insertion Robot

Journal of Robotics and Mechatronics ◽

10.20965/jrm.2020.p0692 ◽

2020 ◽

Vol 32 (3) ◽

pp. 692-700

Author(s):

Kento Yokouchi ◽

Tetsushi Kamegawa ◽

Takayuki Matsuno ◽

Takao Hiraki ◽

Takuya Yamaguchi ◽

...

Keyword(s):

Computed Tomography ◽

Interventional Radiology ◽

Interventional Procedures ◽

Variable Stiffness ◽

Needle Insertion ◽

Medical Procedure ◽

Needle Holder ◽

Ct Guided ◽

Jamming Transition ◽

Ct Radiation

In recent years, interventional radiology (IR) as a medical procedure has attracted considerable attention. Among the various IR techniques, computed tomography (CT)-guided IR is performed by inserting a specific needle into a lesion under CT guidance, leading to this medical procedure being less invasive. However, as the procedure requires the doctor to be positioned near the CT, radiation exposure may be a major concern. To overcome this problem, we developed a remote-controlled robotic system for needle insertion during CT-guided interventional procedures. The current needle holder for the robot is risky in that it might hurt a patient since a needle is always held firmly even when the patient moves. To solve this problem, we designed and fabricated a gripper with variable stiffness through jamming transition. Subsequently, we conducted experiments to investigate the effect of elements constituting the gripper to improve its performance.

Download Full-text