A Simple Technique for Interventional Tool Placement Combining Fluoroscopy With Interventional Computed Tomography on a C-Arm System

BACKGROUND: Flat-panel cone-beam computed tomography (FP-CBCT) has recently been introduced as a clinical feature in neuroangiography radiographic C-arm systems. OBJECTIVE: To introduce a method of positioning a surgical tool such as a needle or ablation probe within a target specified by intraoperative FP-CBCT scanning. METHODS: Two human cadaver and 2 porcine cadaver heads were injected with a mixture of silicone and contrast agent to simulate a contrast-enhanced tumor. Preoperative imaging was performed using a standard 1.5-T magnetic resonance imaging scanner. Intraoperative imaging was used to define the needle trajectory on a GE Innova 4100 flat panel-based neuroangiography C-arm system. RESULTS: Using a combination of FP-CBCT and fluoroscopy, a needle was successfully positioned within each of the simulated contrast-enhanced tumors, as verified by subsequent FP-CBCT scans. CONCLUSIONS: This proof-of-concept study demonstrates the potential utility of combining FP-CBCT scanning with fluoroscopy to position surgical tools when stereotactic devices and image-guided surgery systems are not available. However, further work is required to fully characterize the precision and accuracy of the method in a variety of realistic surgical sites.