Image-guided percutaneous removal of intramuscular acupuncture needles using biopsy forceps under computed tomography and fluoroscopy: a report of two cases

Foreign body (FB) aspiration occurs less frequently in adults than in children. Among the complications related to FB aspiration, pneumothorax is rarely reported in adults. Although the majority of FB aspiration cases can be diagnosed easily and accurately by using radiographs and bronchoscopy, some patients are misdiagnosed with endobronchial tumors. We describe a case of airway FB that mimicked an endobronchial tumor presenting with pneumothorax in an adult. A 77-year-old man was referred to our hospital due to pneumothorax and atelectasis of the right upper lobe caused by an endobronchial nodule. A chest tube was immediately inserted to decompress the pneumothorax. Chest computed tomography with contrast revealed an endobronchial nodule that was seen as contrast-enhanced. Flexible bronchoscopy was performed to biopsy the nodule. The bronchoscopy showed a yellow spherical nodule in the right upper lobar bronchus. Rat tooth forceps were used, because the lesion was too slippery to grasp with ellipsoid cup biopsy forceps. The whole nodule was extracted and was confirmed to be a FB, which was determined to be a green pea vegetable. After the procedure, the chest tube was removed, and the patient was discharged without any complications. This case highlights the importance of suspecting a FB as a cause of pneumothorax and presents the possibility of misdiagnosing an aspirated FB as an endobronchial tumor and selecting the appropriate instrument for removing an endobronchial FB.

Download Full-text

Robotic Assistance System for Cone-Beam Computed Tomography-Guided Percutaneous Needle Placement

CardioVascular and Interventional Radiology ◽

10.1007/s00270-021-02938-7 ◽

2021 ◽

Author(s):

Michael Kostrzewa ◽

Andreas Rothfuss ◽

Torben Pätz ◽

Markus Kühne ◽

Stefan O. Schoenberg ◽

...

Keyword(s):

Computed Tomography ◽

Target Lesion ◽

Robotic Arm ◽

Cone Beam ◽

Mean Deviation ◽

Robotic Assistance ◽

Needle Placement ◽

Image Guided ◽

Out Of Plane ◽

Tip Position

Abstract Purpose The study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting. Materials and Methods The RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured. Results In total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214). Conclusion Using this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.

Download Full-text

Surgeon radiation exposure in cone beam computed tomography-based, image-guided spinal surgery

International Journal of Medical Robotics and Computer Assisted Surgery ◽

10.1002/rcs.450 ◽

2011 ◽

Vol 8 (2) ◽

pp. 196-200 ◽

Cited By ~ 25

Author(s):

Eric W. Nottmeier ◽

Cammi Bowman ◽

Kevin L. Nelson

Keyword(s):

Computed Tomography ◽

Radiation Exposure ◽

Cone Beam Computed Tomography ◽

Spinal Surgery ◽

Cone Beam ◽

Image Guided

Download Full-text

325P Preliminary review of computed tomography (CT)-based image-guided brachytherapy (IGBT) in treatment of cervical cancers: The National Cancer Institute (NCI) experience

Annals of Oncology ◽

10.1093/annonc/mdw585.029 ◽

2016 ◽

Vol 27 (suppl_9) ◽

Author(s):

N. Salimin ◽

S. Mohammad ◽

H.L. Goh ◽

S.P. Tang ◽

C.T. Chong ◽

...

Keyword(s):

Computed Tomography ◽

National Cancer Institute ◽

Preliminary Review ◽

Cervical Cancers ◽

Image Guided

Download Full-text

Image-Guided Biopsy for Relapsed Neuroblastoma: Focus on Safety, Adequacy for Genetic Sequencing, and Correlation of Tumor Cell Percent With Quantitative Lesion MIBG Uptake

JCO Precision Oncology ◽

10.1200/po.20.00171 ◽

2021 ◽

pp. 275-285

Author(s):

Andrew Samoyedny ◽

Abhay Srinivasan ◽

Lisa States ◽

Yael P. Mosse ◽

Emma Alai ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Tumor Cell ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Mibg Uptake ◽

Genetic Sequencing ◽

Image Guided ◽

Guided Biopsy

PURPOSE Many novel therapies for relapsed and refractory neuroblastoma require tumor tissue for genomic sequencing. We analyze our experience with image-guided biopsy in these patients, focusing on safety, yield, adequacy for next-generation sequencing (NGS), and correlation of tumor cell percent (TC%) with quantitative uptake on 123I-meta-iodobenzylguanidine (MIBG) single-photon emission computed tomography with computed tomography (SPECT/CT). MATERIALS AND METHODS An 11-year retrospective review of image-guided biopsy on 66 patients (30 female), with a median age of 8.7 years (range, 0.9-49 years), who underwent 95 biopsies (55 bone and 40 soft tissue) of relapsed or refractory neuroblastoma lesions was performed. RESULTS There were seven minor complications (7%) and one major complication (1%). Neuroblastoma was detected in 88% of MIBG- or fluorodeoxyglucose-avid foci. The overall NGS adequacy was 69% (64% in bone and 74% in soft tissue, P = .37). NGS adequacy within neuroblastoma-positive biopsies was 88% (82% bone and 96% soft tissue, P = .11). NGS-adequate biopsies had a greater mean TC% than inadequates (51% v 18%, P = .03). NGS-adequate biopsies had a higher mean number of needle passes (7.5 v 3.4, P = .0002). The mean tissue volume from NGS-adequate soft-tissue lesions was 0.16 cm3 ± 0.12. Lesion:liver and lesion:psoas MIBG uptake ratios correlated with TC% (r = 0.74, r = 0.72, and n = 14). Mean TC% in NGS-adequate samples was 51%, corresponding to a lesion:liver ratio of 2.9 and a lesion:psoas ratio of 9.0. Thirty percent of biopsies showed an actionable ALK mutation or other therapeutically relevant variant. CONCLUSION Image-guided biopsy for relapsed or refractory neuroblastoma was safe and likely to provide NGS data to guide therapy decisions. A lesion:liver MIBG uptake ratio of ≥ 3 or a lesion:psoas ratio of > 9 was associated with a TC% sufficient to deliver NGS results.

Download Full-text