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Bodard S, Guinebert S, Tacher V, Cornelis FH. The Emergence of robotics in liver interventional radiology: Navigating New Frontiers. Eur J Radiol 2024; 175:111482. [PMID: 38691945 DOI: 10.1016/j.ejrad.2024.111482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/03/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Sylvain Bodard
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149 rue de Sèvre, 75015, Paris, France; Sorbonne University, CNRS UMR 7371, INSERM U 1146, Laboratoire d'Imagerie Biomédicale, 75006, Paris, France.
| | - Sylvain Guinebert
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; University of Paris Cité, Department of Radiology, Necker Hospital, 149, Rue de Sèvre, 75015, Paris, France
| | - Vania Tacher
- PARIS EST University, Unité INSERM U955 n°18, AP-HP, Henri Mondor Hospital, Department of Radiology, 94000, Créteil, France
| | - Francois H Cornelis
- Memorial Sloan Kettering Cancer Center (MSK), Department of Radiology, 1275 York Avenue, New York, NY 10065, USA; Sorbonne University, Department of Radiology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France; Weill Cornell Medical College, 1300 York Avenue, New York, NY 10065, USA
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Tappero S, Fallara G, Chierigo F, Micalef A, Ambrosini F, Diaz R, Dorotei A, Pompeo E, Limena A, Bravi CA, Longoni M, Piccinelli ML, Barletta F, Albano L, Mazzone E, Dell'Oglio P. Intraoperative image-guidance during robotic surgery: is there clinical evidence of enhanced patient outcomes? Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06706-w. [PMID: 38607386 DOI: 10.1007/s00259-024-06706-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND To date, the benefit of image guidance during robot-assisted surgery (IGS) is an object of debate. The current study aims to address the quality of the contemporary body of literature concerning IGS in robotic surgery throughout different surgical specialties. METHODS A systematic review of all English-language articles on IGS, from January 2013 to March 2023, was conducted using PubMed, Cochrane library's Central, EMBASE, MEDLINE, and Scopus databases. Comparative studies that tested performance of IGS vs control were included for the quantitative synthesis, which addressed outcomes analyzed in at least three studies: operative time, length of stay, blood loss, surgical margins, complications, number of nodal retrievals, metastatic nodes, ischemia time, and renal function loss. Bias-corrected ratio of means (ROM) and bias-corrected odds ratio (OR) compared continuous and dichotomous variables, respectively. Subgroup analyses according to guidance type (i.e., 3D virtual reality vs ultrasound vs near-infrared fluoresce) were performed. RESULTS Twenty-nine studies, based on 11 surgical procedures of three specialties (general surgery, gynecology, urology), were included in the quantitative synthesis. IGS was associated with 12% reduction in length of stay (ROM 0.88; p = 0.03) and 13% reduction in blood loss (ROM 0.87; p = 0.03) but did not affect operative time (ROM 1.00; p = 0.9), or complications (OR 0.93; p = 0.4). IGS was associated with an estimated 44% increase in mean number of removed nodes (ROM 1.44; p < 0.001), and a significantly higher rate of metastatic nodal disease (OR 1.82; p < 0.001), as well as a significantly lower rate of positive surgical margins (OR 0.62; p < 0.001). In nephron sparing surgery, IGS significantly decreased renal function loss (ROM 0.37; p = 0.002). CONCLUSIONS Robot-assisted surgery benefits from image guidance, especially in terms of pathologic outcomes, namely higher detection of metastatic nodes and lower surgical margins. Moreover, IGS enhances renal function preservation and lowers surgical blood loss.
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Affiliation(s)
- Stefano Tappero
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppe Fallara
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Chierigo
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Department of Urology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Micalef
- Department of General Surgery, Luigi Sacco University Hospital, Milan, Italy
- Università Degli Studi Di Milano, Milan, Italy
| | - Francesca Ambrosini
- Department of Urology, IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Raquel Diaz
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genoa, Italy
| | - Andrea Dorotei
- Department of Orthopaedics, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Edoardo Pompeo
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessia Limena
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Andrea Bravi
- Department of Urology, Northampton General Hospital, Northampton, UK
- Department of Urology, Royal Marsden Foundation Trust, London, UK
| | - Mattia Longoni
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, European Institute of Oncology (IEO), University of Milan, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Albano
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Department of Urology, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
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Bodard S, Guinebert S, Petre EN, Alexander E, Marinelli B, Sarkar D, Cornelis FH. Percutaneous Lung Biopsies With Robotic Systems: A Systematic Review of Available Clinical Solutions. Can Assoc Radiol J 2024:8465371241242758. [PMID: 38581355 DOI: 10.1177/08465371241242758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
Objectives: This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. Methods: A systematic review was performed and identified 4 studies involving robotic systems used for lung biopsy. Outcomes assessed were operation time, radiation dose to patients and operators, technical success rate, diagnostic yield, and complication rate. Results: One hundred and thirteen robot-guided percutaneous lung biopsies were included. Technical success and diagnostic yield were close to 100%, comparable to manual procedures. Technical accuracy, illustrated by needle positioning, showed less frequent needle adjustments in robotic guidance than in manual guidance (P < .001): 2.7 ± 2.6 (range 1-4) versus 6 ± 4 (range 2-12). Procedure time ranged from comparable to reduced by 35% on average (20.1 ± 11.3 minutes vs 31.4 ± 10.2 minutes, P = .001) compared to manual procedures. Patient irradiation ranged from comparable to reduced by an average of 40% (324 ± 114.5 mGy vs 541.2 ± 446.8 mGy, P = .001). There was no significant difference in reported complications between manual biopsy and biopsies that utilized robotic guidance. Conclusion: Robotic systems demonstrate promising results for percutaneous lung biopsy. These devices provide adequate accuracy in probe placement and could both reduce procedural duration and mitigate radiation exposure to patients and practitioners. However, this review underscores the need for larger, controlled trials to validate and extend these findings.
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Affiliation(s)
- Sylvain Bodard
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
- Laboratoire d'Imagerie Biomédicale, Sorbonne University, CNRS UMR 7371, INSERM U 1146, Paris, France
| | - Sylvain Guinebert
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Elena N Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Erica Alexander
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Francois H Cornelis
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
- Weill Cornell Medical College, New York, NY, USA
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Bodard S, Guinebert S, N. Petre E, Marinelli B, Sarkar D, Barral M, H Cornelis F. Percutaneous liver interventions with robotic systems: a systematic review of available clinical solutions. Br J Radiol 2023; 96:20230620. [PMID: 37873927 PMCID: PMC10646656 DOI: 10.1259/bjr.20230620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVE Robotic-guided interventions are emerging techniques that are gradually becoming a common tool for performing biopsies and tumor ablations in liver. This systematic review aims to evaluate their advancements, challenges, and outcomes. METHODS A systematic review was conducted using the PubMed database to identify relevant articles published between January 2000 and February 2023. Inclusion criteria focused on studies that assessed robotic systems for percutaneous liver biopsies and tumor ablations. Data extraction was performed to collect information on study characteristics; robotic systems; components and software; imaging modality; degree of freedom; and needle insertion methods. The outcome measures analyzed were procedure time, radiation dose, and accuracy. RESULTS 10 studies met the inclusion criteria. The robotic devices used included MAXIO, EPIONE, ROBIO-EX, AcuBot, and ACE robotic systems. The data set consisted of 429 percutaneous thermal ablations and 57 biopsies, both robot-guided. On average, the mean deviation of probes was reduced by 30% (from 1.6 vs 3.3 mm to 2.4 vs 3.9 mm (p < 0.001)), and 40% (p < 0.05) fewer readjustments were required during the robotic-assisted interventions. Moreover, robotic systems contributed to a reduction in operating time, ranging from 15% (18.3 vs 21.7 min, p < 0.001) to 25% (63.5 vs 87.4 min, p < 0.001). Finally, the radiation dose delivered to both the patient and the operator was decreased by an average of 50% (p < 0.05) compared to manual procedures. ADVANCES IN KNOWLEDGE Robotic systems could provide precise navigation and guidance during liver biopsies and percutaneous ablations.
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Affiliation(s)
| | - Sylvain Guinebert
- Department of Radiology, University of Paris Cité, Necker Hospital, Paris, France
| | - Elena N. Petre
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Brett Marinelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Debkumar Sarkar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Matthias Barral
- Department of Radiology, Sorbonne University, Tenon Hospital, Paris, France
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Krammer L, Hostettler R, Wetzel S. Evaluation of the Access Cube Patient-Mounted Navigation System for CT-Guided Percutaneous Needle Placement-A Phantom Study. J Vasc Interv Radiol 2023; 34:1809-1814. [PMID: 37406773 DOI: 10.1016/j.jvir.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/13/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Free-hand computed tomography (CT)-guided interventions are common in interventional radiology. Their accuracy and technical success are highly dependent on the skill and experience of the performing interventionalist. This study evaluates a new, patient-mounted navigation device, which aims to facilitate percutaneous interventions-the Access Cube (AC). Sixty punctures were performed on 2 phantoms (rigid vs nonrigid) comparing the Free-Hand Method (FHM) to the AC on measures of accuracy, time, and the need for intraprocedural scans. Using the AC, punctures were significantly more accurate (3.8 mm ± 1.3 mm vs FHM 6.7 mm ± 4.5 mm, P = .004), significantly faster (263.1 s ± 84.4 s vs FHM 411.2 s ± 141.0 s, P < .001) and needed significantly fewer intraprocedural scans (1.4 ± 0.6 vs FHM 2.8 ± 0.4, P < .001). The AC may enable interventionalists to perform faster and more accurate punctures in a clinical setting.
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Affiliation(s)
| | - Rafael Hostettler
- Robotics and Embedded Systems, Technical University Munich, Munich, Germany
| | - Stephan Wetzel
- Medical Templates AG, Egg, Switzerland; Department of Neuroradiology, Hirslanden Clinic Zurich, Zurich, Switzerland
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6
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Johnston EW, Haslam P, Wah TM, Fotiadis N. A survey of liver ablation amongst UK interventional radiologists. Clin Radiol 2023:S0009-9260(23)00139-3. [PMID: 37147230 DOI: 10.1016/j.crad.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/07/2023] [Accepted: 03/27/2023] [Indexed: 05/07/2023]
Abstract
AIM To characterise training for, and conduct of, image-guided liver tumour ablation amongst UK interventional radiologists. MATERIALS AND METHODS A web-based survey of British Society of Interventional Radiology members was carried out between 31 August to 1 October 2022. Twenty-eight questions were designed, covering four domains: (1) respondent background, (2) training, (3) current practice, and (4) operator technique. RESULTS One hundred and six responses were received, with an 87% completion rate and an approximate response rate of 13% of society members. All UK regions were represented, with the majority from London (22/105, 21%). Seventy-two out of 98 (73%) were either extremely or very interested in learning about liver ablation during training, although levels of exposure varied widely, and 37/103 (36%) had no exposure. Performed numbers of cases also varied widely, between 1-10 cases and >100 cases per operator annually. All (53/53) used microwave energy, and most routinely used general anaesthesia (47/53, 89%). Most 33/53 (62%) did not have stereotactic navigation system, and 25/51(49%) always, 18/51 (35%) never, and 8/51(16%) sometimes gave contrast medium (mean 40, SD 32%) after procedures. Fusion software to judge ablation completeness was never used by 86% (43/55), sometimes used by 9% (5/55), and always used by 13% (7/55) of respondents. CONCLUSION Although there are high levels of interest in image-guided liver ablation amongst UK interventional radiologists, training arrangements, operator experience, and procedural technique vary widely. As image-guided liver ablation evolves, there is a growing need to standardise training and techniques, and develop the evidence base to ensure high-quality oncological outcomes.
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Affiliation(s)
- E W Johnston
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London SW36JJ, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
| | - P Haslam
- Interventional Radiology, The Freeman Hospital, Newcastle Upon Tyne NE7 7DN, UK
| | - T M Wah
- Department of Diagnostic and Interventional Radiology, Institute of Oncology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - N Fotiadis
- Interventional Radiology, Royal Marsden Hospital, 203 Fulham Road, London SW36JJ, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK.
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Chen X, Yan Y, Li A, Wang T, Wang Y. Robot-Assisted Needle Insertion for CT-Guided Puncture: Experimental Study with a Phantom and Animals. Cardiovasc Intervent Radiol 2023; 46:128-135. [PMID: 36380153 DOI: 10.1007/s00270-022-03301-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This study aimed to evaluate the accuracy and safety of robotic CT-guided needle insertion in phantom and animal experiments. MATERIALS AND METHODS A robotic system was developed for CT-guided needle insertion. For the phantom experiment, a specially made phantom containing multiple spherical was used. 15 robotic and manual insertions were conducted, and the accuracy, time, number of needle insertions, and radiation dose were compared between the robotic and manual insertion using Student's t-test. For the animal experiment, 20 robotic needle insertions were attempted toward simulated pulmonary nodules in the swine lung. The accuracy and safety of robotic CT-guided needle insertions were evaluated. RESULTS In the phantom experiment, the mean accuracies of manual and robotic insertion were 1.8 ± 0.3 mm and 1.9 ± 0.2 mm. The accuracy of robotic needle insertion had no significant difference with manual needle insertion, but the number of needle insertions and radiation dose of the robotic needle placement significantly decreased compared to manual needle placement. In the animal experiment, the mean accuracy of the robotic needle insertion was 3.8 ± 1.3 mm. The time for the whole needle insertion was 14.4 ± 4.8 min. The whole robotic needle insertions were safe and only one mild pneumothorax occurred. CONCLUSION CT-guided robotic needle insertion showed accuracy comparable to manual needle insertion, but the number of needle insertions, confirmatory scans, and radiation exposure had been reduced significantly. In future, we will further apply the robotic system to clinical experiments.
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Affiliation(s)
- Xiangqian Chen
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yadong Yan
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China
| | - Ailing Li
- Beijing TrueHealth Medical Technology Co., Ltd., Beijing, China
| | - Tianmiao Wang
- School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Yu Wang
- School of Biological Science and Medical Engineering, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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Johnston EW, Fotiadis N, Cummings C, Basso J, Tyne T, Lameijer J, Messiou C, Koh DM, Winfield JM. Developing and testing a robotic MRI/CT fusion biopsy technique using a purpose-built interventional phantom. Eur Radiol Exp 2022; 6:55. [PMID: 36411379 PMCID: PMC9679095 DOI: 10.1186/s41747-022-00308-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Magnetic resonance imaging (MRI) can be used to target tumour components in biopsy procedures, while the ability to precisely correlate histology and MRI signal is crucial for imaging biomarker validation. Robotic MRI/computed tomography (CT) fusion biopsy offers the potential for this without in-gantry biopsy, although requires development. METHODS Test-retest T1 and T2 relaxation times, attenuation (Hounsfield units, HU), and biopsy core quality were prospectively assessed (January-December 2021) in a range of gelatin, agar, and mixed gelatin/agar solutions of differing concentrations on days 1 and 8 after manufacture. Suitable materials were chosen, and four biopsy phantoms were constructed with twelve spherical 1-3-cm diameter targets visible on MRI, but not on CT. A technical pipeline was developed, and intraoperator and interoperator reliability was tested in four operators performing a total of 96 biopsies. Statistical analysis included T1, T2, and HU repeatability using Bland-Altman analysis, Dice similarity coefficient (DSC), and intraoperator and interoperator reliability. RESULTS T1, T2, and HU repeatability had 95% limits-of-agreement of 8.3%, 3.4%, and 17.9%, respectively. The phantom was highly reproducible, with DSC of 0.93 versus 0.92 for scanning the same or two different phantoms, respectively. Hit rate was 100% (96/96 targets), and all operators performed robotic biopsies using a single volumetric acquisition. The fastest procedure time was 32 min for all 12 targets. CONCLUSIONS A reproducible biopsy phantom was developed, validated, and used to test robotic MRI/CT-fusion biopsy. The technique was highly accurate, reliable, and achievable in clinically acceptable timescales meaning it is suitable for clinical application.
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Affiliation(s)
- Edward W. Johnston
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Nicos Fotiadis
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Craig Cummings
- grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Jodie Basso
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK
| | - Toby Tyne
- grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Joost Lameijer
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK
| | - Christina Messiou
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Dow-Mu Koh
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
| | - Jessica M. Winfield
- grid.424926.f0000 0004 0417 0461Royal Marsden Hospital, 203 Fulham Road, London, SW3 6JJ UK ,grid.18886.3fInstitute of Cancer Research, 123 Old Brompton Road, London, SW73RP UK
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Ierardi AM, Grillo P, Bonanno MC, Coppola A, Vespro V, Andrisani MC, Tosi D, Mendogni P, Franzi S, Venturini M, Carrafiello G. Prediction of Ablation Volume in Percutaneous Lung Microwave Ablation: A Single Centre Retrospective Study. Tomography 2022; 8:2475-2485. [PMID: 36287805 PMCID: PMC9607488 DOI: 10.3390/tomography8050206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Percutaneous Microwave Ablation (MWA) of lung malignancies is a procedure with many technical challenges, among them the risk of residual disease. Recently, dedicated software able to predict the volume of the ablated area was introduced. Cone-beam computed tomography (CBCT) is the imaging guidance of choice for pulmonary ablation in our institution. The volumetric prediction software (VPS) has been installed and used in combination with CBCT to check the correct position of the device. Our study aimed to compare the results of MWA of pulmonary tumours performed using CBCT with and without VPS. METHODS We retrospectively reviewed 1-month follow-up enhanced contrast-enhanced computed tomography (CECT) scans of 10 patients who underwent ablation with the assistance of VPS (group 1) and of 10 patients who were treated without the assistance of VPS (group 2). All patients were treated for curative purposes, the maximum axial diameter of lesions ranged between 5 and 22 mm in group 1 and between 5 and 25 mm in group 2. We compared the presence of residual disease between the two groups. RESULTS In group 1 residual disease was seen in only 1 patient (10%) in which VPS had ensured complete coverage of the tumour. In group 2 residual disease was found in 3 patients (30%). CONCLUSIONS Using this software during MWA of lung malignancies could improve the efficacy of the treatment compared to the conventional only CBCT guidance.
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Affiliation(s)
- Anna Maria Ierardi
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Pasquale Grillo
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Maria Chiara Bonanno
- Postgraduate School of Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
| | - Valentina Vespro
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Maria Carmela Andrisani
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sara Franzi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, 21100 Varese, Italy
- Department of Health Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Department of Radiology, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Department of Health Sciences, University of Milan, 20122 Milan, Italy
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Ma L, Liang H, Han B, Yang S, Zhang X, Liao H. Augmented reality navigation with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. Int J Comput Assist Radiol Surg 2022; 17:1543-1552. [PMID: 35704238 DOI: 10.1007/s11548-022-02671-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a novel augmented reality (AR) surgical navigation method with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. A preliminary study is carried out to verify its feasibility. METHODS Two three-dimensional (3D) point clouds of the liver surface are derived from the preoperative images and intraoperative tracked US images, respectively. To compensate for the soft tissue deformation, the point cloud registration between the preoperative images and the liver is performed using the non-rigid iterative closest point (ICP) algorithm. A 3D AR device based on integral videography technology is designed to accurately display naked-eye 3D images for surgical navigation. Based on the above registration, naked-eye 3D images of the liver surface, planning path, entry points, and tumor can be overlaid in situ through our 3D AR device. Finally, the AR-guided targeting accuracy is evaluated through entry point positioning. RESULTS Experiments on both the liver phantom and in vitro pork liver were conducted. Several entry points on the liver surface were used to evaluate the targeting accuracy. The preliminary validation on the liver phantom showed average entry-point errors (EPEs) of 2.34 ± 0.45 mm, 2.25 ± 0.72 mm, 2.71 ± 0.82 mm, and 2.50 ± 1.11 mm at distinct US point cloud coverage rates of 100%, 75%, 50%, and 25%, respectively. The average EPEs of the deformed pork liver were 4.49 ± 1.88 mm and 5.02 ± 2.03 mm at the coverage rates of 100% and 75%, and the average covered-entry-point errors (CEPEs) were 4.96 ± 2.05 mm and 2.97 ± 1.37 mm at 50% and 25%, respectively. CONCLUSION Experimental outcomes demonstrate that the proposed AR navigation method based on US-assisted point cloud registration has achieved an acceptable targeting accuracy on the liver surface even in the case of liver deformation.
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Affiliation(s)
- Longfei Ma
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hanying Liang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Boxuan Han
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Shizhong Yang
- Hepato-Pancreato-Biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
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Huber TC, Bochnakova T, Koethe Y, Park B, Farsad K. Percutaneous Therapies for Hepatocellular Carcinoma: Evolution of Liver Directed Therapies. J Hepatocell Carcinoma 2021; 8:1181-1193. [PMID: 34589446 PMCID: PMC8476177 DOI: 10.2147/jhc.s268300] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/31/2021] [Indexed: 12/13/2022] Open
Abstract
Percutaneous ablation is a mainstay of treatment for early stage, unresectable hepatocellular carcinoma (HCC). Recent advances in technology have created multiple ablative modalities for treatment of this common malignancy. The purpose of this review is to familiarize readers with the technical and clinical aspects of both existing and emerging percutaneous treatment options for HCC.
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Affiliation(s)
- Timothy C Huber
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Teodora Bochnakova
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Yilun Koethe
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Brian Park
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Khashayar Farsad
- Dotter Department of Interventional Radiology, Oregon Health and Science University, Portland, OR, USA
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12
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Strojan P, Grošelj A, Serša G, Plaschke CC, Vermorken JB, Nuyts S, de Bree R, Eisbruch A, Mendenhall WM, Smee R, Ferlito A. Electrochemotherapy in Mucosal Cancer of the Head and Neck: A Systematic Review. Cancers (Basel) 2021; 13:cancers13061254. [PMID: 33809141 PMCID: PMC7999968 DOI: 10.3390/cancers13061254] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
Electrochemotherapy (ECT) is a local ablative treatment that is based on the reversible electroporation and intracellular accumulation of hydrophilic drug molecules, which greatly increases their cytotoxicity. In mucosal head and neck cancer (HNC), experience with ECT is limited due to the poor accessibility of tumors. In order to review the experience with ECT in mucosal HNC, we undertook a systematic review of the literature. In 22 articles, published between 1998 and 2020, 16 studies with 164 patients were described. Curative and palliative intent treatment were given to 36 (22%) and 128 patients (78%), respectively. The majority of tumors were squamous cell carcinomas (79.3%) and located in the oral cavity (62.8%). In the curative intent group, complete response after one ECT treatment was achieved in 80.5% of the patients, and in the palliative intent group, the objective (complete and partial) response rate was 73.1% (31.2% and 41.9%). No serious adverse events were reported during or soon after ECT and late effects were rare (19 events in 17 patients). The quality-of-life assessments did not show a significant deterioration at 12 months post-ECT. Provided these preliminary data are confirmed in randomized controlled trials, ECT may be an interesting treatment option in selected patients with HNC not amenable to standard local treatment.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-5879290
| | - Aleš Grošelj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana and Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Gregor Serša
- Department of Experimental Oncology, Institute of Oncology Ljubljana and Faculty of Health Sciences, University of Primorska, Izola and Faculty of Health Sciences, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital Rigshospitalet, 2100 Copenhagen, Denmark;
| | - Jan B. Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, and Department of Medical Oncology, Antwerp University Hospital, 2650 Edegem, Belgium;
| | - Sandra Nuyts
- Department of Oncology, KU Leuven, University of Leuven and Department of Radiation Oncology, UZ Leuven, 3000 Leuven, Belgium;
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109-5010, USA;
| | - William M. Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385, USA;
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW 2031, Australia;
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy;
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Cornelis FH, Solomon SB. Image guidance in interventional radiology: Back to the future? Diagn Interv Imaging 2020; 101:429-430. [DOI: 10.1016/j.diii.2020.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Takai Takamatsu R, Okano A, Yamakawa G, Mizukoshi K, Obayashi H, Ohana M. Impact of an ultrasound-guided radiofrequency ablation training program on the outcomes in patients with hepatocellular carcinoma. Diagn Interv Imaging 2019; 100:771-780. [PMID: 31477516 DOI: 10.1016/j.diii.2019.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of this study was to retrospectively evaluate the impact of a training program on the safety and efficacy of percutaneous ultrasound-guided radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS A total of 227 patients with 296 HCC nodules who underwent percutaneous RFA with or without transcatheter arterial chemoembolization at our institution were included. There were 163 men and 64 women with a mean age of 74.2±8.3 (SD) years (range: 41-89 years). Percutaneous ultrasound-guided RFA was performed by three trainees (205 HCC nodules in 157 patients) or a mentor (91 HCC nodules in 70 patients) after preprocedural preparation including planning ultrasonography. We compared background-related, tumor-related, and treatment-related factors, and local recurrence and complication rates between the trainee group and the mentor group. Similarly, we compared these variables among the years 2015, 2016, and 2017 for trainee group. RESULTS The proportion of easy-to-treat tumors in the trainee group (109/205; 53.2%) was greater than that in the mentor group (33/91; 36.3%) (P=0.020). No significant differences were observed in procedure difficulty among the years 2015, 2016, and 2017 for trainee group (easy-to-treat HCC nodules: 25/47; 53.2% vs. 39/79; 49.4% vs. 45/79; 57.0%. P=0.775). The local recurrence rate in the trainee group was 8.8% (18/205 HCC nodules) which was equivalent to 7.7% in the mentor group (7/91 HCC nodules). No significant differences were observed in local recurrence rate (8.8% vs. 7.7%, respectively; P=0.621) and major complication rate (1.3% vs. 1.4%, respectively; P=0.999) between the trainee group and the mentor group. No significant differences were observed in local recurrence rates ([5/47; 10.6%] vs. [11/79; 13.9%] vs. [2/79; 2.5%]) (P=0.109) and major complication rates ([1/36; 2.8%] vs. [1/62; 1.6%] vs. [0/59; 0%]) (P=0.701) between the years 2015, 2016, and 2017 for trainee group. CONCLUSION A well supervised training program that includes planning ultrasonography fosters the efficacy and treatment quality of RFA for HCC.
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Affiliation(s)
- R Takai Takamatsu
- Department of Gastroenterology, Tenri Hospital, Nara, Japan; Third Department of Internal Medicine, Nara Medical University, Nara, Japan
| | - A Okano
- Department of Gastroenterology, Tenri Hospital, Nara, Japan.
| | - G Yamakawa
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
| | - K Mizukoshi
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
| | - H Obayashi
- Department of Clinical Pathology, Tenri Hospital, Nara, Japan
| | - M Ohana
- Department of Gastroenterology, Tenri Hospital, Nara, Japan
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15
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Reversible phrenic nerve injury after radiofrequency ablation of lung tumor. Diagn Interv Imaging 2019; 100:725-727. [PMID: 31255573 DOI: 10.1016/j.diii.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 11/20/2022]
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16
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Mokry A, Willmitzer F, Hostettler R, Richter H, Kircher P, Kneissl S, Wetzel S. Evaluation of a novel, patient-mounted system for CT-guided needle navigation—an ex vivo study. Neuroradiology 2018; 61:55-61. [DOI: 10.1007/s00234-018-2107-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 09/24/2018] [Indexed: 02/06/2023]
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17
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Campana LG, Edhemovic I, Soden D, Perrone AM, Scarpa M, Campanacci L, Cemazar M, Valpione S, Miklavčič D, Mocellin S, Sieni E, Sersa G. Electrochemotherapy - Emerging applications technical advances, new indications, combined approaches, and multi-institutional collaboration. Eur J Surg Oncol 2018; 45:92-102. [PMID: 30528893 DOI: 10.1016/j.ejso.2018.11.023] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022] Open
Abstract
The treatment of tumors with electrochemotherapy (ECT) has surged over the past decade. Thanks to the transient cell membrane permeabilization induced by the short electric pulses used by ECT, cancer cells are exposed to otherwise poorly permeant chemotherapy agents, with consequent increased cytotoxicity. The codification of the procedure in 2006 led to a broad diffusion of the procedure, mainly in Europe, and since then, the progressive clinical experience, together with the emerging technologies, have extended the range of its application. Herein, we review the key advances in the ECT field since the European Standard Operating Procedures on ECT (ESOPE) 2006 guidelines and discuss the emerging clinical data on the new ECT indications. First, technical developments have improved ECT equipment, with custom electrode probes and dedicated tools supporting individual treatment planning in anatomically challenging tumors. Second, the feasibility and short-term efficacy of ECT has been established in deep-seated tumors, including bone metastases, liver malignancies, and pancreatic and prostate cancers (long-needle variable electrode geometry ECT), and gastrointestinal tumors (endoscopic ECT). Moreover, pioneering studies indicate lung and brain tumors as suitable future targets. A further advance relates to new combination strategies with immunotherapy, gene electro transfer (GET), calcium EP, and radiotherapy. Finally and fourth, cross-institutional collaborative groups have been established to refine procedural guidelines, promote clinical research, and explore new indications.
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Affiliation(s)
- Luca G Campana
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy.
| | - Ibrahim Edhemovic
- Department of Surgical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Anna M Perrone
- Oncologic Gynecology Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Marco Scarpa
- Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Laura Campanacci
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Sara Valpione
- Christie NHS Foundation Trust, CRUK Manchester Institute, The University of Manchester, Manchester, M20 4GJ, UK
| | - Damijan Miklavčič
- University of Ljubljana, Faculty of Electrical Engineering, Ljubljana, Slovenia
| | - Simone Mocellin
- Department of Surgery Oncology and Gastroenterology (DISCOG), University of Padua, Italy; Surgical Oncology, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Elisabetta Sieni
- Department of Industrial Engineering, University of Padua, Italy
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
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Lyons GR, Pua BB. Ablation Planning Software for Optimizing Treatment: Challenges, Techniques, and Applications. Tech Vasc Interv Radiol 2018; 22:21-25. [PMID: 30765071 DOI: 10.1053/j.tvir.2018.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Percutaneous ablation can deliver effective anticancer therapy with minimal side effects; however, undertreatment can lead to disease recurrence and overtreatment can lead to unnecessary complications. Ablation planning software can support the procedure during the planning, treatment, and follow-up phases. In this review, 2 examples of microwave ablation software are described with attention to how the software can influence procedural choices. In the future, ablation software will entail larger source datasets and more refined algorithms to better model the in vivo ablation zone. Moreover, ablation simulation has the potential to augment clinical care beyond the interventional suite, such as procedural demonstration for patients, clinical consultation with referring providers, documentation for the medical record, and educational simulation for trainees.
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Affiliation(s)
- Gray R Lyons
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Bradley B Pua
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
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Elhelf IS, Albahar H, Shah U, Oto A, Cressman E, Almekkawy M. High intensity focused ultrasound: The fundamentals, clinical applications and research trends. Diagn Interv Imaging 2018; 99:349-359. [DOI: 10.1016/j.diii.2018.03.001] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/22/2018] [Accepted: 03/06/2018] [Indexed: 02/06/2023]
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20
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Probst U, Fuhrmann I, Beyer L, Wiggermann P. Electrochemotherapy as a New Modality in Interventional Oncology: A Review. Technol Cancer Res Treat 2018; 17:1533033818785329. [PMID: 29986632 PMCID: PMC6048674 DOI: 10.1177/1533033818785329] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/01/2018] [Accepted: 05/24/2018] [Indexed: 12/18/2022] Open
Abstract
Electroporation is a well-known phenomenon that occurs at the cell membrane when cells are exposed to high-intensity electric pulses. Depending on electric pulse amplitude and number of pulses, applied electroporation can be reversible with membrane permeability recovery or irreversible. Reversible electroporation is used to introduce drugs or genetic material into the cell without affecting cell viability. Electrochemotherapy refers to a combined treatment: electroporation and drug injection to enhance its cytotoxic effect up to 1000-fold for bleomycin. Since several years, electrochemotherapy is gaining popularity as minimally invasive oncologic treatment. The adoption of electrochemotherapy procedure in interventional oncology poses several unsolved questions, since suitable tumor histology and size as well as therapeutic efficacy still needs to be deepen. Electrochemotherapy is usually applied in palliative settings for the treatment of patients with unresectable tumors to relieve pain and ameliorate quality of life. In most cases, it is used in the treatment of advanced stages of neoplasia when radical surgical treatment is not possible (eg, due to lesion location, size, and/or number). Further, electrochemotherapy allows treating tumor nodules in the proximity of important structures like vessels and nerves as the treatment does not involve tissue heating. Overall, the safety profile of electrochemotherapy is favorable. Most of the observed adverse events are local and transient, moderate local pain, erythema, edema, and muscle contractions during electroporation. The aim of this article is to review the recent published clinical experiences of electrochemotherapy use in deep-seated tumors with particular focus on liver cases. The principle of electrochemotherapy as well as the application to cutaneous metastases is briefly described. A short insight in the treatment of bone metastases, unresectable pancreas cancer, and soft tissue sarcoma will be given. Preclinical and clinical studies on treatment efficacy with electrochemotherapy of hepatic lesions and safety of the procedure adopted are discussed.
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Affiliation(s)
- Ute Probst
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Irene Fuhrmann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
| | - Lukas Beyer
- Städtisches Klinikum Braunschweig, Institut für Röntgendiagnostik und
Nuklearmedizin, Braunschweig, Germany
| | - Philipp Wiggermann
- Universitätsklinikum Regensburg Institut für Röntgendiagnostik, Regensburg,
Germany
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Cornelis F. The interventional oncologist: The fourth musketeer of cancer care. Diagn Interv Imaging 2017; 98:579-581. [DOI: 10.1016/j.diii.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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