Percutaneous screw fixation of pelvic bone metastases using cone-beam computed tomography navigation

Evaluation of navigation and robotic systems for percutaneous image-guided interventions: A novel metric for advanced imaging and artificial intelligence integration

PURPOSE

Navigation and robotic systems aim to improve the accuracy and efficiency of percutaneous image-guided interventions, but the evaluation of their autonomy and integration of advanced imaging and artificial intelligence (AI) is lacking. The purpose of this study was to evaluate the level of automation and integration of advanced imaging and artificial intelligence in navigation and robotic systems for percutaneous image-guided interventions, using established and novel metrics to categorize and compare their capabilities.

MATERIALS AND METHODS

Following PRISMA guidelines, a systematic review was conducted to identify studies on clinically validated navigation and robotic systems published between 2000 and May 2024. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data on navigation devices were extracted and analyzed. The levels of autonomy in surgical robotics (LASR) classification system (from 1 to 5) was used to analyze automation. A novel taxonomy, the Levels of Integration of Advanced Imaging and AI (LIAI2) classification system, was created to categorize the integration of imaging technologies and AI (from 1 to 5). These two scores were combined into an aggregate score (from 1 to 10) to reflect the autonomy in percutaneous image-guided intervention.

RESULTS

The review included 20 studies assessing two navigation systems and eight robotic devices. The median LASR score was 1 (Q1, Q3: 1, 1), the median LIAI2 score was 2 (Q1, Q3: 2, 3), and the median aggregate score was 3 (Q1, Q3: 3, 4). Only one robotic system (10 % of those reviewed) achieved the highest LASR qualification in the literature, a level 2/5. Four systems (40 %) shared the highest rating for LIAI2, which was a score of 3/5. Four systems (40 %) achieved the highest aggregate scores of 4/10.

CONCLUSION

None of the navigation and robotic systems achieved full autonomy for percutaneous image-guided intervention. The LASR and LIAI2 scales can guide innovation by identifying areas for further development and integration.

Extra axial bone ablation with augmentation

Pelvic bone metastases frequently result in severe pain and disability. Open surgical reconstruction is associated with a high complication and mortality rate. Percutaneous screw fixation is a minimally invasive treatment that is safe and effective for the management of periacetabular metastases. This article details our technique for pelvic screw fixation, including (1) perioperative care, (2) navigation and needle guidance, (3) access, (4) biopsy and ablation, (5) screw placement, and (6) cement augmentation.

Interventional Oncology: 2024 Update

Interventional Oncology (IO) stands at the forefront of transformative cancer care, leveraging advanced imaging technologies and innovative interventions. This narrative review explores recent developments within IO, highlighting its potential impact facilitated by artificial intelligence (AI), personalized medicine and imaging innovations. The integration of AI in IO holds promise for accelerating tumour detection and characterization, guiding treatment strategies and refining predictive models. Imaging modalities, including functional MRI, PET and cone beam CT are reshaping imaging and precision. Navigation, fusion imaging, augmented reality and robotics have the potential to revolutionize procedural guidance and offer unparalleled accuracy. New developments are observed in embolization and ablative therapies. The pivotal role of genomics in treatment planning, targeted therapies and biomarkers for treatment response prediction underscore the personalization of IO. Quality of life assessment, minimizing side effects and long-term survivorship care emphasize patient-centred outcomes after IO treatment. The evolving landscape of IO training programs, simulation technologies and workforce competence ensures the field's adaptability. Despite barriers to adoption, synergy between interventional radiologists' proficiency and technological advancements hold promise in cancer care.

Management of metastatic bone disease of the pelvis: current concepts

PURPOSE

Metastatic disease of the pelvis is frequently associated with severe pain and impaired ambulatory function. Depending on the patient's characteristics, primary tumor, and metastatic pelvic disease, the treatment choice may be varied. This study aims to report on the current management options of metastatic pelvic disease.

METHODS

We comprehensively researched multiple databases and evaluated essential studies about current concepts of managing a metastatic bone disease of the pelvis, focusing on specific indications as well as on the result of treatment.

RESULTS

Pelvic metastases not in the periacetabular region can be managed with modification of weight-bearing, analgesics, bisphosphonates, chemotherapy and/or radiotherapy. Minimally invasive approaches include radiofrequency ablation, cryoablation, embolization, percutaneous osteoplasty, and percutaneous screw placement. Pathological or impending periacetabular fracture, excessive periacetabular bone defect, radioresistant tumor, and persistent debilitating pain despite non-surgical treatment and/or minimally invasive procedures can be managed with different surgical techniques. Overall, treatment can be divided into nonoperative, minimally invasive, and operative based on specific indications, the expectations of the patient and the lesion.

CONCLUSION

Different treatment modalities exist to manage metastatic pelvic bone disease. Decision-making for the most appropriate treatment should be made with a multidisciplinary approach based on a case-by-case basis.

Perspectives of Cone-beam Computed Tomography in Interventional Radiology: Techniques for Planning, Guidance, and Monitoring

Cone-beam computed tomography (CBCT) has emerged as a prominent imaging modality in interventional radiology that offers real-time visualization and precise guidance in various procedures. This article aims to provide an overview of the techniques used to guide and monitor interventions that use CBCT. It discusses the advantages of CBCT, its current applications, and potential future CBCT-related developments in the field of interventional radiology.

Middle meningeal artery embolization using cone-beam computed tomography augmented guidance in patients with cancer

PURPOSE

The purpose of this study was to evaluate the safety and efficacy of middle meningeal artery embolization (MMAE) performed under cone-beam computed tomography (CBCT) augmented guidance in patients with cancer.

MATERIALS AND METHODS

Eleven patients with cancer (seven women, four men; median age, 75 years; age range: 42-87 years) who underwent 17 MMAEs under CBCT with a combination of particles and coils for chronic subdural hematoma (SDH) (n = 6), postoperative SDH (n = 3), or preoperative embolization of meningeal tumor (n = 2) from 2022 to 2023 were included. Technical success, fluoroscopy time (FT), reference dose (RD), kerma area product (KAP) were analyzed. Adverse events and outcomes were recorded.

RESULTS

The technical success rate was 100% (17/17). Median MMAE procedure duration was 82 min (interquartile range [IQR]: 70, 95; range: 63-108 min). The median FT was 24 min (IQR: 15, 48; range: 21.5-37.5 min); the median RD was 364 mGy (IQR: 37, 684; range: 131.5-444.5 mGy); and the median KAP was 46.4 Gy.cm2 (9.6, 104.5; range: 30.2-56.6 Gy.cm2). No further interventions were needed. The adverse event rate was 9% (1/11), with one pseudoaneurysm at the puncture site in a patient with thrombocytopenia, which was treated by stenting. The median follow-up was 48 days (IQR; 14, 251; range: 18.5-91 days]. SDH reduced in 11 of 15 SDHs (73%) as evidenced by follow-up imaging, with a size reduction greater than 50% in 10/15 SDHs (67%) .

CONCLUSION

MMAE under CBCT is a highly effective treatment option, but appropriate patient selection and careful consideration of potential risks and benefits is important for optimal patient outcomes.

Initial Characterization of Focal Bone Lesions with Conventional Radiographs or Computed Tomography: Diagnostic Performance and Interobserver Agreement Assessment

Objectives: To ascertain the role of CT and conventional radiographs for the initial characterization of focal bone lesions.Methods: Images from 184 patients with confirmed bone tumors included in an ethics committee-approved study were retrospectively evaluated. The reference for benign-malignant distribution was based on histological analysis and long-term follow-up. Radiographs and CT features were analyzed by 2 independent musculoskeletal radiologists blinded to the final diagnosis. Lesion margins, periosteal reaction, cortical lysis, endosteal scalloping, presence of pathologic fracture, and lesion mineralization were evaluated. Results: The benign-malignant distribution in the study population was 68.5-31.5% (126 benign and 58 malignant). In the lesions that could be seen in both radiographs and CT, the performance of these methods for the benign-malignant differentiation was similar (accuracy varying from 72.8% to 76.5%). The interobserver agreement for the overall evaluation of lesion aggressiveness was considerably increased on CT compared to radiographs (Kappa of .63 vs .22). With conventional radiographs, 18 (9.7%) and 20 (10.8%) of the lesions evaluated were not seen respectively by readers 1 and 2. Among these unseen lesions, 50%-61.1% were located in the axial skeleton. Compared to radiographs, the number of lesions with cortical lysis and endosteal scalloping was 26-34% higher with CT. Conclusion: Although radiographs remain the primary imaging tool for lesions in the peripheral skeleton, CT should be performed for axial lesions. CT imaging can assess the extent of perilesional bone lysis more precisely than radiographs with a better evaluation of lesion fracture risk.