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Fischer E, Gebremeskel M, Stoianovici D, Sharma K, Cleary K. A novel pneumatic drill for bone biopsy under MRI imaging. Int J Comput Assist Radiol Surg 2024; 19:405-409. [PMID: 38148438 DOI: 10.1007/s11548-023-03042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 11/22/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Bone biopsies are currently conducted under computed tomography (CT) guidance using a battery-powered drill to obtain tissue samples for diagnosis of suspicious bone lesions. However, this procedure is suboptimal as images produced under CT lack soft tissue discrimination and involve ionizing radiation. Therefore, our team developed an MRI-safe pneumatic drill to translate this clinical workflow into the MR environment, which can improve target visualization and eliminate radiation exposure. We compare drill times and quality of samples between the 2 drills using animal bones. METHODS Five porcine spare rib bones were obtained from a butcher shop. Each bone was drilled twice using the Arrow OnControl battery-powered drill and twice using our pneumatically actuated drill. For this study, we used an 11-gauge bone biopsy needle set with an internal core capturing thread. A stopwatch recorded the overall time of drilling for each specimen obtained. RESULTS All 20 samples collected contained a high-quality inner core and cortex. The total average time for drilling with the pneumatic drill was 8.5 s (+ / - 2.5 s) and 7.1 s (+ / - 1.4 s) with the standard battery-powered drill. CONCLUSION Both drills worked well and were able to obtain comparable specimens. The pneumatic drill took slightly longer, 1.39 s on average, but this extra time would not be significant in clinical practice. We plan to use the pneumatic drill to enable MRI-safe bone biopsy for musculoskeletal lesions. Biopsy under MRI would provide excellent lesion visualization with no ionizing radiation.
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Affiliation(s)
- Elizabeth Fischer
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA.
| | - Mikias Gebremeskel
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Dan Stoianovici
- Brady Urological Institute, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Karun Sharma
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Kevin Cleary
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
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Deng X, Duan Z, Fang S, Wang S. Advances in The Application and Research of Magnetic Resonance Diffusion Kurtosis Imaging in The Musculoskeletal System. J Magn Reson Imaging 2023; 57:670-689. [PMID: 36200754 DOI: 10.1002/jmri.28463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance diffusion kurtosis imaging (DKI) is an emerging magnetic resonance imaging (MRI) technique that can reflect microstructural changes in tissue through non-Gaussian diffusion of water molecules. Compared to traditional diffusion weighted imaging (DWI), the DKI model has shown greater sensitivity for diagnosis of musculoskeletal diseases and can help formulate more reasonable treatment plans. Moreover, DKI is an important auxiliary examination for evaluation of the motor function of the musculoskeletal system. This article briefly introduces the basic principles of DKI and reviews the application and research of DKI in the evaluation of disorders of the musculoskeletal system (including bone tumors, soft tissue tumors, spinal lesions, chronic musculoskeletal diseases, musculoskeletal trauma, and developmental disorders) as well as the normal musculoskeletal tissues. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: 1.
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Affiliation(s)
- Xiyang Deng
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Zhiqing Duan
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shaobo Fang
- Department of Medical Imaging, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, Henan, China.,Academy of Medical Sciences, Zhengzhou University, Zhengzhou, Henan, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
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Thompson SM, Gorny KR, Koepsel EMK, Welch BT, Mynderse L, Lu A, Favazza CP, Felmlee JP, Woodrum DA. Body Interventional MRI for Diagnostic and Interventional Radiologists: Current Practice and Future Prospects. Radiographics 2021; 41:1785-1801. [PMID: 34597216 DOI: 10.1148/rg.2021210040] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical use of MRI for guidance during interventional procedures emerged shortly after the introduction of clinical diagnostic MRI in the late 1980s. However, early applications of interventional MRI (iMRI) were limited owing to the lack of dedicated iMRI magnets, pulse sequences, and equipment. During the 3 decades that followed, technologic advancements in iMRI magnets that balance bore access and field strength, combined with the development of rapid MRI pulse sequences, surface coils, and commercially available MR-conditional devices, led to the rapid expansion of clinical iMRI applications, particularly in the field of body iMRI. iMRI offers several advantages, including superior soft-tissue resolution, ease of multiplanar imaging, lack of ionizing radiation, and capability to re-image the same section. Disadvantages include longer examination times, lack of MR-conditional equipment, less operator familiarity, and increased cost. Nonetheless, MRI guidance is particularly advantageous when the disease is best visualized with MRI and/or when superior soft-tissue contrast is needed for treatment monitoring. Safety in the iMRI environment is paramount and requires close collaboration among interventional radiologists, MR physicists, and all other iMRI team members. The implementation of risk-limiting measures for personnel and equipment in MR zones III and IV is key. Various commercially available MR-conditional needles, wires, and biopsy and ablation devices are now available throughout the world, depending on the local regulatory status. As such, there has been tremendous growth in the clinical applications of body iMRI, including localization of difficult lesions, biopsy, sclerotherapy, and cryoablation and thermal ablation of malignant and nonmalignant soft-tissue neoplasms. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Scott M Thompson
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Krzysztof R Gorny
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Erica M Knavel Koepsel
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Brian T Welch
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Lance Mynderse
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Aiming Lu
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Christopher P Favazza
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - Joel P Felmlee
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
| | - David A Woodrum
- From the Department of Radiology (S.M.T., K.R.G., E.M.K.K., B.T.W., A.L., C.P.F., J.P.F., D.A.W.), Division of Vascular and Interventional Radiology (S.M.T.), and Department of Urology (L.M.), Mayo Clinic, 200 1st St SW, Rochester, MN 55905
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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