Hayet Amalou MD, Presenter: Nothing to Disclose

Jochen Kruecker PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Sheng Xu PhD, Abstract Co-Author: Employee, Koninklijke Philips Electronics NV

Julia Locklin MS, Abstract Co-Author: Nothing to Disclose

Aradhana Mukherjea Venkatesan MD, Abstract Co-Author: Nothing to Disclose

Bradford Johns Wood MD, Abstract Co-Author: Support, Koninklijke Philips Electronics NV Support, Celsion Corporation Advisory Board, Koninklijke Philips Electronics NV Support, Biocompatibles International plc, UK Intellectual Property, Koninklijke Philips Electronics NV Intellectual Property, Traxtal, Inc

Elliot Brian Levy MD, Abstract Co-Author: Nothing to Disclose

Neil Glossop PhD, Abstract Co-Author: Employee, Traxtal, Inc

Ankur Kapoor PhD, Abstract Co-Author: Nothing to Disclose

Peter L. Choyke MD, Abstract Co-Author: Research agreement, Koninklijke Philips Electronics NV Research agreement, General Electric Company Research agreement, Siemens AG

Baris Ismail Turkbey MD, Abstract Co-Author: Nothing to Disclose

Nadine Abi-Jaoudeh MD, Abstract Co-Author: Nothing to Disclose

Peter Pinto, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

The accuracy, clinical utility, and impact upon patient outcomes is defined for multi-modality fusion-guidance for biopsy and RFA.

Commercial and research navigation systems were used in 60 pts undergoing biopsy (18) or RFA (22). 40 procedures were performed in 37 pts with prospective needle guidance and target definition. Some combination of ultrasound (US), CT, PET, or MRI fusion was used for guidance. The role of fusion guidance was determined to be accessory (20), facilitating (21) or enabling (19). In a subset of 15 pts, the needle angles (vectors) were compared between conventional image guidance and fusion guidance in a blinded design. The angles were compared in the ability to aim towards the predetermined point target. Biopsy and RFA were correlated with follow-up pathology and imaging to assess clinical outcomes.  

19 of the 40 procedures were enabled by fusion guidance, where the target could not be defined by standard procedure guidance tools. All 19 of 19 procedures enabled by fusion had outcomes directly impacted by the ability to target the tumor. All 13 biopsies enabled by fusion guidance had diagnostic specimens. In the 15 pts, the physician ability to guide a needle towards a target markedly improved with tracking (needle path off-target error) from 17.8 ± 17.1 mm to 3.3 ± 3.1 mm. Tracking improved the insertion angle by 13.3 ± 6.5 degrees. The RMS error of the registration process was 1.6 ± 0.7 mm. Overall error (defined as the difference between displayed and actual needle tip position) was 3.8 ± 2.3 mm for 35 evaluable pts. This error was reduced to 2.7 ± 1.6 mm with non-rigid registration adjustment. Realtime fusion of ultrasound (US) with CT was most commonly used. Fused PET guidance was used in 8 biopsies and 3 RFA's. All 6 RFA's enabled by fusion guidance were successfully treated (mean 10 mos follow up). 

The error and accuracy of the navigation system is clinically tolerable and fusion guidance improved accurate angle selections over conventional guidance methods for biopsy and ablation. The navigation system was requisite for successful identification and localization of targets, including focal metabolic targets, and this procedures impacted patient outcomes.

Fusion guidance enabled more accurate targeting than standard techniques and directly impacted patient outcomes for RFA and biopsy.

Amalou, H, Kruecker, J, Xu, S, Locklin, J, Venkatesan, A, Wood, B, Levy, E, Glossop, N, Kapoor, A, Choyke, P, Turkbey, B, Abi-Jaoudeh, N, Pinto, P, et al, 0, Clinical Value of Needle Navigation with Multimodality Fusion (Medical GPS) for Biopsy and Ablation.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8012460.html