Real-Time 3D fluoroscopy guidance during needle interventions: technique, accuracy, and feasibility

Real-time 3D fluoroscopy guidance using cone beam CT with dedicated needle path planning software is a promising new interventional technique. The objective of this study was to evaluate the procedure and to assess the accuracy and feasibility of this technique for use in needle interventions.

All procedures were performed using a flat panel-based fluoroscopy system capable of acquiring cone beam CT images and dedicated needle path-planning software. This new technology allows the use of fluoroscopy coregistered with a 3D data set reconstructed from the acquired attenuation information. The needle trajectory is planned in the 3D data set using the needle path-planning software. The calculated trajectory is then projected on to the real-time fluoroscopy image. Fluoroscopy time, accuracy, technical success of the procedures, median procedure time, and complications were recorded in 145 interventions.

One hundred forty-five needle interventions were performed in 139 patients using real-time 3D fluoroscopy guidance. Procedures were divided into five groups according to anatomic region: upper thoracic (n = 19; 13.1%), lower thoracic (n = 18; 12.4%), upper abdominal (n = 65; 44.8%), lower abdominal (n = 13; 9.0%), and musculoskeletal (n = 30; 20.7%). Thirty needle interventions were therapeutic, and 115 were diagnostic biopsies. All interventions were within the predefined 5-mm safety margin and achieved 100% technical success. A histopathologic diagnosis could be made in 91.4% of the diagnostic biopsies. The median interventional procedure time was 28.5 minutes, and the median fluoroscopy time was 2 minutes 58 seconds. There were minor complications in six patients (4.3%) and one major complication (0.7%).

Real-time 3D fluoroscopy guidance is a new, promising, and feasible technique providing high accuracy in needle interventions.