Cone beam CT guidance provides superior accuracy for complex needle paths compared with CT guidance

Area of Science:

• Medical Imaging
• Interventional Radiology
• Image-Guided Therapy

Background:

• Accurate needle placement is crucial for effective interventional procedures.
• Computed tomography (CT) guidance has limitations with increasing needle path complexity.
• Cone beam CT (CBCT) guidance offers potential improvements in real-time imaging and needle navigation.

Purpose of the Study:

• To compare the accuracy of CBCT guidance versus CT guidance for needle placement in a phantom model.
• To evaluate the impact of needle path complexity (inplane, angulated, double angulated) on guidance accuracy.
• To assess the influence of user experience on CBCT guidance accuracy.

Main Methods:

• A phantom study was conducted using CBCT and CT guidance for needle placement.
• Four interventional radiologists performed needle insertions targeting small lesions.
• Accuracy was quantified as deviation from the target, comparing CBCT and CT across different needle path complexities.

Main Results:

• CBCT guidance demonstrated significantly higher accuracy than CT guidance for double angulated needle paths (2.2 mm vs 6.7 mm, p<0.001).
• CT guidance accuracy decreased with increasing needle path complexity (inplane: 3.3 mm, angulated: 4.4 mm, double angulated: 6.7 mm).
• Experienced CBCT users achieved higher accuracy than trained users for double angulated paths (1.8 mm vs 3.3 mm, p=0.003).

Conclusions:

• CBCT guidance is the preferred modality for accurate needle placement, particularly for complex, double angulated paths.
• CBCT guidance accuracy is maintained irrespective of needle path complexity.
• The findings support CBCT as a superior guidance tool for oncological interventions and other complex procedures.