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Interventional non-vascular, Lung, Oncology, CT, PET-CT, Image manipulation / Reconstruction, Biopsy, Perception image, Instrumentation, Image registration, Cancer
G. Bizzarri, A. Bianchini, D. Valle, L. Di Vito, L. Velari, S. De Nuntis, A. Dell'Era; Albano Laziale/IT
Our preliminary study demonstrates that PVNG transthoracic lung biopsies are feasible as the ferromagnetic environment of the CT unit does not significantly affect the accuracy of the EM tracking device according to the experience of Wood et al .
A test with a phantom is however mandatory,
as the results can be related to the specific CT unit used.
The use of a small reference device (i.e.
omniTRAX) allows a small Z-Axis CT scan to be performed during the planning phase,
significantly reducing the radiation dose to the patient.
As regards the cost,
we have to consider that many commercial ultrasound units are currently equipped with EM tracking devices,
as well as software,
with a variety of diagnostic and interventional applications.
A break-even point can be fairly rapidly reached in a standard radiology department.
All these considerations overcome some of the concerns reported by Sarti et al in a previous paper .
The time necessary for the PVNG biopsies is comparable with the time for CT-Fluoroscopy procedures .
that a single step procedure without needle repositioning and manipulation was possible in all cases,
encourages further developments as the reduction in the number of complications can be reasonably expected.
Excessive needle manipulation due to an incorrect initial position can result in pleural laceration,
pneumothorax and hemorrhage .
The evidence that complex and large angulations were frequently used highlights another advantage of PVNG biopsy with respect to CT- fluoroscopy and C-Arm CT .
PVNG biopsy overcomes all limitations and restraints due to gantry-tilting and the geometry of these imaging modalities.
With an increase in the current trend of using of PET to select patients for transthoracic biopsy,
PVNG biopsies with PET-CT fusion can be aimed at the area of abnormal metabolic activity.
This is particularly important in large necrotic tumors or smaller tumors producing large atelectasis.
Larger clinical experiences are needed in order to evaluate the precise role of PVNG for transthoracic biopsy.
as it is less operator dependent, PVNG technique can be considered a step ahead of the cognitive techniques and a valid alternative to C-Arm CT and CT fluoroscopy.
We should consider that further technological improvements are still possible in the field of virtual reality,
allowing the production of inexpensive,
more accurate and more user-friendly systems.
Thanks to virtual reality,
future thoracic biopsies can plausibly be performed outside the CT room,
without the risk of additional radiation exposure to both patient and operator.