Intraoperative Multislice CT: An Important Adjunct to Minimally Invasive Cancer Treatment
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Oral presentation: Interventional Guidance Methods
G.M. Onik1, J. Redan2; 1Florida/US, 2Celebration/US
Purpose
Latest generation multi-slice CT scanners have many theoretical advantages in an operating room environment over other intra-operative imaging modalities, including very fast image acquisition, CT angiographic capability, compatibility with existing OR equipment, and ability to image patients with metal implants. This paper describes our initial experience with intra-operative multi-slice CT and the impact it can potentially have on minimally invasive cancer treatment.
Material and methods
A 16 slice CT scanner (Philips Medical Inc.) was integrated into an OR environment. The scanner has a frameless stereotaxic guidance arm using multi-image formatting (Philips Pinpoint system) for guiding various surgical instruments. A specially designed CT compatible table insert facilitates the holding and guidance of surgical instruments and forms the platform for a patient immobilization device and respiratory gating. The OR was designed to accommodate other imaging modalities such as US and Flouro to give a simultaneous multimodality imaging capability. Patients were treated under general anesthesia and combined surgical/interventional percutaneous procedures were carried out on the CT table.
Results
- Twenty-five patients have now been treated using intra-operative multi-slice CT guidance and monitoring. Abdominal cases constituted 19 cases, chest 3, and brain 3. The system was found to be integral to the guidance of laparoscopic and thoracoscopic procedures aiding in the localization of difficult to find pathology, in combining laparoscopy and image guided procedures such as RF ablation to prevent thermal injury to adjacent structures and in the immediate confirmation of surgical results including tumor resection and the assessment of complications.
Conclusion
Intra-operative multi-slice CT can successfully be integrated into an OR environment. Even at this early stage in our experience it has had a significant impact on our practice of minimally invasive image guided treatment of tumors.
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