- Email: [email protected]
A modified abdominal compression device to facilitate CT fluoroscopy-guided percutaneous interventions
JVIR
’
Posters and Exhibits
S197
2. Learn how to safely perform a percutaneous and transjugular liver biopsy. 3. Understand the interventional radiology management of liver biopsy complicated by hemorrhage and fistulation.
Educational Exhibit
Abstract No. 451
A modified abdominal compression device to facilitate CT fluoroscopy-guided percutaneous interventions N.R. Chauhan, J.F. Chick, P.B. Shyn; Radiology, Brigham & Women’s Hospital/Harvard Medical School, Boston, MA Learning Objectives: 1. Provide indications for the use of an abdominal compression device to improve access to a target during CT fluoroscopy-guided interventions. 2. Describe a modified commercially available fluoroscopic compression device. 3. Provide cased-based-examples in which the abdominal compression device was used. Background: CT-guided percutaneous abdominal interventions including biopsies and catheter drainages are common procedures in any interventional practice. While most targets, i.e. masses, lymph nodes, and fluid collections are readily accessible, many can be technically challenging due to intervening critical structures or may have a skin to target distance greater than the length of available needles. For structures that are relatively mobile, predominantly digestive and vascular organs, an abdominal compression device can be utilized to displace these structures, thereby creating a clear pathway to the intended target. Such a device can also employed to decrease the skin to target distance thereby allowing access to deeper targets. Abdominal compression devices have been described in the past, however have used materials which may not be readily available, require recreation of the device with every patient, or make manipulating the access needle relatively difficult. Clinical Findings/Procedure Details: 1. Using an F-Spoon device, a slit and hole can be cut using a drill and saw into the spoon portion of the device. 2. Intraprocedurally, the device is covered with a sterile ultrasound transducer cover and rubber bands making it sterile and reusable. 3. The modified spoon portion can be employed as a compression device and to steer the needle without exposing the operator’s hand to the CT beam. 4. After the procedure, the sterile cover is removed, the device cleaned, and reused for subsequent procedures. 5. Provide several case examples illustrating the use of the abdominal compression device.
1. A fluoroscopic compression paddle can be easily modified into a device that facilitates CT fluoroscopy-guided percutaneous abdominal interventions. 2. This device can be used to displace critical structures, shorten skin to target distance, and steer access needles while minimizing operator radiation dose.
Abstract No. 452
Ongoing experience with ultrasound-guided transhepatic radiofrequency ablation of renal tumors R.J. Knebel1, C. Bent1, V. Bamra2, L. Wright1, J.M. Brock1, J.P. McGahan1; 1Radiology, UC Davis, Sacramento, CA; 2 Specialty Division, Aurora Medical Group, Milwaukee, WI Learning Objectives: To describe the technical approach, saf ety and effectiveness of ultrasound-guided radiofrequency ablation of right renal tumors utilizing a transhepatic approach. Background: Radiofrequency ablation (RFA) is an accepted method of treating stage T1 renal cell carcinoma, especially in patients who are poor surgical candidates. The majority of these procedures are performed utilizing a percutaneous CT-guided approach, with avoidance of the liver. However, an ultrasoundguided transhepatic approach is sometimes advantageous in approaching select cases of right upper pole and right mid kidney lesions. We describe 12 cases in which right renal masses were treated with ultrasound-guided radiofrequency ablation utilizing a transhepatic approach. Technical effectiveness and complication rates were assessed, in comparison to 12 right renal RFA cases performed utilizing a standard CT-guided approach. Clinical Findings/Procedure Details: In each transhepatic case, real-time sonographic evaluation of the liver and right kidney was used to determine the optimal approach to the target lesion, avoid vascular structures during electrode placement, monitor cauterization of the liver tract, and check for postprocedural hemorrhage. 11 out of 12 RFA procedures in both the transhepatic and non-transhepatic groups were technically successful. A single grade 2 complication occurred in the transhepatic group that was not directly related to the technique. Conclusion and/or Teaching Points: The ultrasound-guided transhepatic approach provides a safe and efficacious targeting method for RFA of right upper pole and right mid renal tumors. Careful consideration should be given to avoid intervening blood vessels during electrode placement, cauterize the hepatic tract during electrode withdrawal, and monitor for any post-procedural bleeding complication. References 1. McGahan J P, Ro K M, Evans C P, & Ellison L M. Efficacy of transhepatic radiofrequency ablation of renal cell carcinoma. AJR, American journal of roentgenology. 2006;186(5 Suppl):S311-5. 2. Hegg R M, Schmit G D, Kurup A N, Weisbrod A J, Boorjian S A, et al. Ultrasound-guided transhepatic radiofrequency ablation of renal tumors: a safe and effective approach. Cardiovascular and interventional radiology. 2014;37(2):508-12.
Educational Exhibit
Abstract No. 453
The role of interventional radiology in obstetrics V. Demers, J.R. Kachura; Vascular and Interventional Radiology, Toronto General Hospital, Toronto, ON, Canada Learning Objectives: 1) To gain an overview of the ways in which Interventional Radiology (IR) may benefit obstetrical patients.
Posters and Exhibits
Conclusion and/or Teaching Points:
Educational Exhibit
’
Posters and Exhibits
S197
2. Learn how to safely perform a percutaneous and transjugular liver biopsy. 3. Understand the interventional radiology management of liver biopsy complicated by hemorrhage and fistulation.
Educational Exhibit
Abstract No. 451
A modified abdominal compression device to facilitate CT fluoroscopy-guided percutaneous interventions N.R. Chauhan, J.F. Chick, P.B. Shyn; Radiology, Brigham & Women’s Hospital/Harvard Medical School, Boston, MA Learning Objectives: 1. Provide indications for the use of an abdominal compression device to improve access to a target during CT fluoroscopy-guided interventions. 2. Describe a modified commercially available fluoroscopic compression device. 3. Provide cased-based-examples in which the abdominal compression device was used. Background: CT-guided percutaneous abdominal interventions including biopsies and catheter drainages are common procedures in any interventional practice. While most targets, i.e. masses, lymph nodes, and fluid collections are readily accessible, many can be technically challenging due to intervening critical structures or may have a skin to target distance greater than the length of available needles. For structures that are relatively mobile, predominantly digestive and vascular organs, an abdominal compression device can be utilized to displace these structures, thereby creating a clear pathway to the intended target. Such a device can also employed to decrease the skin to target distance thereby allowing access to deeper targets. Abdominal compression devices have been described in the past, however have used materials which may not be readily available, require recreation of the device with every patient, or make manipulating the access needle relatively difficult. Clinical Findings/Procedure Details: 1. Using an F-Spoon device, a slit and hole can be cut using a drill and saw into the spoon portion of the device. 2. Intraprocedurally, the device is covered with a sterile ultrasound transducer cover and rubber bands making it sterile and reusable. 3. The modified spoon portion can be employed as a compression device and to steer the needle without exposing the operator’s hand to the CT beam. 4. After the procedure, the sterile cover is removed, the device cleaned, and reused for subsequent procedures. 5. Provide several case examples illustrating the use of the abdominal compression device.
1. A fluoroscopic compression paddle can be easily modified into a device that facilitates CT fluoroscopy-guided percutaneous abdominal interventions. 2. This device can be used to displace critical structures, shorten skin to target distance, and steer access needles while minimizing operator radiation dose.
Abstract No. 452
Ongoing experience with ultrasound-guided transhepatic radiofrequency ablation of renal tumors R.J. Knebel1, C. Bent1, V. Bamra2, L. Wright1, J.M. Brock1, J.P. McGahan1; 1Radiology, UC Davis, Sacramento, CA; 2 Specialty Division, Aurora Medical Group, Milwaukee, WI Learning Objectives: To describe the technical approach, saf ety and effectiveness of ultrasound-guided radiofrequency ablation of right renal tumors utilizing a transhepatic approach. Background: Radiofrequency ablation (RFA) is an accepted method of treating stage T1 renal cell carcinoma, especially in patients who are poor surgical candidates. The majority of these procedures are performed utilizing a percutaneous CT-guided approach, with avoidance of the liver. However, an ultrasoundguided transhepatic approach is sometimes advantageous in approaching select cases of right upper pole and right mid kidney lesions. We describe 12 cases in which right renal masses were treated with ultrasound-guided radiofrequency ablation utilizing a transhepatic approach. Technical effectiveness and complication rates were assessed, in comparison to 12 right renal RFA cases performed utilizing a standard CT-guided approach. Clinical Findings/Procedure Details: In each transhepatic case, real-time sonographic evaluation of the liver and right kidney was used to determine the optimal approach to the target lesion, avoid vascular structures during electrode placement, monitor cauterization of the liver tract, and check for postprocedural hemorrhage. 11 out of 12 RFA procedures in both the transhepatic and non-transhepatic groups were technically successful. A single grade 2 complication occurred in the transhepatic group that was not directly related to the technique. Conclusion and/or Teaching Points: The ultrasound-guided transhepatic approach provides a safe and efficacious targeting method for RFA of right upper pole and right mid renal tumors. Careful consideration should be given to avoid intervening blood vessels during electrode placement, cauterize the hepatic tract during electrode withdrawal, and monitor for any post-procedural bleeding complication. References 1. McGahan J P, Ro K M, Evans C P, & Ellison L M. Efficacy of transhepatic radiofrequency ablation of renal cell carcinoma. AJR, American journal of roentgenology. 2006;186(5 Suppl):S311-5. 2. Hegg R M, Schmit G D, Kurup A N, Weisbrod A J, Boorjian S A, et al. Ultrasound-guided transhepatic radiofrequency ablation of renal tumors: a safe and effective approach. Cardiovascular and interventional radiology. 2014;37(2):508-12.
Educational Exhibit
Abstract No. 453
The role of interventional radiology in obstetrics V. Demers, J.R. Kachura; Vascular and Interventional Radiology, Toronto General Hospital, Toronto, ON, Canada Learning Objectives: 1) To gain an overview of the ways in which Interventional Radiology (IR) may benefit obstetrical patients.
Posters and Exhibits
Conclusion and/or Teaching Points:
Educational Exhibit