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First experience with iGuide navigational software application for bone biopsies in pediatric interventional radiology
JVIR
’
Scientific Session
Wednesday
for retrograde interventional radiology approaches as well as surgical and endoscopic techniques.
4:33 PM
Abstract No. 282
’ FEATURED ABSTRACT Antegrade gastrostomy insertion in very low weight infants – is it safe? S. Stuart, P.A. Patel, S. Chippington, C. Gibson, A. Barnacle, D. Roebuck; Great Ormond Street Hospital for Children, London, United Kingdom
4:42 PM
Abstract No. 283
Percutaneous CT-guided vertebral biopsies in children S. Sierre1, D. Teplisky1, M. Garriga1, M. Noel2, N. Gonzalez1, E. Bersusky2, J. Lipsich1; 1Interventional Radiology, Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentina; 2Spinal Surgery, Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentina
S131
Purpose: Percutaneous biopsies are a minimally invasive tool that allows early and definitive diagnosis for different lesions affecting the vertebral bodies, leading to appropriate therapeutic decisions. The aim of this study was to evaluate the safety and diagnostic yield of CT-guided percutaneous vertebral biopsies in children. Materials and Methods: Retrospective review of 82 percutaneous vertebral biopsies performed in 75 patients between March 2002 and December 2012. The mean patient age was 6.4 years [3 months-18 ys-old]. The location of lesions was distributed as follows: cervical (n¼14), thoracic (n¼24), lumbar spine (n ¼ 38), sacrum (n ¼ 6). All procedures were performed under general anesthesia and CT guidance. Data collected included: type of lesion, complications, assessment of the specimen (sufficient or not) and pathologic diagnosis. Results: From the 82 biopsies performed, in 75 (91.4%) the specimen was considered adequate for pathological evaluation. From this group, in 68 cases (82.9%) a definitive diagnosis was reached. In the remaining 7 cases, a definitive diagnosis, despite the good quality of the specimen, was not achieved. Regarding etiology, pathologies were distributed as follows: infectious disease (30/68, 44%), histiocytosis (19/68, 28%), benign tumors (5/68, 7%) and malignant tumors (14/68, 20%). There were no major complications related to the procedure. Conclusion: Percutaneous vertebral biopsies in this age group are safe and effective for the diagnosis of spinal lesions, with a high degree of diagnostic accuracy. These results are comparable to those published in series of adult patients.
4:51 PM
Abstract No. 284
First experience with iGuide navigational software application for bone biopsies in pediatric interventional radiology T. Hwang1,2, T. Kurzendorfer2, E. Girard2, X. Zhu1, A. Cahill1; 1Children0 s Hospital of Philadelphia, Philadelphia, PA; 2Siemen0 s Corporation, Corporate Technology, Philadelphia, PA Purpose: Syngo iGuide (Siemens Healthcare AG, Forchheim Germany) is a novel navigational software used for needle guidance whereby a path is defined on an intraprocedural Carm computed tomography (CT) image and the 3D path is transposed onto fluoroscopic images to guide the biopsy. iGuide allows the procedure to be performed in interventional radiology (IR) rather than the conventional CT suite. The purpose of this study is to review the radiation dose and procedure time for our initial experience using iGuide in comparison to CT-guided biopsies. Materials and Methods: Twelve iGuide bone biopsies (5 lumbar, 5 pelvic, 2 extremity) were performed in 9 males and 3 females (mean age 9.77 years) and compared to anatomically matched CT-guided bone biopsies performed from 2008-2012 (19 pelvic, 24 extremity, 7 lumbar). Parameters compared were radiation dose mean and procedure time mean using z-scores. Effective doses for iGuide biopsies were estimated using the PCXMC program (v2.0.1.3, STUK, Helsinki, Finland) with an age-appropriate model and study-specific techniques including kVp and dose-area product. Effective
WEDNESDAY: Scientific Sessions
Purpose: To investigate the technical success and safety of a standardised radiological antegrade primary gastrostomy insertion technique in children weighing 5 kg or less. Materials and Methods: A retrospective analysis of all gastrostomies inserted at a single centre over a ten year period between 2003 and 2013 recognized 596 patients undergoing antegrade gastrostomy insertion. Of these 25 patients weighing less than 5 kg were identified. The standardised technique for primary antegrade gastrostomy insertion included the use of a 9Fr Freka gastrostomy, general anaesthesia, biplane fluoroscopy and oral barium prior to the procedure to visualise the colon. Indications, patient characteristics, technical details and complications were recorded prospectively at the time of procedure using a proforma. Results: The mean age of the children weighing less than 5kg was 6 months, range (2-20m). 20 males, 5 females. Patients weighed from 3-5kg (mean 4.5kg). Antegrade gastrostomy insertion was successful in 24/25 patients with no major complications. The unsuccessful procedure was a result of hepatomegaly preventing a safe route for access to the stomach despite distension with air. 3 patients (13%) had minor complications. 2 exit site infections & 1 exit site leakage. All resolved without sequelae with conservative management. No deaths occurred within 30 days of procedure. The results are comparable to those in this centre for children weighing 45kg and those in the published literature for gastrostomy insertion in children of all weights and ages. Conclusion: Some endoscopists and surgeons consider the lower limit of body weight to insert gastrostomies to be 10kg but gastrostomies can be inserted safely into smaller children. The results of this study suggest antegrade gastrostomy insertion in infants less tan 5kg is technically feasible and safe with comparable technical success and complication rates to radiological or endoscopic gastrostomy insertion in larger children.
’
S132
’
Wednesday
WEDNESDAY: Scientific Sessions
doses for CT-guided biopsies were calculated using dose-length products and age-appropriate k-factors. Results: 11/12 (91.67%) iGuide procedures were diagnostic. Compared to the corresponding CT-guided cases, average iGuide procedure time was longer for pelvic cases but shorter for lumbar and extremity cases, all without statistical significance (p40.05). 5/5 iGuide pelvic biopsies had lower radiation doses (0.5, 0.9, 1.5, 4.6, 4.8 mSv) than the CTguided cases with a mean of 5.39 mSv (z¼ -1.00, -0.92, -0.87, -0.79, -0.16). 5/5 iGuide lumbar biopsies also had lower
Scientific Session
’
JVIR
radiation doses (0.7, 0.8, 2.9, 1.8, 10.5 mSv) than the CTguided mean of 15.6 mSv (z¼ -1.21, -1.20, -1.12, -1.03, -0.41). 2/2 iGuide extremity cases had lower radiation doses (0.03, 0.05 mSv) than the CT-guided mean of 0.47 mSv (z¼ -0.73, -.70). Conclusion: In our initial experience, iGuide technology in the IR suite provided high diagnostic accuracy, lower radiation dose, and no significant change to procedure time. Increased experience and optimized imaging protocols may further decrease procedure time and radiation dose.
’
Scientific Session
Wednesday
for retrograde interventional radiology approaches as well as surgical and endoscopic techniques.
4:33 PM
Abstract No. 282
’ FEATURED ABSTRACT Antegrade gastrostomy insertion in very low weight infants – is it safe? S. Stuart, P.A. Patel, S. Chippington, C. Gibson, A. Barnacle, D. Roebuck; Great Ormond Street Hospital for Children, London, United Kingdom
4:42 PM
Abstract No. 283
Percutaneous CT-guided vertebral biopsies in children S. Sierre1, D. Teplisky1, M. Garriga1, M. Noel2, N. Gonzalez1, E. Bersusky2, J. Lipsich1; 1Interventional Radiology, Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentina; 2Spinal Surgery, Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentina
S131
Purpose: Percutaneous biopsies are a minimally invasive tool that allows early and definitive diagnosis for different lesions affecting the vertebral bodies, leading to appropriate therapeutic decisions. The aim of this study was to evaluate the safety and diagnostic yield of CT-guided percutaneous vertebral biopsies in children. Materials and Methods: Retrospective review of 82 percutaneous vertebral biopsies performed in 75 patients between March 2002 and December 2012. The mean patient age was 6.4 years [3 months-18 ys-old]. The location of lesions was distributed as follows: cervical (n¼14), thoracic (n¼24), lumbar spine (n ¼ 38), sacrum (n ¼ 6). All procedures were performed under general anesthesia and CT guidance. Data collected included: type of lesion, complications, assessment of the specimen (sufficient or not) and pathologic diagnosis. Results: From the 82 biopsies performed, in 75 (91.4%) the specimen was considered adequate for pathological evaluation. From this group, in 68 cases (82.9%) a definitive diagnosis was reached. In the remaining 7 cases, a definitive diagnosis, despite the good quality of the specimen, was not achieved. Regarding etiology, pathologies were distributed as follows: infectious disease (30/68, 44%), histiocytosis (19/68, 28%), benign tumors (5/68, 7%) and malignant tumors (14/68, 20%). There were no major complications related to the procedure. Conclusion: Percutaneous vertebral biopsies in this age group are safe and effective for the diagnosis of spinal lesions, with a high degree of diagnostic accuracy. These results are comparable to those published in series of adult patients.
4:51 PM
Abstract No. 284
First experience with iGuide navigational software application for bone biopsies in pediatric interventional radiology T. Hwang1,2, T. Kurzendorfer2, E. Girard2, X. Zhu1, A. Cahill1; 1Children0 s Hospital of Philadelphia, Philadelphia, PA; 2Siemen0 s Corporation, Corporate Technology, Philadelphia, PA Purpose: Syngo iGuide (Siemens Healthcare AG, Forchheim Germany) is a novel navigational software used for needle guidance whereby a path is defined on an intraprocedural Carm computed tomography (CT) image and the 3D path is transposed onto fluoroscopic images to guide the biopsy. iGuide allows the procedure to be performed in interventional radiology (IR) rather than the conventional CT suite. The purpose of this study is to review the radiation dose and procedure time for our initial experience using iGuide in comparison to CT-guided biopsies. Materials and Methods: Twelve iGuide bone biopsies (5 lumbar, 5 pelvic, 2 extremity) were performed in 9 males and 3 females (mean age 9.77 years) and compared to anatomically matched CT-guided bone biopsies performed from 2008-2012 (19 pelvic, 24 extremity, 7 lumbar). Parameters compared were radiation dose mean and procedure time mean using z-scores. Effective doses for iGuide biopsies were estimated using the PCXMC program (v2.0.1.3, STUK, Helsinki, Finland) with an age-appropriate model and study-specific techniques including kVp and dose-area product. Effective
WEDNESDAY: Scientific Sessions
Purpose: To investigate the technical success and safety of a standardised radiological antegrade primary gastrostomy insertion technique in children weighing 5 kg or less. Materials and Methods: A retrospective analysis of all gastrostomies inserted at a single centre over a ten year period between 2003 and 2013 recognized 596 patients undergoing antegrade gastrostomy insertion. Of these 25 patients weighing less than 5 kg were identified. The standardised technique for primary antegrade gastrostomy insertion included the use of a 9Fr Freka gastrostomy, general anaesthesia, biplane fluoroscopy and oral barium prior to the procedure to visualise the colon. Indications, patient characteristics, technical details and complications were recorded prospectively at the time of procedure using a proforma. Results: The mean age of the children weighing less than 5kg was 6 months, range (2-20m). 20 males, 5 females. Patients weighed from 3-5kg (mean 4.5kg). Antegrade gastrostomy insertion was successful in 24/25 patients with no major complications. The unsuccessful procedure was a result of hepatomegaly preventing a safe route for access to the stomach despite distension with air. 3 patients (13%) had minor complications. 2 exit site infections & 1 exit site leakage. All resolved without sequelae with conservative management. No deaths occurred within 30 days of procedure. The results are comparable to those in this centre for children weighing 45kg and those in the published literature for gastrostomy insertion in children of all weights and ages. Conclusion: Some endoscopists and surgeons consider the lower limit of body weight to insert gastrostomies to be 10kg but gastrostomies can be inserted safely into smaller children. The results of this study suggest antegrade gastrostomy insertion in infants less tan 5kg is technically feasible and safe with comparable technical success and complication rates to radiological or endoscopic gastrostomy insertion in larger children.
’
S132
’
Wednesday
WEDNESDAY: Scientific Sessions
doses for CT-guided biopsies were calculated using dose-length products and age-appropriate k-factors. Results: 11/12 (91.67%) iGuide procedures were diagnostic. Compared to the corresponding CT-guided cases, average iGuide procedure time was longer for pelvic cases but shorter for lumbar and extremity cases, all without statistical significance (p40.05). 5/5 iGuide pelvic biopsies had lower radiation doses (0.5, 0.9, 1.5, 4.6, 4.8 mSv) than the CTguided cases with a mean of 5.39 mSv (z¼ -1.00, -0.92, -0.87, -0.79, -0.16). 5/5 iGuide lumbar biopsies also had lower
Scientific Session
’
JVIR
radiation doses (0.7, 0.8, 2.9, 1.8, 10.5 mSv) than the CTguided mean of 15.6 mSv (z¼ -1.21, -1.20, -1.12, -1.03, -0.41). 2/2 iGuide extremity cases had lower radiation doses (0.03, 0.05 mSv) than the CT-guided mean of 0.47 mSv (z¼ -0.73, -.70). Conclusion: In our initial experience, iGuide technology in the IR suite provided high diagnostic accuracy, lower radiation dose, and no significant change to procedure time. Increased experience and optimized imaging protocols may further decrease procedure time and radiation dose.