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ECR 2015 / C-1007
Virtual Biopsy and Three Dimensional Ultrasound for Radio Frequency Ablation of Thyroid Nodules
This poster is published under an open license. Please read the disclaimer for further details.
Congress: ECR 2015
Poster No.: C-1007
Type: Scientific Exhibit
Keywords: Thyroid / Parathyroids, Interventional non-vascular, Ultrasound, Elastography, Ablation procedures, Outcomes
Authors: R. Garberoglio1, F. Molinari1, L. Manzoli2, S. de Beni2, S. D'Onofrio3, L. Lodigiani2, L. Forzoni3; 1Torino/IT, 2Genoa/IT, 3Firenze/IT
DOI:10.1594/ecr2015/C-1007

Conclusion

 

In this preliminary study, Virtual Biopsy technology facilitated the RFA electrodes insertion. With its graphical representation of the electrode tip insertion point and the planning of the path within the area to be treated, it represented a valuable tool for improved practical confidence. The confidence is even increased by the possibility to monitor in real-time the tissue stiffness with elastosonography and the hemodynamics of the nodule and surrounding areas using Doppler technologies and CEUS.

 

Virtual Biopsy technology enabled a secure visualization of the RFA electrode tip during the complex shot moving technique, also during the gas out phases of the ablation procedure, which gave the operator a bad or completely dark view of the treated area. Furthermore, the presence of nerves (i.e. vagus or laryngeal) and vessels (i.e. carotid artery, internal jugular vein) in the treated area, requires a high level of attention during the procedure.  

 

Virtual Navigator real-time fusion imaging can help, during the gas out phases of the RFA treatment, the correct and complete visualization of the area already treated respect to the one still present. This, enhancing the overlap of the 3D pre-treatment volume over the 2D real-time acquisition.

 

Virtual Navigator 3D Pan technology showed to be a reliable and easy tool that fused 3D US thyroid anatomical data with bi-dimensional US scans. Real-time Color Doppler, Power Doppler, CEUS and Elastonography evaluations were performed, while navigating within the 3D Pan volume, in order to respectively analyze the hemodynamic and stiffness characteristics of the examined area.

 

Custom color targeting of the nodule allowed the operator to easily identify and spatially localize the targets, navigating within the whole picture given by the 3D Panoramic view. The EM tracked free-hand acquisition enabled the operator to cover all the areas of interest.

 

The extended duration of the treatment time for the 3D US acquisitions (before and after the treatment) was balanced by the increased level of confidence and the easier navigation within the 3D US volume for both the treatment and checking phase.

 

For all the patients a satisfactory visual matching between the US volume and the relative 2D US was obtained.

 

All the ablation treatments were successfully performed without any patients’ complication.

 

The 3D Pan technology was highly preferred to the traditional 3D US acquisition performed with the volumetric probe, as it was not necessary to change any probe between the 3D acquisition and the 2D scanning. Moreover, the 3D probe was too large in order to perform a correct and secure RFA treatment with the required shot moving technique. The substitution of the probe was performed three times: one for the initial volume acquisition, one for the 2D scan and the RFA electrode guidance and one for the final volume acquisition for the ablated area check with respect to the initial volume. The substitution of the EM receiver between a 2D and a 3D probe increased the use of sterile covers, therefore increasing the overall costs of the treatment.

 

MCS is an innovative technology that corrected subject’s movements, in order to simultaneously increase patient’s and operator’s comfort and to ease US scanning and US-guided treatment procedures.

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