Computed Tomography Intervention

This module is designed to provide the viewer an overview of CT Intervention and the equipment and procedures that are associated with CT Intervention. After viewing this module, the participant should be able to: Identify the most common procedures that use CT intervention Identify equipment used during the procedures Identify common workflow We will be covering the following learning points: Definition   Common Uses   Approaches to CT Intervention   An Interventional Procedure Overview   The Common Tools for CT Intervention   Three Video Case Studies Definition: An interventional procedure is defined as using guidance methods to gain access to vessels and organs.   Can be done using:   Computed Tomography Ultrasound Angiography Lab Pain therapy E.g., the injection of therapeutic agents into a spinal disk space to  relieve pain Tissue biopsy Diagnostic biopsy to remove a tissue sample for pathologic or cytologic lab testing Bread-and-butter procedure Necessity for histologic assessment Obligatory for treatment decision (surgery, ctx, etc.) Abscess and cyst drainage High incidence of inflammatory fluid collections in centers with severely ill patients (surgery, ICU) Drainage often difficult due to location and multiplicity Sufficient and repeated drainage often prevents additional surgical interventions Vertebroplasty Image-guided injection of bone cement into a fractured or disrupted vertebral body. Osteoporotic vertebral fracture Painful osteolytic lesion Persistent pain under appropriate medication for > 6 weeks Risk for instability Radiofrequency ablation (RF)  RF is used for treating tumors. Small probes are placed into the tumor and RF energy deposited. The RF energy heats up the tissue around the tip destroying the tumors cells. Malignant, e.g., liver-tumors (primary/secondary) first choice = surgery but surgery feasible in 20 – 25% only radiation = collateral damage ctx often ineffective; therefore, minimally invasive treatment is an option Conventional 2D Intervention Adaptive 3D Intervention CT Fluoroscopy 2D CT-Guided Intervention Currently used by all vendors   Allows for sequential scanning during procedure   Typically 1-3 images 3D CT-Guided Intervention   Adaptive 3D Intervention is a method introduced by and is exclusive to Siemens   3D guidance with obtained spiral scan information   Axial, coronal, sagittal, and arbitrary oblique MPR and VRT visualization Adaptive 3D Intervention Layout: Dual Monitor Real-time imaging of your interventional interaction Fluoroscopic interventional acquisition Real-time overview *For SOMAMTOM Definition AS and AS+ only Intervention i-Control Move to saved table position   Joystick for table movement   Incremental or continuous table move   Gantry tilt Table up / down Move to selected table position Move to last scan table position Toggle between pre-defined windows Scroll image Toggle segment on/off Laser on / off   Save table position Manual selection gantry left / right side of i-Control Joystick mouse   Next When performing a CT intervention case, there are several things to consider: Radiation protection   Patient care   Procedure sterilization   Nursing participation   Lab participation   Technologist participation Here is a list of common tools used during a CT intervention procedure: CT scanner   In-room monitor   Footswitch   Table/gantry control   Sterile drape Sterile biopsy procedure equipment   Sterile procedure tray   Sterile gown, gloves, mask   Lead glasses   Lead aprons   Thyroid shielding   Lung Biopsy Review Review the lung biopsy procedure. Element HTMLLet’s review the previous lung biopsy procedure: Patient scout   Find target lesion   Plan pathway   Mark entry location   Prep patient   Local anesthetic applied Needle placement   Needle adjustment   Sample taken   Sample analyzed   Check for pneumothorax   Procedure completed Sound File Audio ScriptLet’s review the previous lung biopsy procedure. The steps illustrated were: •Patient scout •Find target lesion •Plan pathway •Mark entry location •Prep patient •Local anesthetic applied •Needle placement •Needle adjustment •Sample taken •Sample analyzed •Check for pneumothorax •Procedure completed We will now see a gastrostomy tube placement.     Gastrostomy Tube Placement Review Review the Gastrostomy Tube Placement procedure. Element HTMLLet’s review the previous gastrostomy tube placement: Patient scout   Plan pathway   Mark entry location   Prep patient   Local anesthetic applied   Needle placement   Lock down stays Insert wire   Scan patient   Place gastrostomy tube   Dilate with air   Check position   Procedure complete Sound File Audio ScriptLet’s review the previous gastrostomy tube placement. The steps illustrated were: •Patient scout •Plan pathway •Mark entry location •Prep patient •Local anesthetic applied •Needle placement •Lock down stays •Insert wire •Scan patient •Place gastrostomy tube •Dilate with air •Check position •Procedure complete Let’s return to Dr. Lacey as he performs a liver biopsy.   Liver Biopsy Review Review of Liver Biopsy procedure. Element HTMLLet’s review the previous liver biopsy: Patient scout   Review previous study for comparison   Find target lesion   Plan pathway   Mark entry location   Prep patient Local anesthetic applied   Needle placement   Needle adjustment   Sample taken and   Procedure complete Sound File Audio ScriptLet’s review the previous liver biopsy. The steps illustrated were: •Patient scout •Review previous study for comparison •Find target lesion •Plan pathway •Mark entry location •Prep patient •Local anesthetic applied •Needle placement •Needle adjustment •Sample taken and •Procedure complete Let us review what we have learned. You should now be able to identify: The most common procedures that use CT intervention   Equipment used during the procedures   Common workflow Interventional CT Solutions https://usi03-dev-med.usmlvv1d0a.smshsc.net/CTIntervention/ Low-Dose Guide www.siemens.com\low-dose-CT Siemens UPTIME Service Center at 800-888-7436