title: A simple technique for interventional tool placement combining fluoroscopy with interventional computed tomography on a C-arm system.
abstract: BACKGROUND
  Flat-panel cone-beam computed tomography (FP-CBCT) has recently been introduced as a clinical feature in neuroangiography radiographic C-arm systems.
  
  
  OBJECTIVE
  To introduce a method of positioning a surgical tool such as a needle or ablation probe within a target specified by intraoperative FP-CBCT scanning.
  
  
  METHODS
  Two human cadaver and 2 porcine cadaver heads were injected with a mixture of silicone and contrast agent to simulate a contrast-enhanced tumor. Preoperative imaging was performed using a standard 1.5-T magnetic resonance imaging scanner. Intraoperative imaging was used to define the needle trajectory on a GE Innova 4100 flat panel-based neuroangiography C-arm system.
  
  
  RESULTS
  Using a combination of FP-CBCT and fluoroscopy, a needle was successfully positioned within each of the simulated contrast-enhanced tumors, as verified by subsequent FP-CBCT scans.
  
  
  CONCLUSIONS
  This proof-of-concept study demonstrates the potential utility of combining FP-CBCT scanning with fluoroscopy to position surgical tools when stereotactic devices and image-guided surgery systems are not available. However, further work is required to fully characterize the precision and accuracy of the method in a variety of realistic surgical sites.
authors.affiliation: Department of Medical Physics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Nett
authors.forename: Beverly
authors.initials: B
authors.lastname: Aagaard-Kienitz
authors.forename: Yurdal
authors.initials: Y
authors.lastname: Serarslan
authors.forename: Mustafa K
authors.initials: MK
authors.lastname: Başkaya
authors.forename: Guang-Hong
authors.initials: GH
authors.lastname: Chen
mesh_terms: D000818:Animals; D002102:Cadaver; D054893:Cone-Beam Computed Tomography / Q000295:instrumentation* / Q000379:methods*; D003287:Contrast Media; D005471:Fluoroscopy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods*; D013552:Swine
chemical_list: D003287:Contrast Media