Rutigliano Sandra, Abraham John A, Kenneally Barry E, Zoga Adam C, Nevalainen Mika, Roedl Johannes B
From the *Department of Radiology, University of Pennsylvania; †Rothman Institute of Orthopedic Surgery; and ‡Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA; and §Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
J Comput Assist Tomogr. 2017 Nov/Dec;41(6):957-961. doi: 10.1097/RCT.0000000000000616.
Percutaneous computed tomography (CT)-guided needle biopsy has proven to be an efficacious method for sampling of many soft tissue lesions, especially deep-seated masses in the abdomen and pelvis. This study sought to test the potential for a novel steerable needle to improve localization and to reduce procedure duration and radiation dose compared with a conventional straight needle.
A fresh, raw meat sample (lean bovine flank) was imbedded with cylindrical radiopaque and radiolucent obstacles designed to simulate vessels (radiolucent objects) and bones (radiopaque objects) on CT. A pit-containing olive (partially radiopaque) was imbedded beyond the obstacles to represent the target. Two sites on the surface of the meat were selected and marked to determine initial needle placement. Two radiologists with different levels of experience proceeded to position a straight needle and the steerable needle from each skin site to the target using CT guidance as efficiently as possible, avoiding the obstacles. The total positioning time, the number of CT scans required for positioning, and the number of repositioning events (partial withdrawal followed by advancement) were tracked for the straight and steerable needles.
For the straight needle, total time to reach the target was 499 to 667 seconds (mean, 592 seconds); for the steerable needle, total time to reach the target was 281 to 343 seconds (mean, 309 seconds), on average, 48% lower. The number of CT scans needed for needle positioning averaged 6.25 for the straight needle and 3.5 for the steerable needle, which is 44% lower. Repositioning events (withdrawing and readvancing the needle) ranged from 3 to 10 for the straight needle (mean, 6.5) and 0 for the steerable needle.
Using an in vitro model embedded with obstacles, the steerable needle performed better than a straight needle with regard to procedure time, needle repositioning events, and CT scans required for placement.
经皮计算机断层扫描（CT）引导下的穿刺活检已被证明是一种对许多软组织病变进行取样的有效方法，尤其是腹部和盆腔的深部肿块。本研究旨在测试一种新型可操纵针与传统直针相比，在改善定位、减少操作时间和辐射剂量方面的潜力。
将一个新鲜的生肉样本（牛侧腹瘦肉）嵌入圆柱形的不透射线和可透射线障碍物，这些障碍物在CT上设计用于模拟血管（可透射线物体）和骨骼（不透射线物体）。在障碍物之外嵌入一个含坑的橄榄（部分不透射线）以代表目标。在肉的表面选择并标记两个部位以确定初始针的放置位置。两名经验水平不同的放射科医生在CT引导下，尽可能高效地从每个皮肤部位将直针和可操纵针放置到目标位置，避开障碍物。记录直针和可操纵针到达目标的总定位时间、定位所需的CT扫描次数以及重新定位事件的次数（部分拔出后再推进）。
对于直针，到达目标的总时间为499至667秒（平均592秒）；对于可操纵针，到达目标的总时间为281至343秒（平均309秒），平均降低了48%。直针定位所需CT扫描的平均次数为6.25次，可操纵针为3.5次，降低了44%。直针的重新定位事件（拔出并重新推进针）次数为3至
