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Dual guidance
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Percutaneous cementoplasty, like other interventional procedures, is usually performed with a single imaging technique: fluoroscopy or CT, both of which have advantages and drawbacks. Fluoroscopy offers multiple planes and direct imaging with the isadvantages of poor soft-tissue contrast and non-negligible radiation exposure for both patient and operator. CT is well-suited for precise interventional needle guidance because it rovides good visualization of bone and surrounding soft tissues. It also avoids damage to adjacent vascular, neurological, and visceral structures. The disadvantages of this method are single-plane and delayed imaging.
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To address these concerns on a routine basis, a combination of CT and fluoroscopy for interventional procedures has been recommended. For fluoroscopy, a mobile C-arm is used, positioned in front of the CT-gantry. By using a rotating fluoroscope and CT, the structure to be punctured can be visualized three dimensionally and with exact differentiation of anatomic structures, which in many cases is not possible with fluoroscopy alone. Two mobile monitors are placed in front of the physician, displaying the last stored image and the fluoroscopic image. The operator can switch from CT to fluoroscopy and vice versa at any time as shown in the dual guidance movie.
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In percutaneous vertebroplasty, the intervention begins with CT and is followed by fluoroscopy. The needle is placed precisely and safely under CT guidance. The injection of the polymethylmethacrylate requires real-time imaging and is therefore performed under fluoroscopic control as shown in the cement injection movie cases. This combination has many advantages. The possibilities of the simultaneous combination of the two imaging methods are almost unlimited and other applications in interventional radiology are possible. | |
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Vascular Interventions
Focus on dual guidance