The use of cone beam CT in image guided pain management

Learning Objectives1) Name the main advantages of cone-beam CT in radio-frequency ablation (RFA) and transforaminal epidural injections for pain management. 2) Become familiar with the advantages of using of cone beam CT and fluoroscopy during kyphoplasty. 3) Name the benefits of cone beam CT during sacroplasty.BackgroundC-arm cone-beam computed tomography (CT) with a flat-panel detector represents an evolving generation of imaging technology in the interventional suite with continued improvements in safety and effectiveness of complex vascular and non-vascular procedures. The availability of pre, peri, and post-procedural multiplanar and three dimensional (3D) imaging may result in a reduction of the patient and operator radiation dose. It may also result in an improved safety:benefit ratio as well as an otherwise unattainable subjective operator confidence level. Even though the image resolution of cone-beam CT is inferior to multi-detector CT, the system allows tomographic guidance for needle positioning without moving the patient. Little can be found in the literature regarding the use of cone beam CT in the setting of image guided pain management.Clinical Findings/Procedure DetailsWe describe our experience for the use of cone-beam CT in image guided pain management procedures, including transforaminal epidural injections, sacroplasty, radiofrequency ablation for vertebral metastases, and kyphoplasty.Conclusions1) The major benefit of cone-beam CT prior to RFA of a spinal metastasis for palliative pain management is the accuracy of needle placement in three dimensions prior to ablation, when a specific lesion must be accessed. During transforaminal epidural injections, cone-beam CT may be used to provide exact needle location using a safe route, particularly in patients with complex anatomy. 2) During kyphoplasty we combine the advantages of cone-beam CT for accurate needle guidance and fluoroscopy for visualization during the dynamic injection of cement. 3) In kyphoplasty and sacroplasty, cone-beam CT may also be used immediately after cement injection to assess cement distribution (even with multi-planar reconstructions) before the patient is moved from the interventional radiology suite table. Learning Objectives1) Name the main advantages of cone-beam CT in radio-frequency ablation (RFA) and transforaminal epidural injections for pain management. 2) Become familiar with the advantages of using of cone beam CT and fluoroscopy during kyphoplasty. 3) Name the benefits of cone beam CT during sacroplasty. 1) Name the main advantages of cone-beam CT in radio-frequency ablation (RFA) and transforaminal epidural injections for pain management. 2) Become familiar with the advantages of using of cone beam CT and fluoroscopy during kyphoplasty. 3) Name the benefits of cone beam CT during sacroplasty. BackgroundC-arm cone-beam computed tomography (CT) with a flat-panel detector represents an evolving generation of imaging technology in the interventional suite with continued improvements in safety and effectiveness of complex vascular and non-vascular procedures. The availability of pre, peri, and post-procedural multiplanar and three dimensional (3D) imaging may result in a reduction of the patient and operator radiation dose. It may also result in an improved safety:benefit ratio as well as an otherwise unattainable subjective operator confidence level. Even though the image resolution of cone-beam CT is inferior to multi-detector CT, the system allows tomographic guidance for needle positioning without moving the patient. Little can be found in the literature regarding the use of cone beam CT in the setting of image guided pain management. C-arm cone-beam computed tomography (CT) with a flat-panel detector represents an evolving generation of imaging technology in the interventional suite with continued improvements in safety and effectiveness of complex vascular and non-vascular procedures. The availability of pre, peri, and post-procedural multiplanar and three dimensional (3D) imaging may result in a reduction of the patient and operator radiation dose. It may also result in an improved safety:benefit ratio as well as an otherwise unattainable subjective operator confidence level. Even though the image resolution of cone-beam CT is inferior to multi-detector CT, the system allows tomographic guidance for needle positioning without moving the patient. Little can be found in the literature regarding the use of cone beam CT in the setting of image guided pain management. Clinical Findings/Procedure DetailsWe describe our experience for the use of cone-beam CT in image guided pain management procedures, including transforaminal epidural injections, sacroplasty, radiofrequency ablation for vertebral metastases, and kyphoplasty. We describe our experience for the use of cone-beam CT in image guided pain management procedures, including transforaminal epidural injections, sacroplasty, radiofrequency ablation for vertebral metastases, and kyphoplasty. Conclusions1) The major benefit of cone-beam CT prior to RFA of a spinal metastasis for palliative pain management is the accuracy of needle placement in three dimensions prior to ablation, when a specific lesion must be accessed. During transforaminal epidural injections, cone-beam CT may be used to provide exact needle location using a safe route, particularly in patients with complex anatomy. 2) During kyphoplasty we combine the advantages of cone-beam CT for accurate needle guidance and fluoroscopy for visualization during the dynamic injection of cement. 3) In kyphoplasty and sacroplasty, cone-beam CT may also be used immediately after cement injection to assess cement distribution (even with multi-planar reconstructions) before the patient is moved from the interventional radiology suite table. 1) The major benefit of cone-beam CT prior to RFA of a spinal metastasis for palliative pain management is the accuracy of needle placement in three dimensions prior to ablation, when a specific lesion must be accessed. During transforaminal epidural injections, cone-beam CT may be used to provide exact needle location using a safe route, particularly in patients with complex anatomy. 2) During kyphoplasty we combine the advantages of cone-beam CT for accurate needle guidance and fluoroscopy for visualization during the dynamic injection of cement. 3) In kyphoplasty and sacroplasty, cone-beam CT may also be used immediately after cement injection to assess cement distribution (even with multi-planar reconstructions) before the patient is moved from the interventional radiology suite table.