H.19 Patient Positioning during conebeam ct
Interventional radiology (IR) and image-guided medicine (IGM) continue to impact patients throughout the world. Advanced imaging has revolutionized the ability to reach a target. It is the advanced global positioning system (GPS) that allows us to navigate to the destination and understand how we are treating a patient. Take two examples: 1) A lesion is present in the liver. Use of the embolization guidance software allows us to understand which vessel should be targeted in a treatment (such as Yttrium-90 radioembolization) that safely delivers the material to the tumor, to the whole tumor, and spares other anatomy we wish to avoid. 2) Prostate artery embolization (PAE) remains a technically challenging procedure given the high variability of the pelvic anatomy/origin of the prostate artery yet has the potential to help thousands of patients with a common problem. In each of these scenarios, a conebeam CT (CBCT) must be performed first, whereby the machine spins around the patient. The data set captured then is used with the software to pick a target and pick the origin vessel (“Embolization Guidance Software”). Other software tools are also available, including XPerGuide, which allows for percutaneous targeting of a tumor (for biopsy or ablation). We fully anticipate this “GPS” will be integrated into the next generation of robotics devices that provides some level of autonomy for targeting.
Nevertheless, the positioning of a patient prior to the CBCT remains an issue. Depending on the team’s familiarity with how the machine will spin and how awake the patient is, the setup can be painstaking. Either an “open” or a “closed” spin is chosen. The “open” spin is a new technological modification that allows the left arm to remain by the patient’s side (in cases where it has been used as the access point). The right arm, nevertheless, must be moved above the head. If the patient has intravenous medications running, these get in the way of the spin. If there is a breathing tube (general anesthesia used), these get in the way of the spin. If the patient is too sleepy and cannot raise their arm, this gets in the way of the spin. If the patient is tall or needs to be propped up on pillows for breathing, this gets in the way of the spin.
At present, there is no easy, seamless way to have a patient position appropriately for CBCT despite the ubiquity of the tool for interventional radiology. An ideal solution would be able to be integrated into the table (or an “add-on piece”) that is not dependent upon body habitus and can easily help guide teams both familiar and unfamiliar with the spin trajectory with how to position the patient. It should be vendor agnostic and be prepared to function whether the equipment used is from Philips, Siemens, GE, or Canon (or other vendor). It should be low cost, not block xrays (so that it can be used with the spin), and be comfortable for the patient. An ideal solution will be reproducible, safe, and effective. It should be low cost, scalable, and deliverable across the country. The team will be encouraged to observe procedures in our new state-of-the-art operation at the Winship at Emory Midtown Tower and at the renowned Emory University Hospital campus and to think about how this solution can be democratized to move from the subspecialty care of world renown medical centers to community practices to address health inequity through novel devices.