Use of Tracking Devices to Locate Abnormalities During Invasive Procedures
This study will evaluate the accuracy and effectiveness of an experimental tracking device for locating abnormalities during invasive procedures, such as biopsy or ablation, that cannot easily be visualized by usual imaging techniques, such as computed tomography (CT) scans or ultrasound. Some lesions, such as certain liver or kidney tumors, small endocrine abnormalities, and others, may be hard to find or only visible for a few seconds. The new method uses a needle with a miniature tracking device buried inside the metal that tells where the tip of the needle is located, somewhat like a mini GPS, or global positioning system. It uses a very weak magnet to localize the device like a miniature satellite system. This study will explore whether this system can be used in the future to more accurately place the needle in or near the desired location or abnormality.
Patients 18 years of age and older who have a lesion that needs to be biopsied or an ablation procedure that requires CT guidance may be eligible for this study. Candidates are screened with a medical history and review of medical records, including imaging studies.
Participants undergo the biopsy or ablation procedure as they normally would, with the following exceptions: some stickers are placed on the skin before the procedure and a very weak magnet is placed nearby. The needles used are similar to the ones that would normally be used except that they contain a metal coil or spring buried deep within the needle metal. The procedure involves the following steps:
Small 1-cm plastic donuts are place on the skin with tape.
A planning CT scan is done.
The CT scan is sent to the computer and matched to the patient's body location with the help of a very weak magnet.
The needle used for the procedure is placed towards the target tissue or abnormality and the "smart needle" location lights up on the old CT scan.
A repeat CT is done as it normally is to look for the location of the needle.
After the procedure the CT scans are examined to determine how well the new tool located the needle in the old scan.
|Condition or Disease||Intervention/Treatment||Phase|
The effectiveness of targeting lesions or a specific area for surgery, angiography, CT-guided, or ultrasound-guided biopsy, or ablation, currently may be limited by the visibility of a target during the procedure. Accurate therapeutic intervention may depend upon accurate device placement, which may be very difficult in certain settings, such as when a liver tumor only is visible for a brief moment in time during the transient arterial phase of a contrast injection, soon disappearing on dynamic imaging. Surgery, angiography, image guided therapies and diagnostic procedures could be vastly improved by enabling the use of pre-procedural imaging during the procedure [such as location of difficult to visualize or transiently visible targets]. Tracking devices allow the use of pre-operative imaging during the procedure. Having this information available could vastly improve targeting accuracy of surgery, angiography, CT-guided, or ultrasound-guided biopsy or ablation.
A method of improving targeting could potentially benefit patients in the future by reducing total radiation exposure during CT scan or fluoroscopic monitoring of a biopsy, or decreasing certain surgical risks, although these are not specific subjects of this study. Various methods of device tracking have been used in the past throughout the 20th century in neurosurgery with the use of stereotactic frames for a similar purpose, to register pre-operative imaging to the patient during invasive procedures to guide treatment.
To define the clinical utility of electromagnetic tracking during interventional procedures in specific patient populations.
All patients must have a pre-operative CT, MR, or PET scan performed at NIH.
Age greater than 18 years.
Patients must be actively enrolled on an NIH protocol and be scheduled for surgery, angiography, or CT- or ultrasound-guided biopsy.
This is an exploratory interventional study examining the use of a guidance system for navigating and monitoring devices like biopsy and ablation needles, ultrasound transducers, needle guides, guidewires, scalpels, and cauterization devices (herein referred to as device(s) ) for localization in relation to pre-operative images.There are 9 cohorts included in this protocol. The Open/Laparoscopic surgery and Angiography surgery cohorts are no longer open for accrual.
Percutaneous biopsy for diagnostic correlation
percutaneous ablation for needle placement compilations
Auto registration for biopsy
Auto registration for ablation
prostate biopsy on which to determine the predictive value and relative strength of each MRI sequence in predicting cancer at a specific prostate core location.
The total accrual ceiling for this protocol is 3195 subjects.
All cohorts open for accrual are using exploratory interventions to define the specific patient population where fusion used during interventional procedures may have clinical value, and to characterize that clinical value in a specific patient population, such as but not limited to patients with specific regions of the prostate targeted, specific prostate volumes, prior negative prostate biopsies, or PSA values within a specific range.
Arms and Interventions
|Experimental: All cohorts (prostate biopsy percutaneous biopsy and ablation)|
This study will consist of comparison of tracked imaging with near-simultaneous actual imaging .
Device: EM Tracking
Utilizing electromagnetic tracking technology as a fusion and navigation tool for minimally invasive interventional procedures.
Primary Outcome Measures
- Feasibility of using electromagnetic devices in different cohorts. [Day 1]
"TRE" Target Registration Error (distance between "virtual" needle position (tracking data) and the actual needle position ("CT" Computed Tomography confirmation scan))
Secondary Outcome Measures
- Success of ablation as determined by imaging [3 months]
Primary effectiveness (success of ablation in local tumor control or success of biopsy in diagnostic biopsy sample). Successful ablation equals complete tumor ablation with a 5mm-1cm margin of normal tissue (if possible; quantified by the lack of enhancement of intravenous contrast material at 3 month follow up CT)
- INCLUSION CRITERIA:
Patients must fulfill all of the following criteria to be eligible for study admission:
All patients must have a CT, MR, or PET scan available in digital format.
Age greater than or equal to 18 years.
No serious concurrent medical illness that would preclude the patient from making a rational informed decision on participation.
The ability to understand and willingness to sign a written informed consent form, and to comply with the protocol. If in question, an ethics consult will be obtained.
All patients in non-prostate biopsy cohorts, must be undergoing a surgical or interventional radiology procedure such as an angiography or a CT/ US-guided biopsy and have pre-operative imaging.
PROSTATE BIOPSY COHORT (Cohorts 1 and 9) INCLUSION CRITERIA:
Source of patients will be the community at large as well as patients who have undergone prostate MRI and have had abnormalities identified as follows:
PSA >2.5 or Abnormal digital rectal exam or an abnormality identified on prostate MRI witha clinical indication for biopsy.
Pre-biopsy prostate MRI showing targetable lesions.
Patients with any of the following will be excluded from study entry:
Patients with an altered mental status that precludes understanding or consenting for the biopsy procedure will be excluded from this study.
Patients unlikely able to hold reasonably still on a procedure table for the length of the procedure.
Patients with any known allergy to adhesives or latex or skin reactions to dressings (since the adhesive fiducials could theoretically induce a rash in these patients), if adhesive fiducials are to be used.
Inability to hold breath, if procedure will be performed with conscious sedation, and without general anesthesia.
Patients with pacemakers or automatic implantable cardiac defibrillators.
Gross body weight above the CT table limit (375 pounds), if CT table used.
Contacts and Locations
|1||National Institutes of Health Clinical Center, 9000 Rockville Pike||Bethesda||Maryland||United States||20892|
Sponsors and Collaborators
- National Institutes of Health Clinical Center (CC)
- Principal Investigator: Bradford J Wood, M.D., National Institutes of Health Clinical Center (CC)
Study Documents (Full-Text)None provided.
- Frantz DD, Wiles AD, Leis SE, Kirsch SR. Accuracy assessment protocols for electromagnetic tracking systems. Phys Med Biol. 2003 Jul 21;48(14):2241-51.
- Seiler PG, Blattmann H, Kirsch S, Muench RK, Schilling C. A novel tracking technique for the continuous precise measurement of tumour positions in conformal radiotherapy. Phys Med Biol. 2000 Sep;45(9):N103-10.
- Solomon SB, White P Jr, Wiener CM, Orens JB, Wang KP. Three-dimensional CT-guided bronchoscopy with a real-time electromagnetic position sensor: a comparison of two image registration methods. Chest. 2000 Dec;118(6):1783-7.