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.
|Study Design:||Time Perspective: Prospective|
|Official Title:||Electromagnetic Tracking of Devices During Interventional Procedures|
- To define the clinical utility of electromagnetic tracking during surgery and interventional procedures in specific patient populations [ Time Frame: Completion of study ] [ Designated as safety issue: No ]
|Study Start Date:||January 2005|
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 surgery and 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, except those undergoing prostate biopsy must be actively enrolled on an NIH protocol and be scheduled for surgery, angiography, or CT- or ultrasound-guided biopsy.
This is a pilot 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.
- Prostate biopsy
- Percutaneous biopsy for diagnostic correlation
- percutaneous ablation for needle placement compilations
- Open/Laparoscopic surgery
- Angiography 6) Auto registration for biopsy and
7) ablation 8) PET registration
9) 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.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00102544
|Contact: Charisse Garcia, R.N.||(301) firstname.lastname@example.org|
|Contact: Bradford Wood, M.D.||(301) email@example.com|
|United States, Maryland|
|National Institutes of Health Clinical Center, 9000 Rockville Pike||Recruiting|
|Bethesda, Maryland, United States, 20892|
|Contact: For more information at the NIH Clinical Center contact Patient Recruitment and Public Liaison Office (PRPL) 800-411-1222 ext TTY8664111010 firstname.lastname@example.org|
|Principal Investigator:||Bradford Wood, M.D.||National Institutes of Health Clinical Center (CC)|