Needles, Needle-holders, and Training Models for CT Fluoroscopy-Guided Interventional Procedures

Abstract

The introduction of real-time computed tomographic fluoroscopy (CTF) for guidance during percutaneous interventional procedures will oblige the interventional radiologist to learn new techniques for biopsy or introducer/access needle placement. While manual needle insertion may be used with intermittent CTF, use of a needleholder is mandatory when using real-time CTF guidance during needle manipulation. This technique reduces scattered radiation to the operators' hands but also reduces control over the needle. To optimize real-time CTF guidance, investigations have focused on the development of needle-holder guides and needles, both for accuracy of placement and reliability. During our early experience with CTF we evaluated different combinations of biopsy needles and needle-holder guides for accuracy placement and reliability, in a meat model. We also measured the scattered radiation to operators using needle guides and the tensile strength of currently available biopsy or access needles. Based on this work and experience with nearly 500 CTF-guided interventional procedures in patients, we recommend a metal sponge forceps needle-holder in combination with core biopsy, Luer-locking aspiration biopsy or Luer-locking introducer needles. We also describe training models which allow the interventional radiologist to gain initial practical in-vitro experience with CTF guidance techniques.

Keywords:

CTF - needle-holders - percutaneous interventions