0:00

So let's unpack.

0:02

Guidelines by the cardiovascular and

0:05

the Interventional radiological Society of Europe.

0:08

So when evaluating the different modalities, it's

0:11

important to understand real-time Imaging guidance

0:14

fluoroscopy ultrasound offers

0:17

that as I mentioned before in the setting of CT

0:20

fluoroscopy, that is one way in which we can approximate real-time

0:23

Imaging guidance in the setting of

0:26

CT and when in the case of magnetic resonance, imaging guidance,

0:29

it's now real-time with specific sequences in

0:32

the case of field of view. It's particularly

0:35

limited when it comes to fluoroscopy and

0:38

ultrasound. Whereas there's a large field of view when we're

0:41

using CT and Mr. Guidance when it comes

0:44

to visualization of structures and devices fluoroscopy. Unfortunately

0:47

a touch poor it can be sufficient

0:50

for bone biopsies bone marrow

0:53

biopsies particularly and it offers this multiplayer visualization

0:56

because of our ability to move the image intensifier in

0:59

different views.

1:01

Ultrasound guidance is mentioned before is something

1:04

that can allow us to Pivot and move and

1:07

find our ultrasound probe in order

1:10

to appropriately visualize structures. But again, it's limited in

1:13

individuals of large habitus such as obese patients

1:16

or in those lesions that are at high

1:19

depths in the case of CT guidance.

1:22

It's particularly good

1:24

high resolution and that can actually be

1:27

augmented by the use of contrast medium contrast media

1:30

is also something that can be used in the

1:33

case of contrast enhance ultrasound when we talk about mri's ability

1:36

to visualize structures. It is excellent high

1:40

contrast resolution. It also offers the

1:43

ability to perform multiplayer and 3D visualization

1:46

when we come talk about portability. It

1:49

is particularly important to note that ultrasound is

1:52

one of the few modalities that can

1:55

be used to take to the bedside of

1:58

a patient when indicated in order to perform tissue

2:01

sampling fluoroscopy CT as

2:04

well as MRI are not portable in nature

2:07

in terms of availability ultrasound is the

2:10

most available

2:13

CT fluoroscopy relatively equivalent in

2:16

their availability whereas Mr. Is probably the

2:19

least available across the world in terms of

2:22

ionizing radiation. That's one of the more important things to keep

2:25

in mind as mentioned before when we're using

2:28

tissue sampling techniques. It's important to understand what

2:31

is appropriate for our pediatric populations versus our

2:34

adult populations. The presence of

2:37

ionizing radiation is one of those characteristics that is

2:40

one of those good discriminators ultrasound has

2:43

none as does magnetic residents Imaging

2:46

and so these are two techniques particularly

2:49

helpful in the Pediatric population. There

2:52

are CT and fluoroscopy are used

2:55

in the setting of ionizing radiation procedural time

2:58

is particularly lengthy when it comes the Mr.

3:01

Guidance when it comes to CT guidance little

3:04

less. So an ultrasonic floroscopy a

3:07

relatively Swift in supporting Imaging guidance for

3:10

tissue sampling.

3:12

when it comes to costs MRI as we might suspect

3:15

a little bit on the more costly side where CT

3:18

and fluoroscopy are similar and ultrasound

3:21

less, so

3:24

Let's look at a few tissue sampling techniques.

3:27

Finally aspiration is probably one of the more common

3:30

tissue sampling techniques use

3:33

ubiquitously and then there's core needle

3:36

biopsy which will impact in full.

3:39

So what's a fine needle aspiration a final

3:42

aspiration facilitates the ability to

3:45

obtain a small volume of tissue and

3:48

what we use here is a small diameter Hollow needle

3:51

typically in the order of a 22 or 25

3:54

gauge needle and what we're doing is we are agitating the

3:57

tissues very slowly with

4:00

mechanical disruption of

4:03

the tissue such that those tissue samples move

4:06

through capillary action through the holobore.

4:10

That can then be augmented by the use of

4:13

e syringe with suction

4:16

on the back on the Hub of

4:19

the needle as we're agitating to tissues in

4:22

order to assist with migration of the tissue

4:25

through the bore via capillary action this

4:28

office minimal risks of damage due to the

4:31

small nature of the needle. It said

4:34

that a 22 gauge needle or higher can be placed through any

4:37

part of the body with exception of the eye injury is

4:40

very low risk in

4:43

this particular setting which makes it one of the more common

4:46

techniques that we use in order to

4:50

First achieve tissue sampling. It doesn't maintain tissue

4:53

architecture, which makes it a little challenging for

4:56

our pathologist and being to identify certain certain

4:59

conditions.

5:02

And that's why.

5:03

The next category is important for us.

5:06

This is the core needle biopsy which

5:09

allows us to obtain large volume of tissue the

5:12

needle sizes typically range from 18 or

5:15

20 gauge or even lower in the

5:18

case of kidney biopsies some individuals use 16 gauge

5:21

needles. When we think of a gauge a Gage

5:24

is the amount of needles that can be lined up side

5:27

by side in order to make an inch. So what

5:30

we would say is as the need size decreases the

5:33

gauge actually increases so 16

5:36

engage needle by definition is

5:39

larger than an 18 gauge needle so important to note when

5:42

we're sort of thinking about risk of gauge size

5:45

in particular settings.

5:47

So core needle biopsies particularly interesting because it

5:50

uses a spring-loaded mechanism unlike the

5:53

mechanical agitation. We talked about in the case of the fine needle

5:56

aspiration and usually the outer needle traps the

5:59

material within the inner needle which

6:02

then is ultimately retracted in order to

6:05

visualize and then obtain our sample. One

6:08

of the things of note in this setting is that the core

6:11

needle offers a little bit of a greater risk to damaging

6:14

surrounding structures, but one

6:17

of the beautiful things about it, it does maintain tissue architecture.

6:20

It's able to get a nice column nice sample

6:23

of tissue that is almost clean and

6:26

pristine representative of the sample of

6:29

targeted on Atomic site that it is

6:32

intended to sample here is an example of a

6:35

spring-loaded mechanism for a core biopsy needle