0:00

So let's unpack the modalities that we

0:03

can use for an IRA guided biopsy.

0:05

Of course, there's CAT scan guidance.

0:08

There's ultrasound guidance.

0:10

And then there's fluoroscopic guidance in the

0:13

case of CAT scan guidance. It's really important to understand

0:16

what are the advantages versus the disadvantages

0:19

of using one modality versus another what

0:22

we know about CTS is our office high spatial resolution,

0:25

it offers the ability to sort of really understand

0:28

the cross-sectional anatomy of the

0:31

targeted structure.

0:34

Offering us the ability to perform three-dimensional reconstruction

0:37

and just a 3D representation

0:40

of the area of concern.

0:44

The disadvantages is the lack of

0:47

real-time Imaging guidance during the biopsy in

0:50

question.

0:51

Of course, this can be mitigated to some degree with use of

0:54

CT fluoroscopy, which allows us to place our foot on

0:57

the pedal to step and shoot to create typically

1:00

an image at the level of where I needle

1:03

may be an image just north of it an image

1:06

of south of it. So that's CD fluoroscopy can in some

1:09

degrees really sort of allow us to have as close

1:12

to real-time guidance as we possibly can. Of course, there's the

1:15

step and shoot technique where we can advance the

1:18

needle exit the room,

1:21

Perform a CT of the area move back

1:24

in the room and then Advance our needle and then move

1:27

sequentially in that fashion.

1:29

This is an area of concern in the liver where we

1:32

can see the axial CT.

1:35

Giving us some structures of note. Of

1:38

course. There's the vessels in the hilum of

1:41

the liver. There's the lung there's the plura

1:44

all areas that we want to avoid. The CT

1:47

allows us to see exactly where we want to

1:50

biopsy given us a situation awareness as we

1:53

proceed with choosing our intended trajectory.

1:56

There's ultrasound guidance. And so

1:59

what are some advantages of ultrasound guidance, of course, ultrasound offices

2:02

real-time visualization as our

2:05

needle is being Advanced we can position our ultrasound

2:08

in plane to visualize our needle as

2:11

it advances.

2:13

through structures known structures avoiding structures

2:16

of concern

2:18

we can angle moving from axial

2:21

planes to sagittal planes depending on

2:24

as needed and one of the beautiful things

2:27

about this particular technique is there is no radiation which

2:30

really lends itself to being particularly useful in

2:33

the Pediatric population.

2:36

Of course, there are patients in critical units within

2:39

the hospital where they're transport

2:43

to the ultrasound room can

2:46

be a bit challenging. So this technique is

2:49

portable in nature allowing us to

2:52

take that portable ultrasound to the ICU in

2:55

order to perform bedside targeted tissue

2:58

sampling when indicated what are some

3:01

disadvantages some disadvantages include the decrease resolution, of

3:04

course relative to see Team

3:07

Individuals may be of large girth large

3:10

habitats in the setting of large amounts of air within

3:13

bowel those views of our

3:16

intended trajectory may be obscured and one

3:19

of the things about ultrasound and it is operated dependent.

3:22

So the ability to get good views to follow

3:25

our needle in the setting of an individual with large

3:28

habitus or views that obscured by air or just

3:31

difficult trajectory Dynamics.

3:34

Requires Great skill and so

3:37

this is one of the modalities that requires High degree of operator.

3:41

skill

3:42

so fluoroscopy is the third modality one advantage

3:45

of fluoroscopying which is live x-ray

3:48

every time our foot is on the pedal the live

3:51

x-ray of the fluoroscopy is in View and

3:54

allows us to see

3:56

These structures in question, of course, it has some advantages that

3:59

are similar to CTE and ultrasound but one

4:02

of the beautiful things about it is as I mentioned before as

4:05

long as our foot is on the pedal this allows us to essentially

4:08

facilitate real time visualization. Some

4:11

disadvantages are obvious in

4:14

the sense that the radiation exposure likes CT renders.

4:17

It's something that may not be appropriate in settings

4:20

such as in pediatric cases.