Biomedical Engineering Reference
In-Depth Information
12
Evolving Tools for Navigated
Image-Guided Thermal
Cancer Therapy
12.1 Introduction ............................................................................................................................ 203
12.2 Technology of Navigation Systems ...................................................................................... 203
Definition of Image-Guided Surgery and Historical Review  • 
Imaging  •  Tracking  •  Registration  •  Planning  •  Navigation
12.3 Clinical Applications .............................................................................................................. 208
Introduction and Overview  •  Radiofrequency Ablation  •  Cryoablation  •  Transarterial 
Chemoembolization
12.4 Potential Future Developments .............................................................................................214
Joystick Navigation for Catheter Placement  •  Robotically Assisted Needle 
Placement  •  Combination Therapy and Navigation Assistance
12.5 Summary ...................................................................................................................................215
References .............................................................................................................................................216
Kevin Cleary
Children's National Medical Center
Emmanuel Wilson
Children's National Medical Center
Filip Banovac
Georgetown University
Medical Center
12.1 Introduction
12.2 technology of Navigation Systems
Image-guided interventions have become a mainstay of cancer
diagnosis and treatment. By image-guided we mean the use of
medical imaging such as fluoroscopy or computed tomography
(CT) to carry out minimally invasive procedures. These proce-
dures can be done through percutaneous instrument placement
(through the skin) or through the vasculature using catheter-
based approaches. Navigation systems to assist the physician in
more precisely completing image-guided interventions have also
been introduced in recent years by commercial companies and
are an active area of research. Since we focus on navigation sys-
tems for cancer interventions in this chapter, we will call this
Navigated Image-Guided Thermal Cancer Therapy (NIGTCT).
We will describe the technology of navigated image-guided
interventions, review the literature where image-guided naviga-
tion has been applied to thermal therapy in the interventional
oncology domain, and describe emerging trends relevant to the
future of image-guided thermal cancer therapy.
12.2.1 Definition of Image-Guided
Surgery and Historical review
One definition of image-guided surgery is a surgical proce-
dure facilitated through a correlation between preoperative and
intraoperative imaging. In this regard, as intraoperative imaging
is becoming more common in the clinical arena, more sophisti-
cated image processing and guidance is increasingly employed
for surgical procedures. Image-guided surgery can also refer to
the use of mechanical devices or computers to enable a mapping
from preoperative images to the intraoperative workspace. These
developments began with the introduction of the stereotactic
frame for neurosurgery. The successful adoption of mechanical
digitizers and stereotactic frames for neurosurgical application
was enabled through the availability of easily identifiable exte-
rior landmarks such as the auditory canals and inferior orbital
rims (Galloway et al. 2008).
203
 
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