London, UK - Exceptional insight for challenging interventions is now possible with Philips advanced interventional tools. XperGuide ablation software for precise treatment planning and 2D Perfusion for real-time, high-definition perfusion visualisation are two such software packages that support confident decision-making during complex interventional procedures.
XperGuide facilitates successful tumour coverage through precise ablation needle planning on CT, MR or Philips’ XperCT. Performing successful tumour ablations, without compromising adjacent tissue, requires a clear understanding of the tumour size, each individual needle ablation area, and the optimal path to the target. Philips’ XperGuide ablation feature is the next evolution of the company’s successful XperGuide tool and is the first to provide comprehensive assistance during treatment planning and live needle image guidance for tumour ablation procedures. The unique software visualises the specific isotherms or ablation zones of manufacturers’ needles to assist clinicians in their planning to achieve full tumour coverage.
Until now it has been difficult to visualise the ablation zone with a high degree of accuracy using conventional methods. Philips’ XperGuide ablation software helps in the visualisation, in 3D, of the specific ablation zones and distance between the planned ablation needles, based on manufacturers’ specifications of each needle. This visualisation shows the isotherm of each needle on an Xper CT or on a pre-acquired MR or CT volume. It assists clinicians in planning the optimal placement of the ablation needle to cover the targeted lesion. The needle path can be planned by drawing it or by defining entry and target locations on XperCT, MR or CT slices. By allowing the precise planning of multiple needles, XperGuide’s ablation software assists clinicians in treating large tumours and potentially reduces the risk of repeats.
After the initial needle insertion, the interventionalist can verify full tumour coverage with an automatic fusion of the pre-procedural planning on a control XperCT scan, showing the actual needle location. This allows updating the needle location and ablation zone during the procedure to assist in the identification of areas which might not be covered by the isotherm, thereby obtaining optimal results. A post-procedural XperCT scan after the ablation cycles helps to visualise the achieved ablation zone around the tumour, providing instant feedback of the procedure’s outcome. Commenting on the new software, Dr. Marco van Strijen, of St. Antonius Ziekenhuis, the Netherlands says, “We are now capable of decreasing the risk related to tumour ablation procedures because of the optimal planning and control during the whole treatment.”
2D Perfusion offers key advantages of high definition perfusion imaging with comprehensive data analysis tools; instant perfusion feedback during procedures and dedicated image acquisition protocols for different anatomical regions.
Interventional procedures often require deeper insight and understanding of the underlying organ perfusion, while trying to restore the vessel patency to overcome ischemia and compromised organ function, or while trying to achieve a controlled restriction of perfusion in tumour embolisation. Philips’ real-time 2D Perfusion imaging helps the clinician identify the severity of the condition of the patient before the intervention and verify the effect and completeness of the treatment immediately afterwards. The unique acquisition settings create high-definition visualisations that show the flow of contrast into small blood vessels at a very high level of detail, assisting in the assessment of hypo- and hyper-perfused tissues during endovascular, neurology and oncology interventions. This additional information during angiographic interventions potentially reduces procedure time and facilitates the review of procedural outcome.
Being able to follow, precisely, the uptake of contrast in blood vessels when re-vascularising or occluding an artery is critical for assessing the effectiveness of an interventional procedure. 2D Perfusion software is an interventional tool, which visualises, over time in a single colour image, the flow of contrast through vessels and the organ parenchymal enhancement. These high-definition visualisations are based on DSA acquisition protocols dedicated per anatomical region, which show small blood vessels and parenchymal enhancement with a high degree of specificity.
2D Perfusion typically requires only one contrast media injection and one DSA run, to obtain rich information of vessel and organ perfusion in the interventional suite. By comparing pre- and post-procedural images, clinicians can easily identify perfusion differences in the colour images. This allows the clinician to verify if the required level of perfusion has been achieved in order to define the treatment endpoint.
Clinical applications include neuroradiology: visualisation of perfusion changes of brain parenchyma after carotid artery stenting or cloth removal in case of ischemic stroke and analysis of perfusion behaviour of brain tumours and arteriovenous malformations (AVMs). In oncology, monitoring the perfusion behaviours of feeding vessels and tumours before and after embolisation to evaluate blood flow changes and define procedural endpoints. For endovascular radiology interventions, visualisation of hypo-perfusion in peripheral artery disease and monitoring effects of revascularisation in real-time.