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CT image guided surgery

CT-guided interventional procedures

Innovative CT solutions for efficient procedure planning and needle guidance

Between 2015 and 2050, the proportion of the world’s population over 60 years will nearly double from 12% to 22%1. This demographic shift poses challenges to health systems around the globe. Particularly on the rise will be cancer diagnoses (e.g., biopsies) and treatments (e.g., ablations) as well as orthopedic diseases like chronic back pain or fractured vertebras caused by osteoporosis.

Image-guided minimally invasive procedures2 enable the cost-effective diagnosis and treatment of suspicions lesions. Computed tomography is one of the imaging modalities most often used when cross-sectional image guidance is required in percutaneous interventional procedures3. Dedicated technology that can simplify workflows and maximize safety will help you to optimally handle these procedures and take the best possible care of your patients.

Stay competitive in a growing and dynamic field

The number of CT-guided interventions performed is expected to grow rapidly. While biopsies will remain the core application, therapeutic procedures are expected to become much more important due to the obvious advantages of minimally invasive therapy: fewer complications, faster recovery times, and shorter hospital stays.

The image shows a folder which symbolizes new guidelines.

New guidelines 

The growing importance of thermal ablations in cancer treatment is highlighted by a number of new guidelines.1,2

The image shows an increase of 8 percent.

Increase in ablations 

Ablation procedures in cancer therapy are projected to increase by 8 percent per year between 2020 and 2030.3

The image shows an icon of a CT scanner gantry, which enables CT-guided interventional procedures.

Alternative to surgery 

CT-guided drainages provide an alternative to surgery with lower morbidity and mortality rates.4 

The image shows an icon symbolizing a number of people.

577 million patients 

More than half a billion patients worldwide suffered from low-back pain in 2017.5 Image-guided injections can help ease this burden and minimize surgical interventions.

Customer voices

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David Lacey, MD01
Michael Kostrzewa, MD 01
Doris Csillag, MD 01

“myNeedle Guide on the SOMATOM X.cite really has changed my approach to doing biopsies,” says David Lacey, MD, Interventional Radiologist at Iowa Methodist Medical Center in Des Moines.

Watch to see how myNeedle Companion – a package consisting of myNeedle Guide and myNeedle Laser* – on the SOMATOM X.cite is helping to streamline workflow, reduce dose, and simplify needle planning at Iowa Methodist Medical Center.

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Clinical cases 

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Biopsy04
Pain management01
Drainage placement01
Thermal ablation02
Various CT projections of the clinical case involving the biopsy of a small suspicious lesion at the shoulder blade.

Courtesy of Kantonsspital Baden, Baden, Switzerland

Biopsy of a small suspicious lesion at the shoulder blade

CT-guided intervention with myNeedle Guide 2D on SOMATOM X.ceed 

Planning and control spiral: 
Exposure time: 3.6 s / 1.7 s 
Scan length: 131 mm / 41 mm 
100 kV 
CTDIvol: 3.9 mGy / 3.15 mGy 
DLP: 57.6 mGy*cm / 18.7 mGy*cm 

i-Fluoro: 
3 events 
130 kV 
Scan length: 9 mm 
Exposure time: 0.7 s / 4.3 s / 0.7 s 
CTDIvol: 6.48 mGy / 39.3 mGy / 6.48 mGy 
Accum. DLP: 47.1 mGy*cm 
Complete procedure time: 36 min 

Various CT projections of the clinical case involving the biopsy of a small suspicious lesion at the shoulder blade.
The presentation highlights a biopsy procedure of a suspicious liver lesion, presenting various CT scans alongside a T2 HASTE MR scan. Additionally, it includes a fused reconstruction merging the T2 HASTE MR with the CT scan.
CT-guided interventions Seldinger technique
CT-guided interventions pain management
CT-guided interventions lumbar sympathicolysis
CT-guided interventions needle biopsy
CT-guided interventions needle biopsy
CT-guided interventions low-dose
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Dedicated solutions for CT-guided interventions

Our advanced technologies support routine and complex CT-guided interventions, reduce metal artifacts, enable dose modulation, and simplify workflows by giving radiologists full in-room control of all relevant parameters.

myNeedle Companion

myNeedle Companion is our modular and scalable solution for CT-guided interventions. It helps simplify even advanced needle procedures with targeted needle path planning and guidance facilitated by an AI-based needle detection algorithm, 3D volume registration and image fusion display, as well as laser-guided needle insertion with myNeedle Laser. In addition, dedicated in-room control options offer you the flexibility to work as you prefer – with or without an assistant.

myNeedle Guide 2D 
myNeedle Guide 3D 
myNeedle Laser 
i-Fluoro 
In-room control 
Artifact reduction with iMAR 
Dose modulation 
The image shows an axial CT scan of an abdomen with biopsy needle inserted.

myNeedle Guide 2D 

myNeedle Guide 2D simplifies CT-guided interventions along the whole clinical workflow, from imaging through planning and monitoring the current needle position. 

CT-guided interventions Adaptive 3D Interventions Suite

myNeedle Guide 3D 

myNeedle Guide 3D6 simplifies the workflow for both routine and complex CT-guided interventions. You can easily plan multiple needle pathways in different cross sections. Both path planning and visually guided insertion of multiple needles are supported within the workflow. 

The AI based needle detection algorithm myNeedle Detection supports an efficient workflow by minimizing user interaction when progressing the needle. 

Integrated Image Fusion allows fusing of 3D images from different modalities or contrast-enhanced prior CT studies to accurately plan and guide needle paths around critical anatomy.

The image depicts the laser cross projected onto the patient's body, along with an ablation probe beginning to penetrate the skin. Additionally, the green cross of the laser guidance system aligns with the hub of the needle, aiding the user in determining the correct angle for inserting the needle along the preplanned path.

myNeedle Laser 

myNeedle Laser7 is a powerful, fully integrated option designed to make the intervention workflow more efficient by automatically projecting the needle entry point and insertion angle onto the body of the patient – even in advanced double-angulated procedures with multiple needle paths.

Courtesy of Hospital Sao Joao, Porto, Portugal

i-Fluoro 

i-Fluoro8 mode is designed for precise and fast placement in even the most complex, moving anatomies. At the same time, it offers HandCARE a real-time dose reduction providing significant protection from radiation to both radiologist and patient.9

The presentation showcases the hardware setup in both the control room and the examination room, which are available on CT scanners from Siemens Healthineers.
Clinical images courtesy of RNS Wiesbaden, Wiesbaden, Germany

In-room control 

The in-room control solution simplifies workflows by giving radiologists almost full control of CT-guided interventions. It is designed specifically for targeted needle placement without the need for a supporting technologist.
The presentation visually demonstrates the process of iterative metal artifact reduction.

Artifact reduction with iMAR10

Artifacts due to metal implants or to the tool used in interventional procedures (e.g., RF ablation) often hamper image quality. Special reconstruction algorithms such as iMAR10 can be applied during CT-guided interventional procedures to reduce artifacts and to improve confidence even in areas adjacent to metal implants.

The presentation demonstrates how HandCARE functions and specifies the area within the CT scanner where the dose is deactivated.

Dose modulation 

Dose matters in CT-guided interventions for both the patient and the operator. HandCARE enables real-time dose modulation during CT-guided intervention procedures and prevents direct radiation exposure to the clinician’s hand – by switching off the X-ray exposure for a 100° angle between three possible user positions:

  • 10 o’clock 
  • 12 o’clock 
  • 2 o’clock

Clinical Use 

See myNeedle Companion in action 

In this video, David Lacey, MD, Interventional Radiologist at Iowa Methodist Medical Center in Des Moines, explains how myNeedle Companion has helped simplify CT-guided interventions from start to finish.

Our scanners for CT-guided interventions

By choosing from our comprehensive portfolio of scanners, you can select the solution that best suits your clinical needs and budget for CT-guided interventions. 

SOMATOM go. platform
SOMATOM X. platform
SOMATOM Pro.Pulse
NAEOTOM Alpha
The products/features and/or service offerings (mentioned herein) are not commercially available in all countries. Their future availability cannot be guaranteed.
The statements by Siemens Healthineers’ customers described herein are based on resultsthat were achieved in the customer's unique setting. Because there is no “typical” hospital or laboratoryand many variables exist (e.g., hospital size, samples mix, case mix, level of IT and/or automationadoption) there can be no guarantee that other customers will achieve the same results.
Professor Frank Wacker, MD and Professor Ralf Bauer, MD receive financial support from Siemens Healthineers for collaborations.
1
Genshaft S, et al. (2021): SIR Quality Improvement Standards on Percutaneous Ablation of Non-Small Cell Lung Cancer and Metastatic Disease to the Lungs.
2
Reig M, et al. (2022): BCLC Strategy for Prognosis Prediction and Treatment recommendation.
3
Siemens Healthineers evaluation based on Clarivate: Interventional Oncology Devices Market Insights, 2021.
4
De Filippo, M, et al. (2021): CT-guided percutaneous drainage of abdominopelvic collections: a pictorial essay.
5
Wu A, et al. (2017): Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017.
6
Option. Not available for SOMATOM go.Now.
7
Option. Only available with SOMATOM X.cite, SOMATOM X.ceed, and NAEOTOM Alpha and in combination with myNeedle Guide 3D.
8
Only in combination with myNeedle Guide 2D or myNeedle Guide 3D
9
Hohl C, Suess C, Wildberger JE, Honnef D, Das M, Mühlenbruch G, et al. (2008): Dose reduction during CT fluoroscopy: Phantom study of angular beam modulation.
10
iMAR is designed to yield images with a reduced level of metal artifacts compared to conventional reconstruction if the underlying CT data is distorted by metal being present in the scanned object. The exact amount of metal artifact reduction and the corresponding improvement in image quality achievable depends on a number of factors, including composition and size of the metal part within the object, patient size, anatomical location and clinical practice. It is recommended to perform iMAR reconstruction in addition to conventional reconstruction.  
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