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1 BJJ Abdullah, 1 CH Yeong, 2 KL Goh , 3 BK Yoong , 4 GF Ho, 5 Anjali Kulkarni

Early Experience of a Commercial Available Robot (Maxio) for CT-guided Radiofrequency Ablation of liver tumours. 1 BJJ Abdullah, 1 CH Yeong, 2 KL Goh , 3 BK Yoong , 4 GF Ho, 5 Anjali Kulkarni

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1 BJJ Abdullah, 1 CH Yeong, 2 KL Goh , 3 BK Yoong , 4 GF Ho, 5 Anjali Kulkarni

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  1. Early Experience of a Commercial Available Robot (Maxio) for CT-guided Radiofrequency Ablation of livertumours 1BJJ Abdullah, 1 CH Yeong, 2 KL Goh, 3 BK Yoong, 4 GF Ho, 5AnjaliKulkarni 1 Department of Biomedical Imaging and University of Malaya Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. Departments of 2Internal Medicine, 3Surgery and 4Oncology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 5Perfint Healthcare Corporation, Florence, OR 97439, United State.

  2. Challenges in Ablation • Visualization • Planning Limited Tools • Tumor visualization difficult in many cases Current fusion techniques - Cumbersome • Impossible to visualize related structures Ablation zone Skill dependent • Validation • Positioning No tool to validate Needle visualization Complex spatial orientation of organs Patient follow up Multiple needle Big Learning Curve Ablation tool lacks the critical level of control, accuracy, stability, and guaranteed performance (EmadM. Boctor et. Al, 2004) Local tumor progression occurs due to failures in establishing ablative margin (Minami & Kudo, 2011)

  3. Entry point Depth Angle Target ECR 2014, Vienna Challenges of currentCT-guided RFA Real time High CT fluoro dose Repeated Punctures Time Consuming

  4. Robotic-Assisted RFA MAXIO console MAXIO MAXIOTM (Perfint Healthcare Pvt Ltd, Oregon, USA) ECR 2014, Vienna

  5. Purpose of Study To assess the accuracy of needle placement, radiation dose and performance level during robotic-assisted radiofrequency ablation (RA-RFA) of liver tumours using a CT-guidance robotic system (MAXIO, Perfint Healthcare, USA). ECR 2014, Vienna

  6. Methodology 19 patients (39 lesions, <5.0 cm diameter) were treated with RA-RFA. All the procedures were performed under GA. Following baseline CT scans the lesions were identified. The CT images (1 mm reconstructed SL) were registered to the MAXIO workstation for treatment planning. Target point (X, Y, Z) and needle entry point were determined during the treatment plan. The needle trajectory path, angulation and depth of lesion were calculated and shown on the treatment plan. ECR 2014, Vienna

  7. Methodology The plan was carefully checked to avoid any critical organs or bone across the trajectory. Once the plan was confirmed, MAXIO was executed. The robotic arm then moved automatically to the planned location and the radiologist inserted the RFA needle through the bush holder at the end-effector of the robotic arm. Post-needle insertion, a CT-fluoro was done to confirm accurate placement of the needle within the target volume. ECR 2014, Vienna

  8. Methodology The accuracy of needle placement, number of readjustments and total radiation dose to each patient were recorded. The performance level was evaluated for each procedure on a five-point scale (5-1: Excellent-Poor) by the operated radiologist. The radiation doses and readjustments were then compared against 30 RFA patients treated without robotic assistance. ECR 2014, Vienna

  9. Image Registration Segmentation Simulation Adaptive Intra-op. registration SCAN PLAN VISUALISE EXECUTE VALIDATE MaxioTM Robotic Targeting Post procedure confirmation ECR 2014, Vienna

  10. ECR 2014, Vienna

  11. ECR 2014, Vienna

  12. Results All 39 lesions were targeted successfully. No immediate complications were noted in all the patients. ECR 2014, Vienna.

  13. Conclusion • Robotic-assisted planning and needle placement appears to be • technically easier • requires fewer number of needle passes • fewer check scans • lower radiation dose (patient & staff) • Study with large sample size is needed to confirm these preliminary findings. ECR 2014, Vienna

  14. Other Potential Advantages of RA-RFA Time Pain Allows access to difficult lesions Accuracy & consistency Level of confidence & safety ECR 2014, Vienna

  15. References BJJ Abdullah, CH Yeong, KL Goh, BK Yoong, GF Ho, Carolyn Yim, Anjali Kulkarni. Robotic-assisted radiofrequency ablation of primary and secondary tumours. European Radiology, Vol 23(9), 2013. Perfint Healthcare Corporation official website. www.perfinthealthcare.com ECR 2014, Vienna

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