CardioVascular and Interventional Radiology

, Volume 33, Issue 4, pp 828–834 | Cite as

CT Fluoroscopy-Guided Lung Biopsy with Novel Steerable Biopsy Canula: Ex-Vivo Evaluation in Ventilated Porcine Lung Explants

  • Philipp J. SchaeferEmail author
  • Michael Fabel
  • Hendrik Bolte
  • Fritz K. W. Schaefer
  • Thomas Jahnke
  • Martin Heller
  • Johannes Lammer
  • Juergen Biederer
Laboratory Investigation


The purpose was to evaluate ex-vivo a prototype of a novel biopsy canula under CT fluoroscopy-guidance in ventilated porcine lung explants in respiratory motion simulations. Using an established chest phantom for porcine lung explants, n = 24 artificial lesions consisting of a fat-wax-Lipiodol mixture (approx. 70HU) were placed adjacent to sensible structures such as aorta, pericardium, diaphragm, bronchus and pulmonary artery. A piston pump connected to a reservoir beneath a flexible silicone reconstruction of a diaphragm simulated respiratory motion by rhythmic inflation and deflation of 1.5 L water. As biopsy device an 18-gauge prototype biopsy canula with a lancet-like, helically bended cutting edge was used. The artificial lesions were punctured under CT fluoroscopy-guidance (SOMATOM Sensation 64, Siemens, Erlangen, Germany; 30mAs/120 kV/5 mm slice thickness) implementing a dedicated protocol for CT fluoroscopy-guided lung biopsy. The mean-diameter of the artificial lesions was 8.3 ± 2.6 mm, and the mean-distance of the phantom wall to the lesions was 54.1 ± 13.5 mm. The mean-displacement of the lesions by respiratory motion was 14.1 ± 4.0 mm. The mean-duration of CT fluoroscopy was 9.6 ± 5.1 s. On a 4-point scale (1 = central; 2 = peripheral; 3 = marginal; 4 = off target), the mean-targeted precision was 1.9 ± 0.9. No misplacement of the biopsy canula affecting adjacent structures could be detected. The novel steerable biopsy canula proved to be efficient in the ex-vivo set-up. The chest phantom enabling respiratory motion and the steerable biopsy canula offer a feasible ex-vivo system for evaluating and training CT fluoroscopy-guided lung biopsy adapted to respiratory motion.


CT fluoroscopy Lung biopsy Biopsy canula Chest phantom Experimental study 



The work was supported by the CIRSE Fellowship Education Grant. The authors would like to thank Beata Hoffmann, PhD, and Gerard Morvan for their excellent technical support during the study.


  1. 1.
    Mueller PR, vanSonnenberg E (1990) Interventional radiology in the chest and abdomen. N Engl J Med 322(19):1364–1374PubMedGoogle Scholar
  2. 2.
    Poulou LS, Tsangaridou I, Filippoussis P et al (2008) Feasibility of CT-guided percutaneous needle biopsy in early diagnosis of BOOP. Cardiovasc Intervent Radiol 31(5):1003–1007CrossRefPubMedGoogle Scholar
  3. 3.
    Carlson SK, Felmlee JP, Bender CE et al (2005) CT fluoroscopy-guided biopsy of the lung or upper abdomen with a breath-hold monitoring and feedback system: a prospective randomized controlled clinical trial. Radiology 237(2):701–708CrossRefPubMedGoogle Scholar
  4. 4.
    Katada K, Kato R, Anno H et al (1996) Guidance with real-time CT fluoroscopy: early clinical experience. Radiology 200(3):851–856PubMedGoogle Scholar
  5. 5.
    Bruning R, Muehlstaedt M, Becker C et al (2002) Computed tomography-fluoroscopy guided drainage of pericardial effusions: experience in 11 cases. Invest Radiol 37(6):328–332CrossRefPubMedGoogle Scholar
  6. 6.
    Daliri A, Oehring K, Moosdorf RG et al (2007) Percutaneous left atrial cardiac biopsy with CT fluoroscopy guidance. J Vasc Interv Radiol 18(7):909–913CrossRefPubMedGoogle Scholar
  7. 7.
    Daly B, Krebs TL, Wong-You-Cheong JJ et al (1999) Percutaneous abdominal and pelvic interventional procedures using CT fluoroscopy guidance. AJR Am J Roentgenol 173(3):637–644PubMedGoogle Scholar
  8. 8.
    Daly B, Templeton PA (1999) Real-time CT fluoroscopy: evolution of an interventional tool. Radiology 211(2):309–315PubMedGoogle Scholar
  9. 9.
    Froelich JJ, Ishaque N, Regn J et al (2002) Guidance of percutaneous pulmonary biopsies with real-time CT fluoroscopy. Eur J Radiol 42(1):74–79CrossRefPubMedGoogle Scholar
  10. 10.
    Kirchner J, Kickuth R, Laufer U et al (2002) CT fluoroscopy-assisted puncture of thoracic and abdominal masses: a randomized trial. Clin Radiol 57(3):188–192CrossRefPubMedGoogle Scholar
  11. 11.
    Binkert CA, Verdun FR, Zanetti M et al (2003) CT arthrography of the glenohumeral joint: CT fluoroscopy versus conventional CT and fluoroscopy—comparison of image-guidance techniques. Radiology 229(1):153–158CrossRefPubMedGoogle Scholar
  12. 12.
    Carlson SK, Bender CE, Classic KL et al (2001) Benefits and safety of CT fluoroscopy in interventional radiologic procedures. Radiology 219(2):515–520PubMedGoogle Scholar
  13. 13.
    Schaefer PJ, Schaefer FK, Heller M et al (2007) CT fluoroscopy guided biopsy of small pulmonary and upper abdominal lesions: efficacy with a modified breathing technique. J Vasc Interv Radiol 18(10):1241–1248CrossRefPubMedGoogle Scholar
  14. 14.
    Hiraki T, Fujiwara H, Sakurai J et al (2007) Nonfatal systemic air embolism complicating percutaneous CT-guided transthoracic needle biopsy: four cases from a single institution. Chest 132(2):684–690CrossRefPubMedGoogle Scholar
  15. 15.
    Lattin G Jr, O’Brien W Sr, McCrary B et al (2006) Massive systemic air embolism treated with hyperbaric oxygen therapy following CT-guided transthoracic needle biopsy of a pulmonary nodule. J Vasc Interv Radiol 17(8):1355–1358CrossRefPubMedGoogle Scholar
  16. 16.
    Hirasawa S, Hirasawa H, Taketomi-Takahashi A et al (2008) Air embolism detected during computed tomography fluoroscopically guided transthoracic needle biopsy. Cardiovasc Intervent Radiol 31(1):219–221CrossRefPubMedGoogle Scholar
  17. 17.
    Yeow KM, Su IH, Pan KT et al (2004) Risk factors of pneumothorax and bleeding: multivariate analysis of 660 CT-guided coaxial cutting needle lung biopsies. Chest 126(3):748–754CrossRefPubMedGoogle Scholar
  18. 18.
    Kau T, Rabitsch E, Celedin S et al (2008) When coughing can cause stroke—a case-based update on cerebral air embolism complicating biopsy of the lung. Cardiovasc Intervent Radiol 31(5):848–853CrossRefPubMedGoogle Scholar
  19. 19.
    Hopper KD, Abendroth CS, Sturtz KW et al (1995) CT percutaneous biopsy guns: comparison of end-cut and side-notch devices in cadaveric specimens. AJR Am J Roentgenol 164(1):195–199PubMedGoogle Scholar
  20. 20.
    Schaefer PJ, Jahnke T, Hedderich J et al (2009) Development of a permanently controllable rotating biopsy device, part I: theoretical considerations and in vitro results for five different prototypes. Rofo. doi: 10.1055/s-0028-1109722
  21. 21.
    Schaefer PJ, Kurz B, Schaefer FK et al (2009) Development of a permanently controllable rotating biopsy device, part II: competitive in vitro testing of a canula-like prototype compared to established end-cut and side-notch biopsy devices. Rofo. doi: 10.1055/s-0028-1109723
  22. 22.
    Biederer J, Heller M (2003) Artificial thorax for magnetic resonance imaging studies on porcine heart-lung preparations. Radiology 226(1):250–255CrossRefPubMedGoogle Scholar
  23. 23.
    Bolte H, Müller-Hülsbeck S, Riedel C et al (2004) Ex-vivo injection technique for implanting solid pulmonary nodules into porcine lungs for multi-slice CT studies. Rofo 176(10):1380–1384PubMedGoogle Scholar
  24. 24.
    Bolte H, Riedel C, Jahnke T et al (2006) Reproducibility of computer-aided volumetry of artificial small pulmonary nodules in ex vivo porcine lungs. Invest Radiol 41(1):28–35CrossRefPubMedGoogle Scholar
  25. 25.
    Biederer J, Plathow C, Schoebinger M et al (2006) Reproducible simulation of respiratory motion in porcine lung explants. Rofo 178(11):1067–1072PubMedGoogle Scholar
  26. 26.
    Heck SL, Blom P, Berstad A (2006) Accuracy and complications in computed tomography fluoroscopy-guided needle biopsies of lung masses. Eur Radiol 16(6):1387–1392CrossRefPubMedGoogle Scholar
  27. 27.
    Yoshimatsu R, Yamagami T, Kato T et al (2008) Percutaneous needle biopsy of lung nodules under CT fluoroscopic guidance with use of the “I-I device”. Br J Radiol 81(962):107–112CrossRefPubMedGoogle Scholar
  28. 28.
    Yeow KM, Tsay PK, Cheung YC et al (2003) Factors affecting diagnostic accuracy of CT-guided coaxial cutting needle lung biopsy: retrospective analysis of 631 procedures. J Vasc Interv Radiol 14(5):581–588PubMedGoogle Scholar
  29. 29.
    Plathow C, Klopp M, Fink C et al (2005) Quantitative analysis of lung and tumour mobility: comparison of two time-resolved MRI sequences. Br J Radiol 78(933):836–840CrossRefPubMedGoogle Scholar
  30. 30.
    Teeuwisse WM, Geleijns J, Broerse JJ et al (2001) Patient and staff dose during CT guided biopsy, drainage and coagulation. Br J Radiol 74(884):720–726PubMedGoogle Scholar
  31. 31.
    Paulson EK, Sheafor DH, Enterline DS et al (2001) CT fluoroscopy-guided interventional procedures: techniques and radiation dose to radiologists. Radiology 220(1):161–167PubMedGoogle Scholar
  32. 32.
    Schulz-Wendtland R, Aichinger U, Kraemer S et al (2003) Sonographical breast biopsy: how many core biopsy specimens are needed? Rofo 175(1):94–98PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2009

Authors and Affiliations

  • Philipp J. Schaefer
    • 1
    Email author
  • Michael Fabel
    • 1
  • Hendrik Bolte
    • 1
  • Fritz K. W. Schaefer
    • 1
  • Thomas Jahnke
    • 1
  • Martin Heller
    • 1
  • Johannes Lammer
    • 2
  • Juergen Biederer
    • 1
  1. 1.Department of Diagnostic RadiologyUniversity Hospital Schleswig-Holstein Campus KielKielGermany
  2. 2.Department of Radiology, Division of Cardiovascular and Interventional RadiologyMedical University of ViennaViennaAustria

Personalised recommendations