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Advancing interventional CT
Precise Intervention
Overview
Philips Incisive CT features intellect at every step to help meet the challenges
of interventional CT. Like never before, operator and design efficiencies cometogether for wise decisions from start to finish. With the Precise Intervention
tool of Philips CT Smart Workflow, Incisive CT provides everything a userneeds to quickly and confidently perform an interventional CT scan.

CT-guided percutaneous procedures
are used for many different applications
to aid diagnosis and treatment
Procedure type

Application

Biopsy and puncture

Obtain biological tissue (biopsy) or liquid samples (puncture)
for analysis

Drainage and nephrostomy

Drain air or liquid (urine for nephrostomy)

Alcoholization (celiac plexus block)

Inject alcohol in celiac plexus area for palliative pain management
mainly in the context of tumor infiltration

Articular infiltration

Puncture and inject anti-inflammatory corticosteroid at the levelof lumbar joints

Cementoplasty (i.e., vertebroplasty,kyphoplasty, osteoplasty, sacroplasty)

Inject cement (methyl methacrylate) into an osseous lesion

Radio frequency ablation (RFA)and microwave ablation (MWA)

Destroy tumor tissue with heat

Cryoablation or cryotherapy

Destroy tumor tissue with cold

Embolization

Trans-arterial embolization of tumors or traumatic hemorrhageCancer is becoming a chronic condition
Although there are different types of interventional procedures performed
with CT systems, oncology-based interventions are the most challenging
to perform and are projected to have the most growth.
Background

Globally, 2018 estimates show

The World Health Organization (WHO) states that
1 in every 6 deaths can be attributed to cancer, andthat cancer is the second-leading cause of death after
cardiovascular disease.

Globally,

1 6

Breastcancer
most prevalent

Lungcancer
highest mortality

out ofdeaths are due to cancer

Liver cancer
closest ratio ofmortality to incidence
Cancer incidence and mortality rates vary by country due
to a variety of factors including the age of the population,
prevalence of risk factors such as infections, availability

According to the American Cancer Society, the global cancer burden
is expected to grow to 27.5 million new cancer cases and 16.3 million
cancer deaths by 2040.1

2and use of early detection tests (including preventive care),and the availability of advanced treatments.

CT is often chosen for diagnosis and treatment involving
image-guided procedures because of its exceptional contrast
and spatial resolution compared to other imaging modalities.

Image-guided procedures are increasing
Treatment

drainage,tumor ablation,
pain treatment

Diagnosis
biopsyTreatment

drainage,tumor ablation,
pain treatment

Complexprocedures with
CT guidance
oncology, spine

Potential benefits
over surgery• Less patient discomfort• Improved outcomes• Greater cost-effectivenessDiagnosis
biopsyComplexprocedures withCT guidance
oncology, spine

Typical workflow for CT-guided interventions
Location
Surview(optional)

Contrastenhanced helix

Needle guidance(sequential or fluoroscopy CT)

ProcedureControl

Target and entry
site selection

Low doseHigh accessibility
Work or scan bed motion

Fast and precise
Low accessibility
High dose

Follow-up (sequential or helix)

The goals of interventional CT are to aid in planning, guidance, treatment and control.
3Trends in interventional CT
Traditionally, CT systems have been installed in

Most sites have to schedule extended time slots

radiology departments. As CT image quality andof up to 60 minutes with the CT system for an

speed have improved, so has the use of accurate,interventional procedure. As image quality has

minimally invasive techniques. However, time isimproved, the focus is now on reducing procedure

still a challenge for interventional procedures.

time and also radiation dose.

Radiation dose
Depending on the type of interventional procedure, the entire study
time may be as short as a few minutes, but it may also take many hours.
Therefore, radiation dose plays a key role in decisions before and during
the procedure.
Pre-procedure

During the procedure

When decisions are made about

Image-guiding techniques, single scan for step-by-step guidance vs fluoro CT

the optimal imaging method to use,

for real-time imaging, and radiation dose per scan may be adjusted to optimize

radiation dose is considered forimage quality, and at the same time, minimize dose to the user and the patient.

the planning helical scan and during

There are also techniques to select an angle for the acquisition to minimize

the needle or probe guidance.

radiation dose.

Precise Intervention for confidence
in interventional CT
Incisive CT has AI* advances for optimal lesion
depiction and characterization from the planningstage through follow-up. Expect high image quality
and low dose, with the efficiency to improvethe experience for both patients and clinicians.
Reduce procedure time by 16%2
Perform more exams or proceduresin a day using Precise Intervention.

Needle planning, guidance
and tracking
Ensure visualization of the target pathand needle by allowing the physician
to verify or modify the needle angle
according to scan parameters.

* According to the definition of AI from the EU High-Level Expert Group.
4Radiation dose-conscious scanning
Perform efficient procedureswith high image quality at low dose.

Image display with references
While acquiring images, it can be useful to display one or two
reference images. These reference images allow the user to compare
to a previously acquired image.

Advanced needle guidance
To ensure precise placement of a needle regardlessof the complexity of access, Incisive CT allows the• Supports planning and re-plan and editingof the needle pathuser to plan any needle obliquity, along with tracking• Displays safety margins from 5 mm up to 20 mmof the needle, as it is inserted toward the target lesion.

• Transmits depth and angle information forthe planned path

These tools allow for fast feedback on the accuracyof needle placement, which in turn permits the user
to not only be confident in performing the procedure,
but also to carry out the procedure in as short a time
as possible. These tools assist in ensuring an optimal
outcome of the procedure while reducing time.

• Provides automatic needle tracking algorithm,
tracking results and system display measurementsof needle tip to target, along with deviation fromplan and insertion depth• Workflow available on the gantry, and from in-room
displays and the console

Incisive CT features advanced interventional needle tracking capability.

Needle guidance on console and in-room display.

Needle guidance on the gantry touchscreen.

5

Touchscreen gantry controls for ease of use in interventional CT.

Flexible display
Interventional
tools withthe flexibility
provided by
the OnPlan
gantry controls.

6ImageInterventional images are displayedon the gantry panel, and the images arecontrolled using gesture controls suchas scroll, WW/WL changes, pan and zoom.
Images can also be saved.

Interventional table controls
Saves multiple scan locations and moves
to the selected location. Also allows user
to move the table incrementally to aid
in locating the needle tip.

Acquisition
Allows the physician to immediatelychange scan parameters to ensure
visualization of the target, path andneedle through change of scan modes
or change of scan parameters, including
slice thickness.

LayoutFlexibility to display images according
to user preference. User can selectto display one or three images.
Simultaneously display either a singleroadmap image or a roadmap andsurview image to assist in guidance.

Clinical relevanceInterventional CT is becoming increasingly important in the guidanceof complex procedures in oncology. Incisive CT with Precise Interventiondelivers workflow advances and enables confident procedures in thiscritical but complex area of CT imaging.

Conclusion
Precise Intervention needle planning and tracking is a major enhancement that provides the ability to perform
interventional CT procedures with accuracy and confidence. Incisive CT provides a number of meaningfuladvances encompassing workflow, all to make procedures easy and efficient.

References
1.		 American Cancer Society, Global Cancer Facts & Figures, 4th Edition. 2018.
2. Chacko C. Precise Intervention Clinical Review Report for Loong. Philips Doc ID: D000874955. 2021.
7

References
1. American Cancer Society, Global Cancer Facts & Figures, 4th Edition. 2018.
2. Wang F, Ma J, Wu L, Li N, Luo R, Wei G, Yang J. Percutaneous cryoablation of subcapsular hepatocellular carcinoma:a retrospective study of 57 cases. Diagn Interv Radiol. 2020 Jan;26(1):34–39.
3. IMV Medical Information Division. IMV Imaging in Surgical Environments Outlook Report IV – 78. 2016.
4. Decision Resources Group. Millennium Research Group: Medical Device Analytics, Research and Consulting | DRG (decisionresourcesgroup.com)
5. Mahnken A, König A, Figiel J. Current technique and application of percutaneous cryotherapy. Rofo. 2018 Sep;190(9):836–846.
English, German. doi: 10.1055/a-0598-5134. Epub 2018 Apr 17. PMID: 29665588.
6. The MarketTech Group. Quantitative Report 2020 Incisive CT. November, 2020.

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4522 991 73351 * NOV 2021