Xbox® Meets the Surgical Suite
Advanced imaging helps doctors see beyond traditional cancer care
Children who come to Cincinnati Children’s with cancer and blood diseases might be surprised to know that their doctors are using video game technology to help them get better.
Interventional radiologist, John Racadio, MD, uses advanced 3-D imaging to help replace open surgeries with minimally invasive techniques.
Interventional radiologists here are using the latest multi-dimensional imaging – like that used in video games – to help hematologists, oncologists and surgeons replace open surgery with minimally invasive techniques. Advanced 3-D images give doctors views of the body’s innermost workings that were previously impossible without open surgery, says John Racadio, MD, chief of interventional radiology. As a result, young patients have fewer risks, less pain and shorter hospital stays.
“Imaging technology enables us to define the anatomy accurately. We can create 3-D data sets in the lab and combine them with live X-ray with 3-D imaging,” Dr. Racadio says. “As a result, we can guide the needle or catheter with more accuracy. Whenever you have more control and visualization of what you’re doing, procedures are safer and more effective.”
Leading the Way in Pediatric Use
Cincinnati Children’s is pioneering the use of interventional radiology to help children with cancer. Three interventional radiology labs located in the hospital’s perioperative area encourage collaboration between surgeons and interventional radiologists.
For example, catheter-directed chemotherapy embolization can deliver a higher level of chemotherapy directly to a liver tumor, decreasing the systemic effects of traditional intravenous chemotherapy. “First the interventional radiologist performs an angiogram to guide a catheter to the liver,” Dr. Racadio explains. “Then a microcatheter, deployed from inside the catheter, releases the chemotherapy and agents that block off flow to the tumor, maximizing chemotherapy at the tumor site.”
Using radiofrequency ablation to kill tumors is another new application. “When surgery is not an option, we can use heat to kill tumors such as hepatoblastoma. Guided by imaging, we insert a probe through the skin to reach the tumor on the liver. Radiofrequency-generated heat through an active tip on the probe can then ‘burn’ a segment of the tumor,” Dr. Racadio says. Targeted heat destroys tumors and limits harm to surrounding tissue.
Smaller Resections
3-D multiplanar imaging shows the needle advanced into the chest wall (bottom left). Graphics (green) show the trajectory and act as a guide as the needle is advanced into the pulmonary nodule.
For tumor biopsies, interventional radiologists can help speed recovery time and minimize pain with image-guided percutaneous intervention. They can also localize tumors, allowing surgeons to use a scope instead of open surgery. Many children with cancer must undergo surveillance CTs of the lung to detect new cancer nodules. When suspicious areas are large and close to the lung’s periphery, surgeons can operate thoracoscopically to find the mass and remove it.
However, if the mass is small, successful identification and resection is difficult. Previously, a larger lung resection was required. Now an interventional radiologist and surgeon can collaborate on a needle wire localization and small resection.
Dr. Racadio explains how it works. “Using CT to visualize the lung, we place markers on the skin and plan the path to advance a needle. Through that needle, we inject dye to stain the suspicious lung tissue and place a wire hook into it. Once we reach the lesion, keeping the wire steady, we unsheathe the needle and leave the wire emerging through the lung’s surface.”
The patient is then taken to the operating room where the surgeon uses a thoracoscope to follow the guide wire, locate the hook and perform a smaller, more precise resection.
Interventional radiologists at Cincinnati Children’s were also among the first to go beyond the norm of using rotational angiography in blood vessels, predominantly in the brain. “We began using it outside of the vascular system, working first with our urologists to better evaluate the complex anatomy of anorectal malformations,” Dr. Racadio says.
The Nation’s Only Pediatric Prototype Site
The division’s growing reputation for innovation caught the attention of a major imaging technology manufacturer. They contacted Cincinnati Children’s to set up a collaborative working agreement.
Since 2003, Cincinnati Children’s has been the only site in the United States using prototype imaging technology in children before it’s available elsewhere. Interventional radiologists test new software and hardware, offering real-world feedback to technology developers.
Dr. Racadio says, “Some of our current routine procedures were considered pretty amazing five years ago. Our collaborative agreement gives us the means to ramp up the speed of taking concepts to reality.”
