Angulated fluoroscopy with light localizer in percutaneous lung biopsy.

F or the past six years, three remotely controlled fluoroscopic units equipped with rotating cradles and overhead tube light localizers have been used for percutaneous lung biopsies under fluoroscopic control with angulation of the fluoroscopic beam and rotation of the patients in a rotating cradle. The purpose of using this equipment was to plan our biopsy procedures traversing a minimum distance through lung tissue, avoiding interfering or vital structures. The addition of light localizer directed needle guidance further shortened the procedure and reduced the need fur fluoroscopically guided needle redirection. The result in our small series was a low complication rate, expeditious performance ofthe procedure, and a reasonable percentage of positive studies. METHODS Preprocedure studies included plain chest x-ray films, In approximately one third of the cases, conventional tomography was also utilized to determine depth and location,' In some cases, computed tomographic studies were also used in planning the procedure. Angulated fluoroscopy was utilized in the following manner: the appropriate imaging modalities were assessed to determine the shortest path to the lesion and avoidance of interfering structures. Under fluoroscopic guidance, the patient was turned in the cradle and the tube angulated, keeping the lesion centered to avoid parallax until the safest short path to the lesion was visualized and the skin marked. After the biopsy needle was advanced through the pleura into the lung parenchyma for approximately half the total path length, the radiologist-operator then performed fluoroscopy from the control booth. Lfproper alignment ofthe needle based on super-imposition ofthe needle hub, tip and mass was observed, it was advanced blindly duringbreath holding until the lesion was felt to be entered or the predetermined depth was reached. ffthe needle was not " on target, " the patient and/or fluoroscopic tube was reangulated from the control booth during fluoroscopy until the hub ofthe needle was projected over the tip. ffthese were also aligned with alesion (Fig 1, lower), the needle was advanced into the lesion. ffnot, the needle was redirected and the hub-tip superimposition again performed. In approximately the last 20 cases, the overhead tube light localizer served as an ongoing guide for needle alignment using the hub-puncture site superimposition of the needle light shadow in place offluoroscopy. Since the properlyadjustedlightlocalizer emits light following a path identical to that of the fluoroscopic beam, it may substitute for fluoroscopy. The light shadow ofthe needle may therefore substitute for the fluoroscopic image ofthe needle. …