Baptiste Bonnet

Purpose: To prospectively evaluate the feasibility, safety, and targeting accuracy of robotic-assisted CT-guided percutaneous bone procedures. Materials and Methods: This prospective multicenter pilot study included adult patients undergoing CT-guided percutaneous bone consolidation or tumor ablation between September 2024 and January 2025 at three academic institutions. All procedures were planned and performed using the Epione® robotic platform. Targets included the thoracic and lumbar spine and the pelvis. The primary endpoint was feasibility of robotic-assisted needle insertion, defined as successful needle placement without conversion to manual technique. Secondary endpoints included safety, targeting accuracy, procedural time, and radiation dose. Targeting accuracy was measured as lateral tip deviation and angular deviation between planned and final needle positions. Results: Thirty-four patients underwent 90 needle insertions, including 66 in the spine (73.3%) and 24 in the pelvis (26.7%). Indications were bone consolidation in 87/90 insertions (97%) and tumor ablation in 3/90 (3%). Robotic insertion was feasible in 89/90 insertions (98.9%). Seven adverse events occurred in 6 patients (17.6%), including four serious events, none related to the device or procedure. Mean lateral tip deviation was 2.0 ± 1.4 mm, and mean angular deviation was 3.1° ± 2.7°. Mean dose–length product was 3224 ± 2215 mGy.cm. Mean total procedure time was 03 h 09 min ± 50 min. Conclusions: Robotic-assisted CT-guided bone procedures showed high feasibility and satisfactory targeting accuracy, with no device- or procedure-related adverse events. These findings support further evaluation in larger comparative studies. Clinical Trial Registration: NCT06376682.

Purpose: To assess the feasibility, safety, and accuracy of robotic needle placement for abdominal percutaneous interventions in a real-world, post-market setting. Patients and methods: This prospective single-center study assessed a robotic guidance device for CT-guided needle placement during abdominal thermal ablation procedures. The primary endpoint was technical success, defined as successful robotic needle placement without technical failure (full manual insertion or two failed robotic attempts). Secondary endpoints included procedural safety, needle placement accuracy (3D deviation and manual adjustments categorized as minor [depth-only], moderate [lateral], and major [complete needle retrieval]), immediate ablation success, 2-month and 1-year local recurrence, and operator satisfaction (5-point Likert scale). Results: Between April 2022 and January 2023, 54 patients (one duplicate inclusion excluded) were analyzed (30 men, 24 women); mean age 64.7 (± 12.9). Most had metastatic disease (74.1%). Target organs included mainly the liver (68.5%) and the kidney (24.1%). Mean lesion diameter was 24.7 mm (± 13.1), with 59.0% considered technically challenging. Ablation modalities included microwave (63.3%), cryoablation (35.0%), and radiofrequency (1.7%). A total of 108 needles were placed (mean 1.8/patient), yielding a technical success rate of 94.4%. The mean final 3D accuracy after adjustments when required was 2.5 mm (± 3.7). Immediate ablation success was achieved in 98.4% lesions (60/61), with a mean minimal margin of 5.6 mm (± 3.2). Local recurrence occurred in 8.3% of cases at 2 months and in 25.6% at 1 year. Operator satisfaction averaged 3.1/4. Conclusion: Robotic guidance for CT-guided abdominal thermal ablation is feasible, safe, and provides high needle placement accuracy. Early oncologic outcomes appear comparable to conventional freehand techniques, supporting the integration of robotic systems into routine interventional radiology practice.

To compare liver parenchymal enhancement and tumor washout on portal and delayed phases between rapid kVp-switching dual-energy CT (DECT) with a low-iodine-dose (LID) contrast medium protocol (350 mg/kg) and conventional single-energy CT (SECT) with a standard-iodine-dose protocol (525 mg/kg), in patients referred for primary liver cancer. All consecutive patients referred for primary liver cancer assessment who underwent both SECT with standard iodine dose and DECT with LID protocol were retrospectively reviewed. Relative Liver Enhancement (RLE) and parenchymal contrast-to-noise ratio (pCNR) on portal venous (PVP) and delayed phases were compared between 50 keV virtual monochromatic DECT and SECT images. A sub-analysis at 77 keV was also performed. Quantitative tumor enhancement (QTE) and tumoral contrast-to-noise ratio (tCNR) were compared between techniques in a subset of patients bearing LI-RADS 5 liver tumors. Seventy-seven patients (mean age 66±9 years) were included and 154 CT scans were analyzed (February 2023-October 2023). RLE and pCNR were significantly higher on 50-keV DECT than on SECT during both PVP (RLE: 1.68 ± 0.45 vs. 0.82 ± 0.18; pCNR: 2.90 ± 1.01 vs. 2.54 ± 0.76; all p < 0.01) and delayed phases (RLE: 1.17 ± 0.41 vs. 0.61 ± 0.19; pCNR: 1.84 ± 0.90 vs. 1.61 ± 0.67; p < 0.05). At 77 keV, RLE and pCNR were similar to SECT. Among thirty-one LR-5 tumors (n = 17 patients), QTE and tCNR were significantly greater on 50-keV DECT than SECT across all phases including PVP (-29.48 ± 16.4 vs. -13.38 ± 11.98 p < 0.001) and delayed phase (-23.48 ± 13.43 vs. -8.14 ± 10.49 p < 0.001). Rapid kVp-switching DECT at 50-keV DECT VMIs improves liver and tumor contrast on PVP and delayed phase despite a 33% iodine dose reduction, supporting its use in cirrhotic patients.

Purpose Managing hepatocellular carcinoma (HCC) in patients with a transjugular intrahepatic portosystemic shunt (TIPS) is becoming increasingly common. This study aimed to evaluate the safety and efficacy of percutaneous thermal ablation for treating HCC in patients with TIPS. Methods This retrospective longitudinal study was conducted at Nantes University Hospital. The main inclusion criteria were patients undergoing percutaneous thermal ablation for HCC. Patients with a pre-existing TIPS were included in the ‘TIPS group’. A 1:1 control group without TIPS, the ‘n-TIPS group’, was created for this case-control study. The primary endpoints were overall survival and progression-free survival over 12 months. Safety was assessed by comparing complications between the groups. Results Between 2008 and 2020, 371 patients underwent percutaneous thermal ablation for HCC. The ‘TIPS group’ included 34 patients (66 nodules), while 34 patients (84 nodules) were randomly assigned to the ‘n-TIPS group.’ Overall survival rates at 1 year were 97% and 94% respectively (p = 0.52). The progression-free survival rate was 68% and 57% respectively (p = 0.35). No deaths occurred within 30 days post-procedure. There were 3 immediate complications in the TIPS group and 4 in the n-TIPS group (p = 1), none of which were related to the TIPS, including thrombosis. Conclusion Percutaneous thermal ablation for HCC in patients with TIPS appears to be as safe and effective as in TIPS-naïve patients. These results suggest that the presence of a TIPS should not be considered a contraindication for percutaneous thermal ablation in treating HCC.