A research group from Brigham and Women's Hospital in Boston has found that PET/CT fluoroscopy is feasible and has the potential to assist doctors performing PET/CT-guided tumor ablations.
A team led by Dr. Liwei Jiang tested a high-speed image fusion technique to generate and display PET/CT fluoroscopy images during PET/CT-guided tumor ablations in a group of cancer patients. The first-time use of the technique showed promise, the investigators noted.
"PET/CT fluoroscopy may facilitate targeting of radiotracer-avid masses with poor visibility on CT fluoroscopy images," the group wrote. The study was published May 2 in the Journal of Vascular and Interventional Radiology.
PET/CT is being increasingly used to guide tumor ablations because of its advantages in revealing tumors not conspicuous on other modalities, the authors explained. CT fluoroscopy is a safe and effective guidance tool, yet it is limited in detecting tumors with poor visibility -- for example, those obscured by metallic artifacts from interventional procedures.
In this study, the authors hypothesized that high-speed image fusion technology could be used to potentially overcome such obstacles by generating and displaying PET/CT fluoroscopy images during PET/CT-guided tumor ablations.
They used a multimodal image fusion platform (IGTFusion, IGI Medical Technologies) with proprietary software running on a dedicated workstation. The system received DICOM images pushed from the scanner, followed by near real-time image registration. The acquired PET dataset was fused to each CT fluoroscopy dataset as it arrived, and the fused images were displayed for physicians on an in-room monitor.
During 14 procedures, PET/CT fluoroscopy images were generated and displayed, with a mean of four PET/CT fluoroscopy acquisitions obtained per procedure. In three procedures treating four hepatic metastatic tumors, target visibility was poor on CT and CT fluoroscopy images alone. However, PET/CT and PET/CT fluoroscopy allowed for more confident targeting of the tumors, the researchers reported.
In addition, the mean lag time from CT fluoroscopy acquisition to the in-room display of the fused PET/CT fluoroscopy image was 21 seconds (plus or minus 8 seconds), with registration accuracy visually satisfactory in all but one procedure, the investigators reported.
"Conceptually, PET/CT fluoroscopy represents the extension of CT fluoroscopy to PET/CT for guiding interventional procedures of radiotracer-avid tumors," the group wrote.
While promising, the authors noted that this was a proof-of-concept study and not designed to demonstrate clinical outcomes, reductions in procedural time, or reductions in number of intraprocedural PET/CT acquisitions.
"These endpoints will be studied in the future," they concluded.
![Axial images from unenhanced calcium score cardiac CT (left) and curved planar reformation images from CT angiography (right) show that higher long-term exposure to air pollution is associated with greater coronary artery calcium and more obstructive coronary artery disease (CAD). Top row: Images in a 68-year-old male patient with higher 10-year mean ambient air pollution exposure (7.9 μg/m3 for particulate matter measuring ≤2.5 μm in diameter [PM2.5] and 17.4 parts per billion [ppb] for NO2) with extensive CAD (coronary artery calcium score [CACS] >1,000 and obstructive CAD [≥70% diameter stenosis]). Bottom row: Images in a 57-year-old female patient with lower 10-year mean ambient air pollution exposure (6.3 μg/m3 for PM2.5 and 4.6 ppb for NO2) with no CAD (CACS = 0 and no obstructive stenosis).](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/06/hanneman.r6SMLzkezo.png?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
