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.
![Images show the pectoralis muscles of a healthy male individual who never smoked (age, 66 years; height, 178 cm; body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], 28.4; number of cigarette pack-years, 0; forced expiratory volume in 1 second [FEV1], 97.6% predicted; FEV1: forced vital capacity [FVC] ratio, 0.71; pectoralis muscle area [PMA], 59.4 cm2; pectoralis muscle volume [PMV], 764 cm3) and a male individual with a smoking history and chronic obstructive pulmonary disorder (COPD) (age, 66 years; height, 178 cm; BMI, 27.5; number of cigarette pack-years, 43.2, FEV1, 48% predicted; FEV1:FVC, 0.56; PMA, 35 cm2; PMV, 480.8 cm3) from the Canadian Cohort Obstructive Lung Disease (i.e., CanCOLD) study. The CT image is shown in the axial plane. The PMV is automatically extracted using the developed deep learning model and overlayed onto the lungs for visual clarity.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/03/genkin.25LqljVF0y.jpg?auto=format%2Ccompress&crop=focalpoint&dpr=2&fit=crop&h=167&q=70&w=250)
