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Title: SU-G-IeP4-15: Ultrasound Imaging of Absorbable Inferior Vena Cava Filters for Proper Placement

Abstract

Purpose: Inferior vena cava filters (IVCFs) are used in patients with a high risk of pulmonary embolism in situations when the use of blood thinning drugs would be inappropriate. These filters are implanted under x-ray guidance; however, this provides a dose of ionizing radiation to both patient and physician. B-mode ultrasound (US) imaging allows for localization of certain implanted devices without radiation dose concerns. The goal of this study was to investigate the feasibility of imaging the placement of absorbable IVCFs using US imaging to alleviate the dosage concern inherent to fluoroscopy. Methods: A phantom was constructed to mimic a human IVC using tissue-mimicking material with 0.5 dB/cm/MHz acoustic attenuation, while agar inclusions were used to model acoustic mismatch at the venous interface. Absorbable IVCF’s were imaged at 15 cm depth using B-mode US at 2, 3, 5, and 7 MHz transmit frequencies. Then, to determine temporal stability, the IVCF was left in the phantom for 10 weeks; during this time, the IVCF was imaged using the same techniques as above, while the integrity of the filter was analyzed by inspecting for fiber discontinuities. Results: Visualization of the inferior vena cava filter was possible at 5, 7.5, and 15 cmmore » depth at US central frequencies of 2, 3, 5, and 7 MHz. Imaging the IVCF at 5 MHz yielded the clearest images while maintaining acceptable spatial resolution for identifying the IVCF’s, while lower frequencies provided noticeably worse image quality. No obvious degradation was observed over the course of the 10 weeks in a static phantom environment. Conclusion: Biodegradable IVCF localization was possible up to 15 cm in depth using conventional B-mode US in a tissue-mimicking phantom. This leads to the potential for using B-mode US to guide the placement of the IVCF upon deployment by the interventional radiologist. Mitch Eggers is an owner of Adient Medical Technologies. There are no other conflicts of interest to disclose.« less

Authors:
; ; ;  [1];  [2]
  1. University of Texas MD Anderson Cancer Center, Houston, TX (United States)
  2. Adient Medical Technologies, Pearland, TX (United States)
Publication Date:
OSTI Identifier:
22649450
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; FILTERS; IMAGES; MHZ RANGE 01-100; PHANTOMS; RADIATION DOSES; SPATIAL RESOLUTION; VEINS

Citation Formats

Mitcham, T, Bouchard, R, Melancon, A, Melancon, M, and Eggers, M. SU-G-IeP4-15: Ultrasound Imaging of Absorbable Inferior Vena Cava Filters for Proper Placement. United States: N. p., 2016. Web. doi:10.1118/1.4957110.
Mitcham, T, Bouchard, R, Melancon, A, Melancon, M, & Eggers, M. SU-G-IeP4-15: Ultrasound Imaging of Absorbable Inferior Vena Cava Filters for Proper Placement. United States. doi:10.1118/1.4957110.
Mitcham, T, Bouchard, R, Melancon, A, Melancon, M, and Eggers, M. 2016. "SU-G-IeP4-15: Ultrasound Imaging of Absorbable Inferior Vena Cava Filters for Proper Placement". United States. doi:10.1118/1.4957110.
@article{osti_22649450,
title = {SU-G-IeP4-15: Ultrasound Imaging of Absorbable Inferior Vena Cava Filters for Proper Placement},
author = {Mitcham, T and Bouchard, R and Melancon, A and Melancon, M and Eggers, M},
abstractNote = {Purpose: Inferior vena cava filters (IVCFs) are used in patients with a high risk of pulmonary embolism in situations when the use of blood thinning drugs would be inappropriate. These filters are implanted under x-ray guidance; however, this provides a dose of ionizing radiation to both patient and physician. B-mode ultrasound (US) imaging allows for localization of certain implanted devices without radiation dose concerns. The goal of this study was to investigate the feasibility of imaging the placement of absorbable IVCFs using US imaging to alleviate the dosage concern inherent to fluoroscopy. Methods: A phantom was constructed to mimic a human IVC using tissue-mimicking material with 0.5 dB/cm/MHz acoustic attenuation, while agar inclusions were used to model acoustic mismatch at the venous interface. Absorbable IVCF’s were imaged at 15 cm depth using B-mode US at 2, 3, 5, and 7 MHz transmit frequencies. Then, to determine temporal stability, the IVCF was left in the phantom for 10 weeks; during this time, the IVCF was imaged using the same techniques as above, while the integrity of the filter was analyzed by inspecting for fiber discontinuities. Results: Visualization of the inferior vena cava filter was possible at 5, 7.5, and 15 cm depth at US central frequencies of 2, 3, 5, and 7 MHz. Imaging the IVCF at 5 MHz yielded the clearest images while maintaining acceptable spatial resolution for identifying the IVCF’s, while lower frequencies provided noticeably worse image quality. No obvious degradation was observed over the course of the 10 weeks in a static phantom environment. Conclusion: Biodegradable IVCF localization was possible up to 15 cm in depth using conventional B-mode US in a tissue-mimicking phantom. This leads to the potential for using B-mode US to guide the placement of the IVCF upon deployment by the interventional radiologist. Mitch Eggers is an owner of Adient Medical Technologies. There are no other conflicts of interest to disclose.},
doi = {10.1118/1.4957110},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: Absorbable IVC filters are shown to be safe and efficacious in preventing pulmonary embolism. These absorbable filters disappear from the body after their required duration, alleviating costly removal procedures and downstream complications. Monitoring the positioning and integrity of absorbable devices using dual-energy computed tomography (DECT) would improve treatment efficacy. The purpose of this study is to determine the limit of detection and the energy dependence of DECT for various contrast agents that may be infused within the IVC filters including gold nanoparticles (AuNP) having diameters of 2 and 4 nm. Methods: All imaging studies were performed on a GEmore » Discovery CT750 system in Gemstone Spectral Imaging (GSI) mode. Plastic vials containing the contrast agent solutions of water and blood were placed in a water bath, and images were acquired with the GSI-5 preset. The images were reformatted into the coronal plane and 5mm diameter ROIs were placed within each solution on a GE Advantage Workstation. Monoenergetic reconstructions were generated from 40 – 140 keV. Results: Mass attenuation (contrast per unit density) for AuNPs was greater than iron, but less than barium and iodine. Contrast was 10.2 (± 3.6) HU for 4 nm AuNP at 0.72 mg/ml and 12.1 (± 4.2) for 2 nm AuNP at 0.31 mg/ml at 70 keV suggesting reasonable chance of visualization at these concentrations for 70 keV reconstruction. The contrast as a function of CT energy is similar in both water and blood. Iodine is most dependent, followed closely by barium and iron, and trailed by a large margin by the AuNP. This was unexpected given Au’s large atomic number and the predominance of photoelectric effect at low energy. Conclusion: Infusion of IVC filters with AuNP is feasible. Discrimination of AuNP-infused IVC filters from surrounding anatomy warrants further investigation.« less
  • An 18-year-old man with a gastrointestinal hypomotility syndrome required lifelong parenteral nutrition. Both the superior and inferior vena cava were occluded. Computed tomography guidance was used to place a long-term central venous catheter via a large tributary to the azygos vein.
  • Thrombosis of the inferior vena cava is a life-threatening complication in cancer patients leading to pulmonary embolism. These patients can also be affected by superior vena cava syndrome causing dyspnea followed by trunk or extremity swelling. We report the case of a 61-year-old female suffering from an extended colorectal tumor who became affected by both of the mentioned complications. Due to thrombus formation within the right vena jugularis interna, thrombosis of the inferior vena cava, and superior vena cava syndrome, a combined interventional procedure via a left jugular access with stenting of the superior vena cava and filter placement intomore » the inferior vena cava was performed As a consequence, relief of the patient's symptoms, prevention of pulmonary embolism, and paving of the way for further venous chemotherapy were achieved.« less
  • To prevent embolization of necrotic renal vein tumor after transcatheter embolization of a left renal cell carcinoma, we placed a suprarenal Bird's nest inferior vena cava filter. The patient tolerated the procedure well and had extensive tumor infarction including the tumor thrombus on 6-month follow-up computed tomography.
  • Purpose: To assess the usefulness of percutaneous transluminal angioplasty (PTA) and expandable metallic stent (EMS) placement for treatment of Budd-Chiari syndrome (BCS). Methods: Thirty-two patients with BCS were treated by PTA alone or by PTA and EMS placement. Among the 32 patients, a membranous obstruction was found in 24 and a segmental stenosis or occlusion in 8 patients. The follow-up period for PTA was 38<+>-<+>68 months (mean 52.2 months); for EMS it was 20<+>-<+>36 months (mean 24.3 months). Results: Twenty-one patients underwent PTA as the primary treatment. Of these, one patient died of disseminated intravascular coagulation shortly after the procedure;more » 20 had good to excellent initial angiographic and clinical results. Of the 20, restenosis or reocclusion developed in 10 patients (48%), all before 27 months; 8 patients (38%) became symptomatic, and 2 remained symptom-free for a total recurrent obstruction rate of 50%. The EMS group of 17 patients included 11 patients who underwent primary stenting and 6 patients with secondary stenting after recurrence following primary PTA; restenosis was demonstrated in only 2 patients (12%). Conclusions: We conclude that PTA alone produces excellent short-term results and about 50% sustained patency after 2 years in patients with BCS; therefore it should remain the procedure of first choice. Stents should be reserved for primary or secondary PTA failures.« less