CT-Guided Intervention in the Thorax

Abstract

Percutaneous intervention in the thorax has been performed using radiologic guidance since 1966 when Dahlgren and colleagues described fluoroscopic needle biopsy in the lung (Dahlgren Scand J Respir Dis 47(3):187-194, 1966). With the advent of CT, percutaneous access to smaller lesions in more challenging locations became possible (vanSonnenberg et al. Radiology 167(2):457-461, 1988). CT allows for determination of an optimal cutaneous entry point in such a way as to avoid transgression of sensitive structures with greater accuracy and control than conventional fluoroscopy (Ghaye and Dondelinger Eur Respir J 17(3):507-528, 2001). CT-guided thoracic intervention has since grown to comprise pleural and mediastinal drainage, thermal ablation, mediastinal biopsy and drainage, and tumor localization to enable radiation therapy and surgical resection. This chapter describes the pre-procedure planning, techniques, outcomes, and complications of contemporary CT-guided thoracic intervention.