99mTc Sealed Sources for Localization in Biopsy Needles and Catheters | Lecture notes Nuclear medicine

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FIG. 1. @mTc.filledprobeswere preparedfrom commonly

available needles and catheters. Variety of filling patterns are dem

onstrated.

For the purpose of anatomic localization, a

variety of sealed sources containing o9mTc were

constructed. These sources, when inserted into

biopsy needles and imaged with a portable scm

tillation camera, served to direct the proper

placement of those needles. Concomitant organ

imaging was used to identify the target site for

biopsy. indwelling CVP and Swan-Canz cathe

ters filled with sterile sodium pertechnetate were

localized against the mediastinal silhouette pro

vided by a flooded field transmission source

placed behind the patient. Larger diameter

catheters containing sealed sources within their

lumens were similarly imaged. These techniques

have proven to be clinically useful.

Successful percutaneous biopsy depends on a cli

nician's ability to direct a biopsy needle to its target.

Biopsy should be easy to perform provided the tar

get is large and its location certain. However, percu

taneous biopsy of a large organ, such as the liver,

is sometimes unsuccessful. Small targets deep in the

body present an even more difficult task. In addition

to the clinician's knowledge of anatomy and his abil

ity to palpate and percuss, several adjunctive meth

ods are available to guide him during needle biopsy.

These include conventional radiography, single and

biplane fluoroscopy, stereotatic devices, and ultra

sound.

Some clinicians use scintiphotography to localize

organs for subsequent percutaneous biopsy (1). Rou

tine radionuclide organ imaging is performed and

the anatomic location of the â€œtargetâ€•organ is out

lined on the skin. The biopsy procedure is then per

formed in some other hospital location.

Similarly, verification of the proper placement of

indwelling catheters is usually accomplished with

conventional radiographs or fluoroscopy. Van Dyke,

Ct al have reported the added utility of a â€œradioac

tiveâ€•catheter in the cardiac catheterization labora

tory in which localization is accomplished by exter

nal imaging with a scintillation camera (2).

This report outlines our experience in constructing

and using sources of 9omTcsealed in short lengths of

sterile polyethylene tubing or standard hypodermic

needles. These are inserted into the lumen of a van

ety of biopsy needles and catheters to facilitate their

placement. Confirmation of proper alignment is by

imaging in the appropriate projections with a scm

tillation camera transported to the location where

the biopsy on catheterization procedure is to be per

formed.

MATERIALS AND METHODS

A variety of 9ftmTcsources have been constructed

and are shown in Fig. 1. In each case up to 1 mCi

Received Mar. 13, 1973; original accepted Apr. 23, 1973.

For reprints contact : Joseph P. Green, Div. of Nuclear

Medicine, Dept. of Radiology, University Hospital, 225 W.

Dickinson St., San Diego, Calif. 92103.

Volume 14, Number 10 743

SEALED SOURCES OF 99mTc INSERTED INTO

STANDARD BIOPSY NEEDLES AND CATHETERS:

USE IN ANATOMIC LOCALIZATION BY

EXTERNAL RADIONUCLIDE IMAGING

Joseph P. Green, William 1. Ashburn, Sheldon R. Hurwitz, and Samuel E. Halpern

University of California at San Diego, La Jolla, California

99mTc Sealed Sources for Localization in Biopsy Needles and Catheters, Lecture notes of Nuclear medicine

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These include conventional radiography, single and

formed in some other hospital location.

Similarly, verification of the proper placement of

tory in which localization is accomplished by exter

nal imaging with a scintillation camera (2).

and using sources of 9omTcsealed in short lengths of

needles. These are inserted into the lumen of a van

ety of biopsy needles and catheters to facilitate their

placement. Confirmation of proper alignment is by

A variety of 9ftmTcsources have been constructed

and are shown in Fig. 1. In each case up to 1 mCi

Volume 14, Number 10 743

of o9mTcas sterile sodium pertechnetate was placed

either into lengths of sterile polyethylene tubing, ap

short indwelling plastic catheters. The tips of the

metal needles and short plastic catheters were sealed

with an epoxy glue while the tip of polyethylene tub

ing was sealed by pinching the distal end with a hot

then heat-sealed. A previously sealed needle or cath

eter was filled by inserting a smaller diameter needle

inner needle was withdrawn. Continuous (linear)

sources were made by filling the entire length with

the radioactive solution, and interrupted (calibrated)

sources were formed by interposing air bubbles at

1-cm intervals during the filling process. The short

plastic catheters and metal needles were autoclaved

before filling, and the entire operation was carried

out under sterile conditions.

The selection of appropriate length and source

arrangement depended on the diameter and length

of the biopsy needle or catheter into which the source

was to be placed as well as the intended purpose, i.e.,

In the case of small-diameter vascular catheters,

monary arterial catheters, external visualization was

accomplished by filling the entire length of the cath

the catheter had been inserted in the conventional

manner. None or very little of the radioactive solu

tion was injected into the patient since only the vol

ume necessary to fill the dead space of the catheter

was used.

Verification of the position of biopsy needles and

Nuclear Data scintillation camera. As previously de

an appropriate radiopharmaceutfÃ¨al was adminis

desired organ or tissue. Insertion of the biopsy needle

the needle was desired. The stylus of the needle was

then withdrawn and replaced with the previously

prepared sterile â€œÂ°â€œTcsealed source, followed by

standard imaging in two or more right angle pro

anatomic features of interest. Similarly, localization

appropriate imaging.

or great vessels was facilitated by placing a trans

F1G.2. Routnebrainscanshows

GREEN, ASHBURN, HURWITZ, AND HALPERN

The anatomic localization of any larger diameter

sealed source can be inserted the length of its lumen.

anatomic landmarks to help in determining the loca

tional possible uses of this technique are suggested,

Abbott or similar indwelling tube from the stomach

into the small bowel.

REFERENCES

FIG. 5. (A)Anteriorchestimagewith@Â°mTcflooded-fieldtrans.

eter is manipulated into a desired location. Although

tine procedure, it may prove to be valuable in those

mally a â€œblindâ€•procedure, it has become a valuable

teaching aid in our experience for the therapist doing

the suctioning to be able to follow the movement

of the catheter as it is manipulated. It is clinically

January 4â€”6,1974 Fairmont-Roosevelt^ Hotel^ New Orleans, La.

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