For CT-guided percutaneous lung biopsy, positioning biopsy-side down, needle removal during expiration, autologous blood patch sealing, rapid rollover, and pleural patching, or PEARL, reduced pneum... Background Percutaneous CT-guided biopsy of lung nodules is an established method with high diagnostic accuracy but a high rate of pneumothorax and chest tube insertion compared with endobronchial ...

While artificial intelligence (AI) is already well established in diagnostic radiology, it is beginning to make its mark in interventional radiology. AI has the potential to dramatically change the daily practice of interventional radiology at several levels. In the preoperative setting, recent advances in deep learning models, particularly foundation models, enable effective management of multimodality and increased autonomy through their ability to function minimally without supervision. Multimodality is at the heart of patient-tailored management and in interventional radiology, this translates into the development of innovative models for patient selection and outcome prediction. In the perioperative setting, AI is manifesting itself in applications that assist radiologists in image analysis and real-time decision making, thereby improving the efficiency, accuracy, and safety of interventions. In synergy with advances in robotic technologies, AI is laying the groundwork for an increased autonomy. From a research perspective, the development of artificial health data, such as AI-based data augmentation, offers an innovative solution to this central issue and promises to stimulate research in this area. This review aims to provide the medical community with the most important current and future applications of AI in interventional radiology.

Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors. Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate. Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41). These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors.

Purpose: We report a 10-year experience in cancer therapy with concomitant treatment of percutaneous thermal ablation (PTA) and immune checkpoint blockers (ICBs). Material and methods: This retrospective cohort study included all patients at a single tertiary cancer center who had received ICBs at most 90 days before, or 30 days after, PTA. Feasibility and safety were assessed as the primary outcomes. The procedure-related complications and immune-related adverse events (irAEs) were categorized according to the Common Terminology Criteria for Adverse Events v5.0 (CTCAE). Efficacy was evaluated based on overall survival (OS), progression-free survival (PFS), and local progression-free survival (_LPFS) according to the indication, ablation modality, neoplasm histology, and ICB type. Results: Between 2010 and 2021, 78 patients (57% male; median age: 61 years) were included. The PTA modality was predominantly cryoablation (CA) (61%), followed by radiofrequency ablation (RFA) (31%). PTA indications were the treatment of oligo-persistence (29%), oligo-progression (14%), and palliation of symptomatic lesions or prevention of skeletal-related events (SREs) (56%). Most patients received anti-PD1 ICB monotherapy with pembrolizumab (n = 35) or nivolumab (n = 24). The feasibility was excellent, with all combined treatment performed and completed as planned. Ten patients (13%) experienced procedure-related complications (90% grade 1–2), and 34 patients (44%) experienced an irAE (86% grade 1–2). The only factor statistically associated with better OS and PFS was the ablation indication, favoring oligo-persistence (p = 0.02). Tumor response was suggestive of an abscopal effect in four patients (5%). Conclusions: The concomitant treatment of PTA and ICBs within 2–4 weeks is feasible and safe for both palliative and local control indications. Overall, PTA outcomes were found to be similar to standards for patients not on ICB therapy. While a consistently reproducible abscopal effect remains elusive, the safety profile of concomitant therapy provides the framework for continued assessment as ICB therapies evolve.

To evaluate the feasibility and accuracy of a robotic device used clinically in soft tissues (abdomen and lung), modified in design and workflow, to perform needle insertion in percutaneous bone procedures. The primary objective was safety (severe complications) of robotic-assisted insertion in this new application. Secondary objectives were feasibility (placement technical success), performance (acceptable insertions rate), accuracy (lateral deviation), number of intermediate CT-scans and tolerance (minor/moderate complications). Robotic-assisted insertions were performed by six interventional radiologists on three male pigs under general anaesthesia. Needle trajectory was planned on the device software, then needles were inserted with robotic guidance to reach the cortical bone; an intermediate CT-scan was then performed to verify needle direction; if needed, the trajectory was modified, and robotic-assisted modified insertion to target was performed. As many intermediate CT scans and trajectory modifications as needed by the operator were allowed. 28 needles were inserted (10 spine, 18 pelvis). No complication was reported. Technical success rate was 96.4% (27/28). One insertion was not feasible after several robotic attempts. The placement success rate was 100% (27/27). After the planned intermediate CT-scan, 13/27 (48.1%) trajectories did not require any modification, and 11/27 trajectories (40.7%) required a single modification. One needle was removed and replaced to achieve correct placement. Placement accuracy was similar for spinal and pelvic insertions, with a mean lateral deviation of 2.1 mm (±1.3). Pre-clinical robotic-assisted needle insertions in bone were safe and feasible, with satisfactory accuracy. A multicentre first-in-human study is on-going to evaluate feasibility and safety for percutaneous bone ablation and consolidation procedures.

Background: Patients with metastatic medullary thyroid cancer (MTC) who progressed under tyrosine kinase inhibitors can benefit from alkylating agent such as Dacarbazine or Temozolomide. Patient Findings: We describe two patients with metastatic MTC who developed a hypermutant phenotype after alkylating agent treatment. This phenotype was characterized by a high tumor mutational burden (TMB) and a mutational signature indicative of alkylating agent mutagenesis (Single Base Substitution 11). Both patients received immune checkpoint inhibitors, with partial morphological responses, clinical benefit and PFS of 6 and 9 months respectively. Summary and Conclusions: Based on the described observations, we suggest that a hypermutant phenotype may be induced after alkylating agent treatment for MTC and the sequential use of immunotherapy should be further explored as a treatment option for MTC patients with increased TMB.