Percutaneous nephrostomy: placement under laser guidance and real-time CT fluoroscopy

The purpose of this paper is to present our experience with real-time computed tomography (CT) fluoroscopy guided percutaneous nephrostomy (PNT) and to describe this technique involving puncture under laser guidance. We attempted 30 placements in 25 patients: puncture was directed by laser guidance and placement of the tube was made under real time CT fluoroscopy. 25 procedures were performed in prone position and 5 procedures in the supine position. The time necessary for the procedure ranged from 10 to 45 min (mean 25 min). The average duration of CT fluoroscopy per placement was 49 seconds (range 7–110 s). The PNT placement was successful as a sole procedure including puncture and catheter placement in 24 of 30 cases; in the remainder of cases, puncture was performed under CT guidance but the catheter was definitively positioned in conventional fluoroscopy. The CT fluoroscopy technique allows routine, efficient and safe PNT placement, especially when encountering difficult access to the pelvicaliceal system. Received: 9 June 1999; Revised: 12 November 1999; Accepted: 12 November 1999     

Multislice CT fluoroscopy: technical principles, clinical applications and dosimetry

PURPOSE: The aim of this study is describing fluoroscopic techniques with multislice CT during interventional procedures. We emphasize the technical principles of the multislice CT fluoroscopy and the relative advantages in clinical application, in comparison to single slice fluoroCT and conventional CT guided procedures. Other topics are dosimetry and patient's and operator's radioprotection. MATERIALS AND METHODS: We describe our experience in 60 cases of interventional procedures performed with CT fluoroscopy array for the TOSHIBA AQUILION-MULTI TSX-101A scanner that allows a real-time 3 slices simultaneous representation of the target: middle target slice, superior and inferior slices. Thirty nine biopsies, 5 abscess drainage, 12 shoulder arthrocentesis previous to arthro-MR and 4 hepatic neoplasm ablations have been performed during the last 9 months. For each procedure questionnaires have been used to evaluate: target organs, scan parameters, fluoroscopy techniques (continuous or spot) and total time of fluoroCT. Basing on these data and on the measurements made on a body phantom we calculated patient's and operator's radiation dose rate. RESULTS AND DISCUSSION: The real-time simultaneous representation of the middle target slice and the adjacent superior and inferior slices has always allowed an immediate identification of the needle tip and direction. The use of a needle holder has been determined by the needle type, the fluoroscopy technique (continuous or spot), the type of interventional procedure and the target. In our experience freehand spot fluoroscopy approach was easier, faster and with less radiation dose rate. 24 seconds were the mean fluoroscopy time for all different CT fluoroscopy modalities and procedures. The mean absorbed equivalent dose rate to patient's skin was 5300 microSv/s while the dose to operator's body and hand was respectively 0.3 microSv/s and 30 microSv/s. CONCLUSIONS: Multislice CT fluoroscopy, specially if performed by spot technique, leads to an acceptable radiation dose rate to patient and operator, is user friendly and guides interventional procedures with rapidity.     

CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure.

PURPOSE: To evaluate the benefits of computed tomographic (CT) fluoroscopy-guided interventions and assess radiation exposures incurred with CT fluoroscopy. MATERIALS AND METHODS: A 6-month period of use of CT fluoroscopy to guide abdominal biopsy procedures and catheter drainage was analyzed. Efficacy measures and needle placement and procedure room times were compared with those of the preceding 6 months during which conventional CT was used. CT fluoroscopic times and estimated radiation exposures were compared for two CT fluoroscopic methods. RESULTS: The sensitivity and negative predictive values for biopsy procedures and the success rate for needle aspiration or catheter drainages for CT fluoroscopy--98%, 86%, and 100%, respectively--were not significantly different from those for conventional CT--95%, 80%, and 97%, respectively. Room time was not reduced significantly, but mean needle placement time for CT fluoroscopy (29 minutes; n = 95) was significantly lower than that for conventional CT (36 minutes; n = 93; P < .005). The mean patient dose index was 74 cGy. Limiting CT fluoroscopy to scanning the needle tip rather than scanning the entire needle pass significantly reduced the dose to the patient and the operator. CONCLUSION: Although CT fluoroscopy is a useful targeting technique, significant radiation exposures may result. Therefore, radiologists need to be aware of different methods of CT fluoroscopic guidance and the factors that contribute to radiation exposure.     

Comparison of C-arm CT fluoroscopy and conventional fluoroscopy for percutaneous biliary drainage procedures

PURPOSE: To conduct a prospective randomized evaluation of C-arm computed tomography (CT) fluoroscopy for external biliary drainage procedures in comparison with conventional fluoroscopic guidance to reduce the number of transhepatic punctures as a primary endpoint. MATERIALS AND METHODS: In 18 patients with biliary obstructions, 20 external percutaneous biliary drainage procedures were prospectively performed with use of either C-arm CT fluoroscopy or conventional fluoroscopy alone. The number of hepatic punctures, procedure time, and fluoroscopy time, were analyzed separately for both methods. RESULTS: C-arm CT fluoroscopy resulted in a reduced number of transhepatic punctures, with decreased procedure and fluoroscopy times (P < .05; t test). When compared with conventional external biliary drainage procedures, a mean of 1.8+/-1 versus 4.8+/-2.8 hepatic punctures at a fluoroscopy time of 3.4+/-1.5 versus 11.4+/-7.4 minutes was required for C-arm CT fluoroscopy, while procedure times were 11+/-3.6 versus 16.2+/-9.3 minutes. CONCLUSIONS: C-arm CT fluoroscopy is associated with decreased procedure and fluoroscopy times, while fewer transhepatic punctures are required to establish external biliary drainage.     

Percutaneous abdominal and pelvic interventional procedures using CT fluoroscopy guidance.

OBJECTIVE: The purpose of our study was to assess the use of low-milliamperage CT fluoroscopy guidance for percutaneous abdominopelvic biopsy and therapeutic procedures. MATERIALS AND METHODS: We reviewed the clinical records and relevant imaging studies of 97 patients who underwent 119 percutaneous CT fluoroscopy-guided abdominal or pelvic procedures: fluid collection aspiration or drainage catheter insertion (n = 59), biopsy (n = 49), hepatocellular carcinoma ethanol ablation (n = 6), chemoneurolysis (n = 4), and brachytherapy catheter insertion (n = 1). These procedures were guided using a helical CT scanner providing real-time fluoroscopy reconstruction at six frames per second. A control panel and video monitor beside the gantry allowed direct operator control during all interventional procedures. RESULTS: One hundred twelve (94.1%) procedures were successfully performed using either a stand-off needle holder and continuous real-time CT fluoroscopy guidance or incremental manual insertion and intermittent CT fluoroscopy to confirm position. Image quality using low milliamperage was adequate for needle or drainage tube placement in all but two low-contrast liver lesions. Two hematomas were accessed but yielded no fluid on aspiration; one drainage procedure was abandoned after the patient developed endotoxic shock. Imaging of ethanol distribution during injection facilitated tumor ablation and neurolytic procedures. CT fluoroscopy allowed rapid assessment of needle, guidewire, dilator, and catheter placement, especially in nonaxial planes. Average CT fluoroscopy time for biopsy and therapeutic procedures was 133 sec (range, 35-336 sec) and 186 sec (range, 20-660 sec), respectively. CONCLUSION: CT fluoroscopy is a practical clinical tool that facilitates effective performance of percutaneous abdominal and pelvic interventional procedures.     

CT fluoroscopy--guided interventional procedures: techniques and radiation dose to radiologists.

PURPOSE: To determine the radiation dose to radiologists who perform computed tomographic (CT) fluoroscopic interventional procedures by using a quick-check method and a low-milliampere technique. MATERIALS AND METHODS: Two hundred twenty CT fluoroscopy--guided interventional procedures were performed in 189 patients. Procedures included 57 spinal injections, 17 spinal biopsies, 24 chest biopsies, 20 abdominal aspirations, 44 abdominal biopsies, and 58 abdominal drainages. Procedure details were prospectively recorded and included site, depth, target diameter, milliampere value, kilovolt peak, fluoroscopic time, and CT technique (continuous CT fluoroscopy, quick-check method, or a combination of these techniques). An individual collar and finger radiation detector were worn by each radiologist during each procedure to determine the dose per procedure. RESULTS: The quick-check technique was performed in 191 (87%) of 220 procedures. Four procedures were performed with continuous CT fluoroscopy, and a combination technique was used for 25 (11%) procedures. The overall mean CT fluoroscopic time was 17.9 seconds (range, 1.2--101.5 seconds). The mean milliampere value was 13.2 mA (range, 10--50 mA). The overall mean radiologist radiation dose per procedure was 2.5 mrem (0.025 mSv) (whole body). Individual procedure doses ranged from 0.66 to 4.75 mrem (0.007--0.048 mSv). The finger radiation dose was negligible. CONCLUSION: By using a low-milliampere technique and the quick-check method, CT fluoroscopic time and radiation exposure can be minimized.     

Mediastinal lymphadenopathy: diagnostic yield of transbronchial mediastinal lymph node biopsy with CT fluoroscopic guidance-initial experience

PURPOSE: To determine whether the use of computed tomographic (CT) fluoroscopy to guide transbronchial needle aspiration (TBNA) of mediastinal lymph nodes can improve the diagnostic yield. MATERIALS AND METHODS: CT fluoroscopy was used to guide TBNA in 12 consecutive patients with mediastinal lymphadenopathy who had previously undergone nondiagnostic conventional TBNA. CT fluoroscopy was used to confirm the location of the biopsy needle by using a "quick-check" technique (ie, fluoroscopy was performed sparingly after needle insertion). The location of each needle, the total procedural and fluoroscopic times, and any complications were recorded. RESULTS: All CT fluoroscopic procedures were performed in less than 1 hour, and a tissue diagnosis was established in all patients. Eighteen lymph nodes with a diameter of 0.8-2.4 cm were sampled with 116 needle passes. CT fluoroscopy documented inadequate positioning in 48 of the 116 (41.3%) needle passes. Eighteen (15.5%) needles did not fully penetrate the tracheobronchial tree. Six needles (5.2%) were placed into the great vessels. Malignant disease was diagnosed in nine patients, and benign disease was diagnosed in three. The mean fluoroscopic exposure time was 20.5 seconds +/- 12.7. No pneumothoraces or substantial hemorrhage were observed. CONCLUSION: CT fluoroscopic guidance for TBNA procedures is a safe and efficient means of providing diagnostic material and should be considered for patients who have previously undergone nondiagnostic blinded TBNA.     

Guidance of percutaneous pulmonary biopsies with real-time CT fluoroscopy

OBJECTIVE: Clinical evaluation of computed tomography (CT) fluoroscopy and comparison with conventional CT guidance for monitoring of percutaneous pulmonary biopsy procedures. METHODS: Twenty CT-guided pulmonary biopsy procedures were conducted. The interventions have prospectively been performed either with CT fluoroscopy or with conventional CT guidance. About 120 kV and 50 mA with a frame-rate of eight images per second were used for CT fluoroscopy. Number of pleural needle passages, procedure times, radiation doses and histologic results were analyzed separately for both methods. RESULTS: Compared with conventional CT guidance, CT fluoroscopy was associated with less pleural needle passages (1.8+/-0.6 vs. 1.1+/-0.3; P=0.003, t-test) and procedure times were shorter than for conventional CT guidance (12.7+/-2.2 min vs. 26.7+/-16.4 min; P=0.02). Analysis of estimated patient related radiation exposure and histologic outcome showed no significant difference between conventional and fluoroscopic CT-guided procedures (P>0.05). CONCLUSION: CT fluoroscopy facilitates guidance of percutaneous pulmonary biopsy procedures. Compared with conventional CT assistance, procedure times are decreased and less pleural needle passages are required. While patient-related radiation exposure is similar, operator-related radiation exposure remains a disadvantage associated with CT fluoroscopy.     

Feasibility of C-Arm-Supported CT Fluoroscopy in Percutaneous Abscess Drainage Procedures

Purpose: Evaluation of C-arm-supported CT fluoroscopy to facilitate percutaneous abscess drainage procedures. Methods: Prospectively, 40 percutaneous drainage procedures were performed either with C-arm-supported CT fluoroscopy or with CT fluoroscopy alone. Hybrid imaging was performed on the CT couch after complementing a CT fluoroscopy scanner with a C-arm fluoroscopy unit. Procedure times, drainage revisions during follow-up, and postinterventional drainage periods were analyzed. Results: When compared with exclusive CT fluoroscopic guidance, a median procedure time of 9 ± 3.7 min versus 14.8 ± 7.3 min was required for C-arm-supported CT fluoroscopy (p < 0.005, t-test). During follow-up, eight drainage catheters had to be revised within the exclusive CT fluoroscopy group, while only two revisions were necessary within the C-arm-supported CT fluoroscopy group. With C-arm-supported CT fluoroscopy, postinterventional drainage periods were reduced (median 13 vs 19 days; p < 0.001, t-test). Conclusion: Compared with exclusive cross-sectional image guidance, C-arm-supported CT fluoroscopy seems to improve placement of abscess drainage catheters to possibly reduce procedure times, drainage catheter revisions, and postinterventional drainage periods.     

Value of CT fluoroscopy for percutaneous biopsy procedures

PURPOSE: To assess the clinical impact of computed tomographic (CT) fluoroscopy (CTF) with regard to procedure time and success rate for CT image-guided biopsy procedures. MATERIALS AND METHODS: One hundred ninety consecutive patients referred to the same radiologist underwent biopsy procedures performed with use of a CT scanner equipped with fluoroscopic capabilities during a 15-month period. CTF procedures were performed predominantly by means of a continuous fluoroscopic technique, with typical exposure factors of 50 mA at 120 kV and a slice thickness of 10 mm. The total procedure time, fluoroscopy time, and complication and procedure success rates were documented prospectively in this group. A control group consisted of retrospective analysis of 93 consecutive patients who had undergone a classic CT-guided procedure performed by the same radiologist. RESULTS: Procedure success rate was increased in the CTF group (93.7 versus 88.2%), although the difference was not statistically significant (P > .05: Fisher exact test). A statistically significant difference was noted when comparing mean procedure times (CTF, 27.56 minutes; range, 20-60 minutes versus control, 43.17 minutes; range, 35-80 minutes; P < .0001; Welch unpaired t test). CONCLUSION: CT fluoroscopy facilitates CT-guided biopsy procedures by allowing visualization of the needle trajectory from skin entry to the target point, allowing procedures to be performed more rapidly and efficiently.     

Percutaneous vertebroplasty with a high-quality rotational angiographic unit

We evaluated the reliability of a rotational angiographic unit (RA) with flat-panel detector as a single technique to guide percutaneous vertebroplasty (PVP) and for post-procedure assessment by 2D and 3D reformatted images. Fifty-five consecutive patients (104 vertebral bodies) were treated under RA fluoroscopy. Rotational acquisitions with 2D and 3D reconstruction were obtained in all patients for immediate post-procedure assessment. In complex cases, this technique was also used to evaluate the needle position during the procedure. All patients underwent CT scan after the procedure. RA and CT findings were compared. In all cases, a safe trans-pedicular access and an accurate control of the bone-cement injection were successfully performed with high-quality fluoroscopy, even at the thoracic levels and in case of vertebra plana. 2D and 3D rotational reconstructions permitted CT-like images that clearly showed needle position and were similar to CT findings in depicting intrasomatic implant-distribution. RA detected 40 cement leakages compared to 42 demonstrated by CT and showed overall 95% sensitivity and 100% specificity compared to CT for final post-procedure assessment. Our preliminary results suggest that high-quality RA is reliable and safe as a single technique for PVP guidance, control and post-procedure assessment. It permits fast and cost-effective procedures avoiding multi-modality imaging.     

Benefits and safety of CT fluoroscopy in interventional radiologic procedures

PURPOSE: To determine the benefits and safety of computed tomographic (CT) fluoroscopy when compared with conventional CT for the guidance of interventional radiologic procedures. MATERIALS AND METHODS: Data on 203 consecutive percutaneous interventional procedures performed with use of CT fluoroscopic guidance and 99 consecutive procedures with conventional CT guidance were obtained from a questionnaire completed by the radiologists and CT technologists who performed the procedures. The questionnaire specifically addressed radiation dose measurements to patients and personnel, total procedure time, total CT fluoroscopy time, mode of CT fluoroscopic guidance (continuous versus intermittent), success of procedure, major complications, type of procedure (biopsy, aspiration, or drainage), site of procedure, and level of operator experience. RESULTS: The median calculated patient absorbed dose per procedure and the median procedure time with CT fluoroscopy were 94% less and 32% less, respectively, than those measurements with conventional CT scanning (P <.05). An intermittent mode of image acquisition was used in 97% of the 203 cases. This resulted in personnel radiation dosimetric readings below measurable levels in all cases. CONCLUSION: As implemented at the authors' institution, use of CT fluoroscopy for the guidance of interventional radiologic procedures markedly decreased patient radiation dose and total procedure time compared with use of conventional CT guidance.     

Radiation protection of patients in diagnostic radiology: status of practice in five Eastern-European countries, based on IAEA project

The purpose of this work was to investigate status of imaging technology and practice in five countries in Eastern-European region and evaluate the impact of IAEA projects on radiation protection of patients. Information collected using standardized IAEA protocol included status of technology, practices and patient dose levels in interventional procedure, radiography, mammography and computed tomography (CT). In spite of increased number of digital units, single phase generators or units older than 30 year are still in use. Examples of obsolete practice such as using fluoroscopy for positioning, photofluorography, chest fluoroscopy and soft-beam technique for chest radiography are also in use. Modern multi-slice CT or digital mammography units are available; however, there is lack of adequate radiation protection and medical physics support in hospitals. Information on patient doses in interventional procedures, conventional radiography, mammography and CT was collected to have baseline data and corrective measures were proposed with appropriate follow up actions taken.     

Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. I. Percutaneous transthoracic needle biopsy

PTNB is a well-established technique for the diagnosis of lung cancer. In recent years, CT guidance has become the primary imaging modality, replacing fluoroscopy guided biopsies in many institutions. CT fluoroscopy, which is currently not universally available, offers promising advantages and may permit accurate and rapid procedures. A recent innovation in biopsy needles has been the introduction of automatic core biopsy needle devices that yield large specimens and improve the diagnostic accuracy of needle biopsy, particularly in benign lesions. PTNB is one of several methods available for tissue diagnosis of suspected lung cancer. The decision as to which method to use should be tailored to each patient, and is preferably reached by a team consisting of pulmonary physicians, chest surgeons, oncologists, cytologists, and radiologists.     

CT-Steuerung

Although ultrasound and magnetic resonance imaging are competitive imaging modalities for the guidance of needle-based interventions, computed tomography (CT) is the only modality suitable for image-guided interventions in all regions of the body, including the lungs and bone. The ongoing technical development of CT involves accelerated image acquisition, significantly improved spatial resolution, CT scanners with an extended gantry diameter, acceleration of the procedure through joystick control of relevant functions of interventional CT by the interventional radiologist and tube current modulation to protect the hands of the examiner and radiosensitive organs of the patient. CT fluoroscopy can be used as a real-time method (the intervention is monitored under continuous CT fluoroscopy) or as a quick check method (repeated acquisitions of individual CT fluoroscopic images after each change of needle or table position). For the two approaches, multislice CT fluoroscopy (MSCTF) technique with wide detectors is particulary useful because even in the case of needle deviation from the center slice the needle tip is simultaneously visualised in the neighboring slices. With the aid of this technique a precise placement of interventional devices is possible even in angled access routes and in the presence of pronounced respiratory organ movements. As the reduction of CT fluoroscopy time significantly reduces radiation exposure for the patient and staff, the combination of a quick check technique and a low milliampere technique with multislice CT fluoroscopy devices is advantageous.     

US-guided injection of the upper and lower extremity joints

There is a growing interest in the application of ultrasound (US) guidance for diagnostic and therapeutic joint injections. US provides direct visualization of soft tissues and the outer borders of bony structures. With real-time needle guidance the success rate of intra-articular injections improves and iatrogenic damage to anatomic structures can be avoided. An US machine is more readily available, transferrable and more affordable than a fluoroscopy machine or CT scanner and lacks the risk of radiation. These factors make US a valuable alternative to procedures performed either blind or under fluoroscopic or CT guidance. This article focuses on the rationale for injections in the upper and lower extremity joints and describes and illustrates the different US-guided injection techniques.     

CT arthrography of the glenohumeral joint: CT fluoroscopy versus conventional CT and fluoroscopy--comparison of image-guidance techniques

PURPOSE: To compare examination time with radiologist time and to measure radiation dose of computed tomographic (CT) fluoroscopy, conventional CT, and conventional fluoroscopy as guiding modalities for shoulder CT arthrography. MATERIALS AND METHODS: Glenohumeral injection of contrast material for CT arthrography was performed in 64 consecutive patients (mean age, 32 years; age range, 16-74 years) and was guided with CT fluoroscopy (n = 28), conventional CT (n = 14), or conventional fluoroscopy (n = 22). Room times (arthrography, room change, CT, and total examination times) and radiologist times (time the radiologist spent in the fluoroscopy or CT room) were measured. One-way analysis of variance and Bonferroni-Dunn posthoc tests were performed for comparison of mean times. Mean effective radiation dose was calculated for each method with examination data, phantom measurements, and standard software. RESULTS: Mean total examination time was 28.0 minutes for CT fluoroscopy, 28.6 minutes for conventional CT, and 29.4 minutes for conventional fluoroscopy; mean radiologist time was 9.9 minutes, 10.5 minutes, and 9.0 minutes, respectively. These differences were not statistically significant. Mean effective radiation dose was 0.0015 mSv for conventional fluoroscopy (mean, nine sections), 0.22 mSv for CT fluoroscopy (120 kV; 50 mA; mean, 15 sections), and 0.96 mSv for conventional CT (140 kV; 240 mA; mean, six sections). Effective radiation dose can be reduced to 0.18 mSv for conventional CT by changing imaging parameters to 120 kV and 100 mA. Mean effective radiation dose of the diagnostic CT arthrographic examination (140 kV; 240 mA; mean, 25 sections) was 2.4 mSv. CONCLUSION: CT fluoroscopy and conventional CT are valuable alternative modalities for glenohumeral CT arthrography, as examination and radiologist times are not significantly different. CT guidance requires a greater radiation dose than does conventional fluoroscopy, but with adequate parameters CT guidance constitutes approximately 8% of the radiation dose.     

Multiple-image in-room CT imaging guidance for interventional procedures

This HIPAA-compliant study was approved by the institutional review board; informed consent was not required. The purpose of this study was to retrospectively compare room use time for interventional procedures performed with multiple-image multi-detector row computed tomographic (CT) fluoroscopy (n=196) and single-image spiral CT fluoroscopy (n=175). There was no statistically significant difference in age, sex, or procedural type between the two groups. The median room use time was 90 minutes (interquartile range, 65-120 minutes) for the single-image technique and 75 minutes (interquartile range, 60-105 minutes) for the multiple-image technique. A two-sample t test with equal variance assumption on the log-transformed data showed a statistically significant difference in log time (P<.001) between the two groups. This time savings could potentially have a substantial clinical effect on resource use and patient throughput.     

Radiation Dose to the Radiologist’s Hand During Continuous CT Fluoroscopy-Guided Interventions

Computed tomography fluoroscopy (CT fluoroscopy) enables real-time image control over the entire body with high geometric accuracy and, for the most part, without significant interfering artifacts, resulting in increased target accuracy, reduced intervention times, and improved biopsy specimens [1–4]. Depending on the procedure being used, higher radiation doses than in conventional CT-supported interventions might occur. Because the radiologist is present in the CT room during the intervention, he is exposed to additional radiation, which is an important aspect. Initial experience with CT fluoroscopically guided interventions is from the work of Katada et al. in 1994 [5] and only relatively few reports on radiation aspects in CT fluoroscopy are found in the literature [1, 2, 6–11]. To date, there are no reported injuries to patients and radiologists occurring with CT fluoroscopy. The time interval since the wide use of CT fluoroscopy is too short to have data on late effects to the operator using CT fluoroscopy on a daily basis. In addition, the spectrum of CT fluoroscopically guided interventional procedures will expand and more sophisticated procedures requiring longer fluoroscopy times will be performed. Thus, effective exposure reduction is very important. The purpose of our study was to assess the radiation dose to the operator’s hand by using data from phantom measurements. In addition, we investigated the effect of a lead drape on the phantom surface adjacent to the scanning plane, the use of thin radiation protective gloves, and the use of different needle holders.     

PET/CT Fluoroscopy during PET/CT-Guided Interventions: Initial Experience

This study assessed the feasibility and functionality of the use of a high-speed image fusion technology to generate and display positron emission tomography (PET)/computed tomography (CT) fluoroscopic images during PET/CT-guided tumor ablation procedures. Thirteen patients underwent 14 PET/CT-guided ablations for the treatment of 20 tumors. A Food and Drug Administration–cleared multimodal image fusion platform received images pushed from a scanner, followed by near–real-time, nonrigid image registration. The most recent intraprocedural PET dataset was fused to each single-rotation CT fluoroscopy dataset as it arrived, and the fused images were displayed on an in-room monitor. PET/CT fluoroscopic images were generated and displayed in all procedures and enabled more confident targeting in 3 procedures. The mean lag time from CT fluoroscopic image acquisition to the in-room display of the fused PET/CT fluoroscopic image was 21 seconds ± 8. The registration accuracy was visually satisfactory in 13 of 14 procedures. In conclusion, PET/CT fluoroscopy was feasible and may have the potential to facilitate PET/CT-guided procedures.