Respiratory motion control during stereotactic thermal ablation of malignant liver tumors: clinical solutions to a technical problem

Percutaneous thermal ablation (TA) is a minimally invasive treatment option for select liver tumors. Stereotactic guidance for percutaneous TA depends on reliable respiratory motion control by the anesthesia team to maintain a consistent liver location and shape throughout the procedure for image acquisition, fusion, and ablation probe placements. This is a single-center prospective registry-based study of patients undergoing stereotactic percutaneous TA between 6/2023 and 8/2024. We compare lateral targeting errors between subsequently introduced respiratory motion control techniques and investigated the influence of body mass index (BMI). In addition, we compare overall organ motion and deformation between pre- and post-ablation CT imaging using biomechanical deformable image registration. High frequency jet ventilation (HFJV) resulted in higher targeting accuracy and reduced the influence of BMI compared to breath holds but overall organ deformation was not significantly reduced. HFJV is the preferred option for respiratory motion control during stereotactic percutaneous TA of liver tumors but deformable image registration is still necessary for accurate image fusion.