Fig 7. Illustration case (CT).

This 54 year old female patient had a growing right adrenal gland mass (white arrow) and an indication for a percutaneous CT-guided biopsy. She gave written informed consent. The operator (resident) in agreement with the supervising senior operator predicted a difficult intervention, due to the necessity of a double angulated trajectory. The patient was randomized to the CT group. The planned trajectory was saved on the CT console. The control CT acquired after the initial needle placement (step Δ₁) showed a large difference between the planned (a, b) and the achieved trajectories (multiplanar reconstructions) (c, d). Twelve more attempts and iterative CT control acquisitions were required to reach the target (step Δ₂). After biopsy, the last control acquisition showed a small periadrenal hematoma without the need for additional treatment. Pathologic findings on the biopsy sample showed adrenal tissues with metastasis from a malignant lung tumor.