Specialist commentator comments

Comments on this technology were invited from clinical experts working in the field. The comments received are individual opinions and do not represent NICE's view.

None of the 3 specialist commentators had used this technology before but all 3 had some awareness of it, including through product demonstrations.

Level of innovation

All 3 specialist commentators considered SimpliCT to be a novel concept and innovative technique for CT‑guided biopsy and drainage procedures.

Potential patient impact

All 3 specialist commentators felt that SimpliCT would have relatively little impact on patient health outcomes.

One commentator observed that procedure time and radiation dose to the patient may be reduced, but that this has not yet been proven. In addition, for cancer patients, any radiation dose reduction from using SimpliCT would be minimal compared with the total radiation dose from diagnosis and follow‑up.

Another commentator considered that any benefit of using SimpliCT would be lost if a patient moved during the procedure, unless it could be recalibrated accurately at that stage. They added that SimpliCT could be useful in some situations but it appeared to increase procedure time in many straightforward cases in the evidence base, so the overall benefit is hard to quantify. The third commentator supported this view, stating that SimpliCT may be helpful specifically for procedures in which the target lesion is small and deep, where CT guidance would be more challenging.

In terms of patient experience, 2 of the specialist commentators agreed that using SimpliCT could result in less patient discomfort than standard care by minimising repeated needle adjustments. However, the third commentator did not expect any potential change in patient experience.

Potential system impact

All 3 specialist commentators considered that some operator training would be needed to use the system, although this was likely to be relatively minimal. One commented that SimpliCT may have a role in training operators in freehand puncture.

One commentator observed that needle guides are available for ultrasound procedures and, if suitable, most operators would prefer to use ultrasound guidance, which is more cost effective than CT guidance.

Another commentator saw the potential to increase accuracy of biopsies, which might reduce the number of second attempts needed. However, the number of such cases would be low in terms of system impact.

The 3 commentators agreed that no changes in facilities or infrastructure would be needed to use SimpliCT, but its adoption would not lead to any significant cost savings for the NHS. Two commented that the capital cost of the technology is very high.

General comments

One specialist commentator observed that there is currently a lack of evidence comparing the effectiveness of SimpliCT with that of freehand puncture, including outcomes, radiation exposure and long-term cost savings. Adverse events from needle manipulations depend on sites, types of procedure, patient factors and complexity. If SimpliCT were to result in fewer needle adjustments, then the frequency of complications related to standard CT‑guided punctures, such as those reported in Nattenmüller et al. (2014), would be reduced.

Another commentator considered SimpliCT to have limited use in the NHS, because most biopsies and drainages are done using ultrasound guidance. They felt that more studies are needed to demonstrate a reduction in patient and operator radiation dose. Although SimpliCT has a potential role to play, the published literature mostly describes its use in cone‑beam CT‑guided procedures, which are rarely used in the NHS for biopsies or drainage.