Trajectory View: “Setup Is Key”

The trajectory view, which is also known as the hubogram, hub view, needle view, down-the-barrel, or coaxial view, provides the initial orientation for needle placement and advancement. In this view, the interventionalist directly visualizes the needle’s path to the final target. Instead of estimating the needle’s trajectory, an unobstructed needle pathway is visualized, and an associated needle entry point is identified (Figure 1–1). An initial trajectory view can be identified for almost all procedures found in this atlas. The trajectory view is typically used only for initial setup and needle placement. On occasion, the trajectory view can also be one of the final multiplanar views.

Figure 1–1 A sample page that demonstrates the trajectory view; note the Trajectory View icons. The trajectory view provides the initial orientation for needle placement and advancement for most procedures found in this atlas. Note how the fluoroscopic image (top left), radiopaque (top right), and radiolucent structures (bottom left) are shown for most figures in this atlas. When there is a safety view, the safety considerations are listed. In particular, lucent structures that should be avoided are shown and described. Note that we typically label the drawing and not the fluoro image.

The setup is obtained by appropriately positioning the fluoroscope relative to the patient. The fluoroscopic image produced with the use of this C-arm position will be depicted via the Trajectory View icon. The ease and timeliness of a procedure will be heavily dependent on an appropriate trajectory view setup.

For most trajectory and multiplanar images found in this atlas, a similar format will be used. The top left picture will be the actual fluoroscopic image. To the right, a drawing with radiopaque structures (that you can see) is outlined and labeled. On the bottom, a drawing with radiolucent structures (that you cannot see) is outlined and labeled. The needle and hub are green. When there is a “safety view,” the safety considerations are listed. In particular, lucent structures that should be avoided are shown and described.

To effectively use the trajectory view, the needle is placed parallel to the direction of the fluoroscopic beam (i.e., perpendicular to the image intensifier’s surface), and a coaxial image of the needle is obtained (Figure 1–2

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