An 82-year-old man with jaundice due to lymphadenopathy of the porta hepatis from a sigmoid cancer. A: The CT image shows a dilated bile duct in the right liver lobe. The stomach cavity is in contact with the liver because the lateral hepatic segment was resected due to a liver metastasis. B: The virtual CT image and the B-mode sonogram show the dilated bile duct (B5: arrow). The virtual image shows that the stomach cavity (arrow head) is close to the liver; a B-mode sonogram cannot show this. C: The radiograph shows that the needle is safety inserted into the bile duct, avoiding the stomach as guided by the RVS system. D: The radiograph shows successful internal-external bile duct drainage.