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Saeed S, Niehoff JH, Boriesosdick J, Michael A, Schönbeck D, Wöltjen MM, Haag NP, Mönninghoff C, Borggrefe J, Kroeger JR. Gyroscope-Assisted CT-Guided Puncture Improves Accuracy and Hit Rate Compared with Free-Hand Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03832-8. [PMID: 39237781 DOI: 10.1007/s00270-024-03832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE To evaluate gyroscope-assisted CT-guided needle puncture (GAP) compared to free hand puncture (FHP) in a phantom. MATERIAL AND METHODS A simple, low-cost gyroscope was equipped with a magnetic rail to attach it to common puncture needles. 18 radiologists with different levels of training and experience in CT-guided punctures first punctured three targets in free hand technique in a special biopsy phantom with different difficulty levels of the puncture path (T1: not angulated, needle path 7.3 cm, size 15 mm in diameter, T2: single angulated 41°, needle path 11.3 cm, size 9 mm in diameter, T3: double angulated 38°/26°, needle path 7 cm, size 8 mm in diameter). Without knowing the result of the puncture, a second puncture was performed directly afterwards with the aid of the gyroscope. Punctures were performed in a continuous procedure without intermediate control. The hit rate and the distance between the needle tip and the center of the lesion were evaluated. Additionally, the time needed for the procedure was measured. RESULTS Thirty-three of 54 insertions (61.1%) hit the target in GAP compared to 20 of 54 (37%) in FHP (p = 0.002). The mean distance of the needle tip to the lesion center was 7.49 ± 5.31 mm in GAP compared to 13.37 ± 10.24 mm in FHP (p < 0.001). Puncture time was not significantly different between GAP (36.72 ± 20.38 s) and FHP (37.83 ± 20.53 s) (p = 0.362). CONCLUSION Needle guidance with a gyroscope enables an improved hit rate and puncture accuracy in CT-guided punctures without prolonging the puncture time. The needle guidance by gyroscope is inexpensive and easy to establish.
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Affiliation(s)
- Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
- Johannes Wesling Klinikum, Muehlenkreiskliniken, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Denise Schönbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias Michael Wöltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nina P Haag
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Mönninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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Xu D, Xie F, Zhang J, Chen H, Chen Z, Guan Z, Hou G, Ji C, Li H, Li M, Li W, Li X, Li Y, Lian H, Liao J, Liu D, Luo Z, Ouyang H, Shen Y, Shi Y, Tang C, Wan N, Wang T, Wang H, Wang H, Wang J, Wu X, Xia Y, Xiao K, Xu W, Xu F, Yang H, Yang J, Ye T, Ye X, Yu P, Zhang N, Zhang P, Zhang Q, Zhao Q, Zheng X, Zou J, Chen E, Sun J. Chinese expert consensus on cone-beam CT-guided diagnosis, localization and treatment for pulmonary nodules. Thorac Cancer 2024; 15:582-597. [PMID: 38337087 PMCID: PMC10912555 DOI: 10.1111/1759-7714.15222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/12/2024] Open
Abstract
Cone-beam computed tomography (CBCT) system can provide real-time 3D images and fluoroscopy images of the region of interest during the operation. Some systems can even offer augmented fluoroscopy and puncture guidance. The use of CBCT for interventional pulmonary procedures has grown significantly in recent years, and numerous clinical studies have confirmed the technology's efficacy and safety in the diagnosis, localization, and treatment of pulmonary nodules. In order to optimize and standardize the technical specifications of CBCT and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Interventional Pulmonology of China Association for Promotion of Health Science and Technology.
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Affiliation(s)
- Dongyang Xu
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Jisong Zhang
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory DiseaseSir Run Run Shaw Hospital of Zhejiang UniversityHangzhouChina
| | - Hong Chen
- Department of Pulmonary and Critical Care MedicineSecond Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhongbo Chen
- Department of Pulmonary and Critical Care Medicine, The Affiliated Hospital of Medical SchoolNingbo UniversityNingboChina
| | - Zhenbiao Guan
- Department of Respiration, Changhai HospitalNaval Medical UniversityShanghaiChina
| | - Gang Hou
- Department of Pulmonary and Critical Care Medicine, China‐Japan Friendship HospitalBeijingChina
| | - Cheng Ji
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Soochow UniversitySuzhouChina
| | - Haitao Li
- Department of Respiratory and Critical Care MedicineThe Second Hospital of Hebei Medical UniversityShijiazhuangHebeiChina
| | - Manxiang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anChina
| | - Wei Li
- Department of Respiratory DiseaseThe First Affiliated Hospital of Bengbu Medical CollegeBengbuChina
| | - Xuan Li
- Department of Respiratory Medicine, Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Yishi Li
- Dept of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hairong Lian
- Department of Respiratory MedicineAffiliated Hospital of Jiangnan UniversityWuxiChina
| | - Jiangrong Liao
- Department of Respiratory MedicineGuizhou Aerospace HospitalZunyiChina
| | - Dan Liu
- Department of Respiratory and Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Zhuang Luo
- Department of Respiratory and Critical Care MedicineFirst Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Haifeng Ouyang
- Department of Respiratory DiseasesXi'an International Medical CenterXi'anChina
| | - Yongchun Shen
- Department of Respiratory and Critical Care MedicineWest China Hospital of Sichuan UniversityChengduChina
| | - Yiwei Shi
- Department of Respiratory and Critical Care MedicineShanxi Medical University Affiliated First HospitalTaiyuanChina
| | - Chunli Tang
- China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory DiseaseThe First Affiliated Hospital of Guangzhou Medical UniversityGuangzhouChina
| | - Nansheng Wan
- Department of Respiratory and Critical Care MedicineTianjin Medical University General HospitalTianjinChina
| | - Tao Wang
- Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Hong Wang
- Department of Respiratory MedicineLanzhou University Second HospitalLanzhouChina
| | - Huaqi Wang
- Department of Respiratory MedicineThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Juan Wang
- Department of Respiratory and Critical Care Medicine, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xuemei Wu
- Department of Respiratory CentreThe Second Affiliated Hospital of Xiamen Medical CollegeXiamenChina
| | - Yang Xia
- Department of Respiratory and Critical Care MedicineSecond Affiliated Hospital of Zhejiang University School of MedicineHangzhouChina
| | - Kui Xiao
- Department of Respiratory Medicine, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wujian Xu
- Department of Respiratory and Critical Care Medicine, Shanghai East HospitalTongji University School of MedicineShanghaiChina
| | - Fei Xu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou UniversityZhengzhouChina
| | - Junyong Yang
- Department of Respiratory MedicineXinjiang Chest HospitalWulumuqiChina
| | - Taosheng Ye
- Department of TuberculosisThe Third People's Hospital of ShenzhenShenzhenChina
| | - Xianwei Ye
- Department of Pulmonary and Critical Care MedicineGuizhou Provincial People's HospitalGuiyangChina
| | - Pengfei Yu
- Department of Respiratory and Critical Care Medicine, Yantai Yuhuangding HospitalAffiliated with the Medical College of QingdaoYantaiChina
| | - Nan Zhang
- Department of Respiratory Medicine, Emergency General HospitalBeijingChina
| | - Peng Zhang
- Pulmonary Intervention DepartmentAnhui Chest HospitalHefeiChina
| | - Quncheng Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou UniversityZhengzhouChina
| | - Qi Zhao
- Department of Respiratory Medicine, Nanjing Drum Tower HospitalNanjing University Medical SchoolNanjingChina
| | - Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
| | - Jun Zou
- Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
| | - Enguo Chen
- Department of Pulmonary and Critical Care Medicine, Regional Medical Center for National Institute of Respiratory DiseaseSir Run Run Shaw Hospital of Zhejiang UniversityHangzhouChina
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Respiratory and Critical Care Medicine, Shanghai Chest HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai Engineering Research Center of Respiratory EndoscopyShanghaiChina
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Becker LS, Ringe KI, Dewald CLA, Canstein C, Hinrichs JB, Wacker FK, Meyer BC. Fully Integrated Laser Guidance for CT-Based Punctures: A Study in Phantoms and Patients. J Vasc Interv Radiol 2023; 34:130-138. [PMID: 36162623 DOI: 10.1016/j.jvir.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 08/09/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To test the hypothesis of equal or even superior applicability and accuracy of a fully integrated, laser-based computed tomography (CT) navigation system compared with conventional CT guidance for percutaneous interventions. MATERIALS AND METHODS CT-guided punctures were first performed in phantoms. Four radiologists with different experience levels (2 residents (L.B., C.D.) and 2 board-certified radiologists (B.M., K.R.) performed 48 punctures using both conventional image-guided and laser-guided approaches. Subsequently, 12 punctures were performed in patients during a clinical pilot trial. Phantom targets required an in-plane or a single-/double-angulated, out-of-plane approach. Planning and intervention time, control scan number, radiation exposure, and accuracy of needle placement (measured by deviation of the needle tip to the designated target) were assessed for each guidance technique and compared (Mann-Whitney U test and t test). Patient interventions were additionally analyzed for applicability in a clinical setting. RESULTS The application of laser guidance software in the phantom study and in 12 human patients in a clinical setting was both technically and clinically feasible in all cases. The mean planning time (P = .009), intervention time (P = .005), control scan number (P < .001), and radiation exposure (P = .013) significantly decreased for laser-navigated punctures compared with those for conventional CT guidance and especially in punctures with out-of-plane-trajectories. The accuracy significantly increased for laser-guided interventions compared with that for conventional CT (P < .001). CONCLUSIONS Interventional radiologists with differing levels of experience performed faster and more accurate punctures for out-of-plane trajectories in the phantom models, using a new, fully integrated, laser-guided CT software and demonstrated excellent clinical and technical success in initial clinical experiments.
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Affiliation(s)
- Lena S Becker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
| | - Kristina I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Cornelia L A Dewald
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | | | - Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Wu B, Wei T, Yao Z, Yang S, Yao Y, Fu C, Xu F, Xiong C. A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study. BMC Musculoskelet Disord 2022; 23:57. [PMID: 35039040 PMCID: PMC8764808 DOI: 10.1186/s12891-022-05012-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study, we present a novel electromagnetic navigation (EMN) system for percutaneous transforaminal endoscopic discectomy (PTED) procedure. The objective of this study was to investigate the safety and effectiveness of the PTED with the assistance of the EMN system and compare it with the conventional PTED with the assistance of fluoroscopic guidance (C-arm). METHODS The clinical data of 79 patients (32 in EMN group and 47 in C-arm group) undergoing PTED for lumbar disc herniation (LDH) from January to September of 2019 were analyzed retrospectively. The radiation time, puncture time, operation time, visual analog scale (VAS), Oswestry disability index (ODI), modified MacNab criteria, and radiological parameters were recorded in both groups. RESULTS Radiation time, puncture time, and operation time were significantly reduced in the EMN group compared with the C-arm group (P < 0.05). Compared with the C-arm group, a steeper learning curve was observed in the EMN group. There were no significant differences between the two groups regarding VAS and ODI scores at different time points (P > 0.05). The satisfaction rates of the EMN and C-arm groups were 90.63 and 87.23%, respectively, but no significant difference was found between the two groups (P > 0.05). There was no significant difference regarding translation and angular motion between the two groups at preoperation and postoperation (P > 0.05). CONCLUSIONS The EMN system can be applied to facilitate the PETD procedure. It can significantly reduce the intraoperative radiation time, puncture time, and operation time, and reshape the learning curve of PTED. Due to limitations of a retrospective study, results may need validation with larger prospective randomized clinical trials.
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Affiliation(s)
- Boyu Wu
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.,Hunan University of Chinese Medicine, Changsha, 410208, China
| | - Tanjun Wei
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China
| | - Zhipeng Yao
- Southern Medical University, Guangzhou, 51000, China
| | - Sai Yang
- Wuhan University of Science and Technology, Wuhan, 430065, China
| | - Yawei Yao
- Southern Medical University, Guangzhou, 51000, China
| | - Chengwei Fu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Feng Xu
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.
| | - Chengjie Xiong
- Orthopaedic Department, General Hospital of Central Theater Command of PLA, Wuhan, 430070, China.
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Ergonomics in Interventional Radiology: Awareness Is Mandatory. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050500. [PMID: 34069174 PMCID: PMC8157181 DOI: 10.3390/medicina57050500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.
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Origami Lesion-Targeting Device for CT-Guided Interventions. J Imaging 2019; 5:jimaging5020023. [PMID: 34460471 PMCID: PMC8320902 DOI: 10.3390/jimaging5020023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to preliminarily evaluate a lesion-targeting device for CT-guided interventions. The device is created by laser cutting the structure from a sheet of medical grade paperboard, 3D printing two radiocontrast agent grids onto the surface and folding the structure into a rectangular prism with a viewing window. An abdominal imaging phantom was used to evaluate the device through CT imaging and the targeting of lesions for needle insertion. The lesion-targeting trials resulted in a mean targeting error of 2.53 mm (SD 0.59 mm, n = 30). The device is rigid enough to adequately support standard biopsy needles, and it attaches to the patient, reducing the risk of tissue laceration by needles held rigidly in place by an external manipulator. Additional advantages include adequate support for the insertion of multiple surgical tools at once for procedures such as composite ablation and the potential to guide off-axial needle insertion. The low-cost and disposability of the device make it well-suited for the minimally invasive image-guided therapy environment.
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Pishnamaz M, Wilkmann C, Na HS, Pfeffer J, Hänisch C, Janssen M, Bruners P, Kobbe P, Hildebrand F, Schmitz-Rode T, Pape HC. Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques. PLoS One 2016; 11:e0148199. [PMID: 26863310 PMCID: PMC4749384 DOI: 10.1371/journal.pone.0148199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures. Methods Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05. Results 160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001). Conclusion Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.
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MESH Headings
- Biomimetic Materials/chemistry
- Bone Screws
- Electromagnetic Radiation
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/methods
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/pathology
- Fractures, Bone/surgery
- Humans
- Ilium/diagnostic imaging
- Ilium/pathology
- Ilium/surgery
- Imaging, Three-Dimensional/instrumentation
- Imaging, Three-Dimensional/methods
- Models, Anatomic
- Sacrum/diagnostic imaging
- Sacrum/pathology
- Sacrum/surgery
- Surgery, Computer-Assisted/instrumentation
- Surgery, Computer-Assisted/methods
- Time Factors
- Tomography, X-Ray Computed/instrumentation
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Miguel Pishnamaz
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
- * E-mail:
| | - Christoph Wilkmann
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
- Helmholtz Institute of RWTH Aachen University & Hospital, Institute of Applied Medical Engineering, Aachen, Germany
| | - Hong-Sik Na
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Jochen Pfeffer
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Christoph Hänisch
- Helmholtz Institute of RWTH Aachen University & Hospital, Chair of Medical Engineering, Aachen, Germany
| | - Max Janssen
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Philipp Bruners
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Philipp Kobbe
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Frank Hildebrand
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Thomas Schmitz-Rode
- Helmholtz Institute of RWTH Aachen University & Hospital, Institute of Applied Medical Engineering, Aachen, Germany
| | - Hans-Christoph Pape
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
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Hata N, Song SE, Olubiyi O, Arimitsu Y, Fujimoto K, Kato T, Tuncali K, Tani S, Tokuda J. Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer. Med Phys 2016; 43:843-53. [PMID: 26843245 PMCID: PMC4723400 DOI: 10.1118/1.4939875] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/10/2015] [Accepted: 01/02/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient's whole body motion. METHODS Keeping the device's minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient's body, even in the presence of the patient's frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors' validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. RESULTS The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth of 80 mm. The phantom test indicated that the accuracy of probe placement was significantly better with the robotic instrument guide (4.1 mm) than without the guide (6.3 mm, p<0.001), even in the presence of body motion. When independent organ motion was artificially added, in addition to body motion, the advantage of accurate probe placement using the robotic instrument guide disappeared statistically [i.e., 6.0 mm with the robotic guide and 5.9 mm without the robotic guide (p = 0.906)]. When the robotic instrument guide was used, the total time required to complete the procedure was reduced from 19.6 to 12.7 min (p<0.001). Multivariable analysis indicated that the robotic instrument guide, not the organ motion, was the cause of statistical significance. The statistical power the authors obtained was 88% in accuracy assessment and 99% higher in duration measurement. CONCLUSIONS The body-mounted robotic instrument guide allows positioning of the probe during image-guided cryotherapy of renal cancer and was done in fewer attempts and in less time than the free-hand approach. The accuracy of the placement of the cryotherapy probe was better using the robotic instrument guide than without the guide when no organ motion was present. The accuracy between the robotic and free-hand approach becomes comparable when organ motion was present.
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Affiliation(s)
- Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Sang-Eun Song
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Olutayo Olubiyi
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | | | | | - Takahisa Kato
- Healthcare Optics Research Laboratory, Canon U.S.A., Cambridge, Massachusetts 02144
| | - Kemal Tuncali
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Soichiro Tani
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Junichi Tokuda
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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Hinrichs JB, von Falck C, Hoeper MM, Olsson KM, Wacker FK, Meyer BC, Renne J. Pulmonary Artery Imaging in Patients with Chronic Thromboembolic Pulmonary Hypertension: Comparison of Cone-Beam CT and 64-Row Multidetector CT. J Vasc Interv Radiol 2016; 27:361-8.e2. [PMID: 26803575 DOI: 10.1016/j.jvir.2015.11.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To compare the depiction of pulmonary arteries in pulmonary arterial catheter-based contrast-enhanced cone-beam CT with peripheral intravenous contrast-enhanced multidetector CT in patients with suspected chronic thromboembolic pulmonary hypertension. MATERIAL AND METHODS In 20 patients (15 men and 5 women, 63.4 y ± 16.3), cone-beam CT using a catheter placed in the main pulmonary artery and 64-row multidetector CT using an appropriate venous access were performed. Contrast enhancement was measured in the main pulmonary artery, the right and left pulmonary arteries, and the left atrium. The amount of peripheral vessel conspicuity adjacent to the pleural surface (distance from vessel-to pleura) was measured. Two readers (R1, R2) independently evaluated the pulmonary arteries for image quality and pathologic findings in both modalities. RESULTS Contrast density was higher in the main pulmonary artery and right and left pulmonary arteries (P < .002) and lower in the left atrium (P = .001) on cone-beam CT. The smallest distance between clearly delineated vessels and the pleura was significantly lower on cone-beam CT images (P < .0001). Interobserver agreement was good for cone-beam CT (κ = 0.79) and multidetector CT (κ = 0.78), whereas intermodality agreement was moderate (R1, κ = 0.60; R2, κ = 0.59). Both readers detected more weblike stenoses with cone-beam CT (76; 22%) compared with multidetector CT (25; 7%). CONCLUSIONS Cone-beam CT shows improved contrast between pulmonary arteries and the left atrium and allows a more detailed depiction of the pulmonary arteries.
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Affiliation(s)
- Jan B Hinrichs
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany.
| | - Christian von Falck
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Marius M Hoeper
- Clinic for Pneumology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Karen M Olsson
- Clinic for Pneumology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Frank K Wacker
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Bernhard C Meyer
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
| | - Julius Renne
- Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany
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Ferrari V, Viglialoro RM, Nicoli P, Cutolo F, Condino S, Carbone M, Siesto M, Ferrari M. Augmented reality visualization of deformable tubular structures for surgical simulation. Int J Med Robot 2015; 12:231-40. [PMID: 26149832 DOI: 10.1002/rcs.1681] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 05/26/2015] [Accepted: 06/03/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgical simulation based on augmented reality (AR), mixing the benefits of physical and virtual simulation, represents a step forward in surgical training. However, available systems are unable to update the virtual anatomy following deformations impressed on actual anatomy. METHODS A proof-of-concept solution is described providing AR visualization of hidden deformable tubular structures using nitinol tubes sensorized with electromagnetic sensors. This system was tested in vitro on a setup comprised of sensorized cystic, left and right hepatic, and proper hepatic arteries. In the trial session, the surgeon deformed the tubular structures with surgical forceps in 10 positions. RESULTS The mean, standard deviation, and maximum misalignment between virtual and real arteries were 0.35, 0.22, and 0.99 mm, respectively. CONCLUSION The alignment accuracy obtained demonstrates the feasibility of the approach, which can be adopted in advanced AR simulations, in particular as an aid to the identification and isolation of tubular structures. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Vincenzo Ferrari
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.,Information Engineering Department, University of Pisa, Italy.,Vascular Surgery Unit, Cisanello University Hospital AOUP, Pisa, Italy
| | - Rosanna Maria Viglialoro
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Paola Nicoli
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Fabrizio Cutolo
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Sara Condino
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Marina Carbone
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Mentore Siesto
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy
| | - Mauro Ferrari
- EndoCAS Center, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Italy.,Vascular Surgery Unit, Cisanello University Hospital AOUP, Pisa, Italy
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Moncharmont L, Moreau-Gaudry A, Medici M, Bricault I. Phantom evaluation of a navigation system for out-of-plane CT-guided puncture. Diagn Interv Imaging 2015; 96:531-6. [DOI: 10.1016/j.diii.2015.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 03/02/2015] [Accepted: 03/23/2015] [Indexed: 12/30/2022]
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Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 2015; 39:53-63. [PMID: 25828726 DOI: 10.1007/s00270-015-1090-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the feasibility and diagnostic performance of contrast-enhanced, C-arm computed tomography (CACT) of the pulmonary arteries compared to digital subtraction angiography (DSA) in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS Fifty-two patients with CTEPH underwent ECG-gated DSA and contrast-enhanced CACT. Two readers (R1, R2) independently evaluated pulmonary artery segments and their sub-segmental branching using DSA and CACT for optimal image quality. Afterwards, the diagnostic findings, i.e., intraluminal filling defects, stenosis, and occlusion, were compared. Inter-modality and inter-observer agreement was calculated, and subsequently consensus reading was done and correlated to a reference standard representing the overall consensus of both modalities. Fisher's exact test and Cohen's Kappa were applied. RESULTS A total of 1352 pulmonary segments were evaluated, of which 1255 (92.8 %) on DSA and 1256 (92.9 %) on CACT were rated to be fully diagnostic. The main causes of the non-diagnostic image quality were motion artifacts on CACT (R1:37, R2:78) and insufficient contrast enhancement on DSA (R1:59, R2:38). Inter-observer agreement was good for DSA (κ = 0.74) and CACT (κ = 0.75), while inter-modality agreement was moderate (R1: κ = 0.46, R2: κ = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent (κ = 0.96), whereas it was inferior for DSA (κ = 0.61) due to the higher number of abnormal consensus findings read as normal on DSA. CONCLUSION CACT of the pulmonary arteries is feasible and provides additional information to DSA. CACT has the potential to improve the diagnostic work-up of patients with CTEPH and may be particularly useful prior to surgical or interventional treatment.
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Arnolli MM, Hanumara NC, Franken M, Brouwer DM, Broeders IAMJ. An overview of systems for CT- and MRI-guided percutaneous needle placement in the thorax and abdomen. Int J Med Robot 2014; 11:458-75. [DOI: 10.1002/rcs.1630] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nevan C. Hanumara
- Mechanical Engineering Department; Massachusetts Institute of Technology; MA USA
| | | | - Dannis M. Brouwer
- Laboratory of Mechanical Automation and Mechatronics, Faculty of Engineering Technology; University of Twente; The Netherlands
| | - Ivo A. M. J. Broeders
- Robotics and Mechatronics, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; The Netherlands
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Franz AM, Haidegger T, Birkfellner W, Cleary K, Peters TM, Maier-Hein L. Electromagnetic tracking in medicine--a review of technology, validation, and applications. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1702-1725. [PMID: 24816547 DOI: 10.1109/tmi.2014.2321777] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without line-of-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.
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Angiographic C-Arm CT– Versus MDCT-Guided Stereotactic Punctures of Liver Lesions: Nonrigid Phantom Study. AJR Am J Roentgenol 2013; 201:1136-40. [DOI: 10.2214/ajr.12.10405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Smith RL, Wen J, Noel C, Mayse ML, Parikh PJ. A respiratory correlated image guided surgery method: quantitative accuracy results in swine and human cadaver environments. Int J Med Robot 2013; 10:44-54. [DOI: 10.1002/rcs.1508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | - Jie Wen
- Department of Radiology; Washington University in St Louis; St Louis MO 63110 USA
| | | | | | - Parag J. Parikh
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis MO 63110 USA
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Rodrigues PL, Rodrigues NF, Fonseca J, Lima E, Vilaça JL. Kidney Targeting and Puncturing During Percutaneous Nephrolithotomy: Recent Advances and Future Perspectives. J Endourol 2013; 27:826-34. [DOI: 10.1089/end.2012.0740] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Pedro L. Rodrigues
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
| | - Nuno F. Rodrigues
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
- HASLab/INESC TEC, University of Minho, Braga, Portugal
| | - Jaime Fonseca
- Algoritmi Center, School of Engineering, University of Minho, Guimarães, Portugal
| | - Estevão Lima
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- Department of Urology, Hospital of Braga, Braga, Portugal
| | - João L. Vilaça
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal
- DIGARC – Polytechnic Institute of Cávado and Ave, Barcelos, Portugal
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Meyer BC, Brost A, Kraitchman DL, Gilson WD, Strobel N, Hornegger J, Lewin JS, Wacker FK. Percutaneous punctures with MR imaging guidance: comparison between MR imaging-enhanced fluoroscopic guidance and real-time MR Imaging guidance. Radiology 2013; 266:912-9. [PMID: 23297324 DOI: 10.1148/radiol.12120117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and compare the technical accuracy and feasibility of magnetic resonance (MR) imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance for percutaneous puncture procedures in phantoms and animals. MATERIALS AND METHODS The experimental protocol was approved by the institutional animal care and use committee. Punctures were performed in phantoms, aiming for markers (20 each for MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance), and pigs, aiming for anatomic landmarks (10 for MR imaging-enhanced fluoroscopic guidance and five for MR imaging guidance). To guide the punctures, T1-weighted three-dimensional (3D) MR images of the phantom or pig were acquired. Additional axial and coronal T2-weighted images were used to visualize the anatomy in the animals. For MR imaging-enhanced fluoroscopic guidance, phantoms and pigs were transferred to the fluoroscopic system after initial MR imaging and C-arm computed tomography (CT) was performed. C-arm CT and MR imaging data sets were coregistered. Prototype navigation software was used to plan a puncture path with use of MR images and to superimpose it on fluoroscopic images. For real-time MR imaging, an interventional MR imaging prototype for interactive real-time section position navigation was used. Punctures were performed within the magnet bore. After completion, 3D MR imaging was performed to evaluate the accuracy of insertions. Puncture durations were compared by using the log-rank test. The Mann-Whitney U test was applied to compare the spatial errors. RESULTS In phantoms, the mean total error was 8.6 mm ± 2.8 with MR imaging-enhanced fluoroscopic guidance and 4.0 mm ± 1.2 with real-time MR imaging guidance (P < .001). The mean puncture time was 2 minutes 10 seconds ± 44 seconds with MR imaging-enhanced fluoroscopic guidance and 37 seconds ± 14 with real-time MR imaging guidance (P < .001). In the animal study, a tolerable distance (<1 cm) between target and needle tip was observed for both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance. The mean total error was 7.7 mm ± 2.4 with MR imaging-enhanced fluoroscopic guidance and 7.9 mm ± 4.9 with real-time MR imaging guidance (P = .77). The mean puncture time was 5 minutes 43 seconds ± 2 minutes 7 seconds with MR imaging-enhanced fluoroscopic guidance and 5 minutes 14 seconds ± 2 minutes 25 seconds with real-time MR imaging guidance (P = .68). CONCLUSION Both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance demonstrated reasonable and similar accuracy in guiding needle placement to selected targets in phantoms and animals.
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Wegner I, Teber D, Hadaschik B, Pahernik S, Hohenfellner M, Meinzer HP, Huber J. Pitfalls of electromagnetic tracking in clinical routine using multiple or adjacent sensors. Int J Med Robot 2012; 9:268-73. [DOI: 10.1002/rcs.1431] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Ingmar Wegner
- German Cancer Research Centre (DKFZ), Division of Medical and Biological Informatics; Heidelberg Germany
| | - Dogu Teber
- Department of Urology; University of Heidelberg; Germany
| | | | | | | | - Hans-Peter Meinzer
- German Cancer Research Centre (DKFZ), Division of Medical and Biological Informatics; Heidelberg Germany
| | - Johannes Huber
- Department of Urology; University of Heidelberg; Germany
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Ritter M, Rassweiler MC, Häcker A, Michel MS. Laser-guided percutaneous kidney access with the Uro Dyna-CT: first experience of three-dimensional puncture planning with an ex vivo model. World J Urol 2012; 31:1147-51. [PMID: 22391646 DOI: 10.1007/s00345-012-0847-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Accepted: 02/20/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Safe and successful puncture of the kidney's collecting system is essential for acute therapy of hydronephrosis or as part of percutaneous nephrolithotomy. The procedure is technically challenging and might lead to major complications. We describe the feasibility of a laser guidance system and three-dimensional puncture planning in the endourological operation room. MATERIALS AND METHODS An Uro Dyna-CT of the biological model was performed with the Artis Zee(®) Ceiling (Siemens Medical Solutions, Erlangen, Germany) to gain multiplanar reconstructions. 10 punctures were performed with the syngo iGuide(®) laser guidance system. Puncture success was depicted with antegrade contrast filling of the collecting system and fluoroscopic control. Puncture time, tract length, and fluoroscopy time was documented. RESULTS Data acquisition (8 s) and 3D rendering (48 s) was possible in approximately 1 min. Median time for planning the punctures was 7 [5-15] min. Median puncture time was 4.6 [2-10.2] min. Median tract length was 4.96 [4.33-6.5] cm. Median fluoroscopy time was 0.4 [0.2-1] min. 9 of 10 punctures were successful. A second puncture was needed to gain access to the collecting system in one case, and one puncture was broken up. CONCLUSION The tested laser guidance system was feasible to perform successful percutaneous punctures of the kidney in this ex vivo study. Handling was intuitive and time within acceptable limits. Due to the requirement of multiplanar reconstructions with higher radiation exposure to the patient than with standard fluoroscopy, this technique should be limited to complex cases.
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Affiliation(s)
- M Ritter
- Department of Urology, Medical Centre Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany,
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Xu HX, Lu MD, Liu LN, Guo LH. Magnetic navigation in ultrasound-guided interventional radiology procedures. Clin Radiol 2011; 67:447-54. [PMID: 22153232 DOI: 10.1016/j.crad.2011.10.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/08/2011] [Accepted: 10/12/2011] [Indexed: 02/07/2023]
Abstract
AIM To evaluate the usefulness of magnetic navigation in ultrasound (US)-guided interventional procedures. MATERIALS AND METHODS Thirty-seven patients who were scheduled for US-guided interventional procedures (20 liver cancer ablation procedures and 17 other procedures) were included. Magnetic navigation with three-dimensional (3D) computed tomography (CT), magnetic resonance imaging (MRI), 3D US, and position-marking magnetic navigation were used for guidance. The influence on clinical outcome was also evaluated. RESULTS Magnetic navigation facilitated applicator placement in 15 of 20 ablation procedures for liver cancer in which multiple ablations were performed; enhanced guidance in two small liver cancers invisible on conventional US but visible at CT or MRI; and depicted the residual viable tumour after transcatheter arterial chemoembolization for liver cancer in one procedure. In four of 17 other interventional procedures, position-marking magnetic navigation increased the visualization of the needle tip. Magnetic navigation was beneficial in 11 (55%) of 20 ablation procedures; increased confidence but did not change management in five (25%); added some information but did not change management in two (10%); and made no change in two (10%). In the other 17 interventional procedures, the corresponding numbers were 1 (5.9%), 2 (11.7%), 7 (41.2%), and 7 (41.2%), respectively (p=0.002). CONCLUSION Magnetic navigation in US-guided interventional procedure provides solutions in some difficult cases in which conventional US guidance is not suitable. It is especially useful in complicated interventional procedures such as ablation for liver cancer.
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Affiliation(s)
- H-X Xu
- Department of Medical Ultrasound, Tenth People's Hospital of Tongji University, Shanghai, China.
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Lin ML, Yang BD, Wang YH, Yang CL, Wang JL. A miniature patient-mount navigation system for assisting needle placement in CT-guided intervention. Int J Med Robot 2011; 7:423-30. [PMID: 21815240 DOI: 10.1002/rcs.412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND CT-guided intervention is routinely performed in an iterative fashion that often leads to lengthy operation and high X-ray exposure to patients. To streamline the workflow, we develop a patient-mount navigation system for assisting needle placement in CT-guided interventions. METHODS The system comprises three components, a miniature patient-mount tracking unit, an auto-registered reference-frame unit and an intuitive image-processing unit. The system is operated like a virtual biplane fluoroscopy with augmented CT reconstructed images to streamline the conventional CT-guided intervention workflow. Surgery efficiency and safety can be increased, while radiation for patients and surgeons can be reduced. Two preclinical validations were conducted to evaluate the technical applicability and accuracy of the system. RESULTS The results of the rigid physical phantom test showed a machine position error of 1.6 mm and a tilting error of 1.5°. The results of the deformable porcine phantom test showed the operation position error to be 3.6 mm and tilting error to be 2.9°. CONCLUSIONS We concluded that the accuracy of our system is within the comparable range of the existing navigation systems.
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Affiliation(s)
- Mu-Lien Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, Republic of China
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Penzkofer T, Bruners P, Isfort P, Schoth F, Günther RW, Schmitz-Rode T, Mahnken AH. Free-hand CT-based electromagnetically guided interventions: Accuracy, efficiency and dose usage. MINIM INVASIV THER 2011; 20:226-33. [DOI: 10.3109/13645706.2011.553256] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Medical imaging in interventional oncology is used differently than in diagnostic radiology and prioritizes different imaging features. Whereas diagnostic imaging prioritizes the highest-quality imaging, interventional imaging prioritizes real-time imaging with lower radiation dose in addition to high-quality imaging. In general, medical imaging plays five key roles in image-guided therapy, and interventional oncology, in particular. These roles are (a) preprocedure planning, (b) intraprocedural targeting, (c) intraprocedural monitoring, (d) intraprocedural control, and (e) postprocedure assessment. Although many of these roles are still relatively basic in interventional oncology, as research and development in medical imaging focuses on interventional needs, it is likely that the role of medical imaging in intervention will become even more integral and more widely applied. In this review, the current status of medical imaging for intervention in oncology will be described and directions for future development will be examined.
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Affiliation(s)
- Stephen B Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
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A patient-mount navigated intervention system for spinal diseases and its clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion. Spine (Phila Pa 1976) 2010; 35:E1126-32. [PMID: 20838268 DOI: 10.1097/brs.0b013e3181e11d73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Development of a patient-mount navigated intervention (PaMNI) system for spinal diseases. An in vivo clinical human trial was conducted to validate this system. OBJECTIVE To verify the feasibility of the PaMNI system with the clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion (PRF-DRG). SUMMARY OF BACKGROUND DATA Two major image guiding techniques, i.e., computed tomography (CT)-guided and fluoro-guided, were used for spinal intervention. The CT-guided technique provides high spatial resolution, and is claimed to be more accurate than the fluoro-guided technique. Nevertheless, the CT-guided intervention usually reaches higher radiograph exposure than the fluoro-guided counterpart. Some navigated intervention systems were developed to reduce the radiation of CT-guided intervention. Nevertheless, these systems were not popularly used due to the longer operation time, a new protocol for surgeons, and the availability of such a system. METHODS The PaMNI system includes 3 components, i.e., a patient-mount miniature tracking unit, an auto-registered reference frame unit, and a user-friendly image processing unit. The PRF-DRG treatment was conducted to find the clinical feasibility of this system. RESULTS The in vivo clinical trial showed that the accuracy, visual analog scale evaluation after surgery, and radiograph exposure of the PaMNI-guided technique are comparable to the one of conventional fluoro-guided technique, while the operation time is increased by 5 minutes. CONCLUSION Combining the virtues of fluoroscopy and CT-guided techniques, our navigation system is operated like a virtual fluoroscopy with augmented CT images. This system elevates the performance of CT-guided intervention and reduces surgeons' radiation exposure risk to a minimum, while keeping low radiation dose to patients like its fluoro-guided counterpart. The clinical trial of PRF-DRG treatment showed the clinical feasibility and efficacy of this system.
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Huber J, Wegner I, Meinzer HP, Hallscheidt P, Hadaschik B, Pahernik S, Hohenfellner M. Multimedia article. Navigated renal access using electromagnetic tracking: an initial experience. Surg Endosc 2010; 25:1307-12. [PMID: 20835720 DOI: 10.1007/s00464-010-1338-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 08/17/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Navigation systems are promising tools for improving efficacy and safety in surgical endoscopy and other minimally invasive techniques. The aim of the current study is to investigate electromagnetic tracking (EMT) for navigated renal access in a porcine model. METHODS For our proof-of-principle study we modified a recently established porcine ex vivo model. Via a ureteral catheter which was placed into the desired puncture site, a small sensor was introduced and located by EMT. Then, a tracked needle was navigated into the collecting system in a "rendezvous" approach. A total of 90 renal tracts were obtained in six kidneys using EMT, with a maximum of three punctures allowed per intervention. For each puncture, number of attempts to success, final distance to probe, puncture time, and localization were assessed. We compared absolute and relative frequencies using the chi-square test and applied the Mann-Whitney U-test for continuous variables. RESULTS No major problems were encountered performing the experiment. Access to the collecting system was successfully obtained after a single puncture in 91% (82/90) and within a second attempt in the remaining 9% (8/90). Thus, a 100% success rate was reached after a maximum of two punctures. Location of the calyx did not have a significant effect on success rate (p = 0.637). After a learning phase of 30 punctures, higher success rate (96% versus 83%; p = 0.041) was accomplished within shorter puncture time (14 versus 17 s; p = 0.049) and with higher precision (1.7 versus 2.8 mm; p < 0.001). CONCLUSIONS With respect to other established techniques, use of EMT seems to decrease the number of attempts and procedural time remarkably. This might contribute to greater safety and efficacy when applied clinically. The presented approach appears to be promising, especially in difficult settings, provided that in vivo data support these initial results.
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Affiliation(s)
- Johannes Huber
- Department of Urology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Penzkofer T, Isfort P, Bruners P, Wiemann C, Kyriakou Y, Kalender WA, Günther RW, Schmitz-Rode T, Mahnken AH. Robot arm based flat panel CT-guided electromagnetic tracked spine interventions: phantom and animal model experiments. Eur Radiol 2010; 20:2656-62. [DOI: 10.1007/s00330-010-1837-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 05/05/2010] [Indexed: 12/18/2022]
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Meyer BC, Wolf KJ, Wacker FK. [Flat-detector CT-based electromagnetic navigation]. Radiologe 2009; 49:856-61. [PMID: 19730807 DOI: 10.1007/s00117-009-1867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Flat-detector CT coupled to an angiography device provides an imaging technique for interventions which can be used for electromagnetically navigated percutaneous punctures. This report explains the functionality of an electromagnetic navigation system and describes the course of an electromagnetically navigated puncture and the capabilities of such a system in the clinical routine.
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Affiliation(s)
- B C Meyer
- Klinik und Hochschulambulanz für Radiologie und Nuklearmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin.
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The value of combined soft-tissue and vessel visualisation before transarterial chemoembolisation of the liver using C-arm computed tomography. Eur Radiol 2009; 19:2302-9. [PMID: 19424701 DOI: 10.1007/s00330-009-1410-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
The purpose of the study was to prospectively evaluate intrahepatic vessel depiction on C-arm CT (CACT) and the influence of the additional combined tissue and three-dimensional vessel visualisation on the positioning of the TACE catheter in comparison to DSA alone. Thirty consecutive patients scheduled for their first transarterial chemoembolisation underwent biphasic CACT and DSA of the liver. After assessing the DSA images for procedure planning, the CACT images were reviewed. The number and origin of the tumour-feeding arteries and the ideal position of the catheter for TACE on both DSA and CACT were assessed and correlated. The number of vessels identified as tumour feeders in each patient was significantly higher using additional CACT than on DSA alone (CACT: 4.0 +/- 1.7; DSA: 3.3 +/- 1.4; P = 0.003, t-test). After considering CACT, in 50% of the patients the catheter position was changed for TACE. Segmental portal vein thrombosis was seen in three patients on CACT, but in only one on DSA. As CACT depicts soft tissue and small vessels with high spatial resolution, tumour vessel allocation is facilitated, and ideal catheter position for TACE can be more accurately identified. The high impact of CACT on the TACE procedure suggests the benefits of its routine use for all patients undergoing their first TACE.
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