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Vavassori A, Mauri G, Mazzola GC, Mastroleo F, Bonomo G, Durante S, Zerini D, Marvaso G, Corrao G, Ferrari ED, Rondi E, Vigorito S, Cattani F, Orsi F, Jereczek-Fossa BA. Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique. Curr Oncol 2023; 30:7926-7935. [PMID: 37754491 PMCID: PMC10529393 DOI: 10.3390/curroncol30090576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/18/2023] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
In this technical development report, we present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation (EMN) for the delivery of ultra-hypofractionated cyberknife (CK) therapy in a patient with localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient's skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure proper positioning. The implantation procedure was safe, without any acute side effects such as pain, hematuria, dysuria, or hematospermia. Our report highlights the ability to use EMN systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases.
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Affiliation(s)
- Andrea Vavassori
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Giovanni Mauri
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 20188 Novara, Italy
| | - Guido Bonomo
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
| | - Stefano Durante
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Dario Zerini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Giulia Corrao
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
| | - Elettra Dorotea Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
| | - Elena Rondi
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Federica Cattani
- Unit of Medical Physics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (E.R.); (S.V.); (F.C.)
| | - Franco Orsi
- Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (G.M.); (G.B.); (F.O.)
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy; (A.V.); (G.C.M.); (S.D.); (D.Z.); (G.M.); (G.C.); (E.D.F.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy
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Van den Bosch V, Salim HS, Chen NZ, Stroosma O, Bruners P, Kuhl CK, Pedersoli F, Isfort P. Augmented Reality-Assisted CT-Guided Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2022; 45:1173-1177. [PMID: 35750863 PMCID: PMC9307551 DOI: 10.1007/s00270-022-03195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Purpose To investigate the feasibility of a novel augmented reality system for CT-guided liver interventions and to compare it with free-hand interventions in a phantom setting. Methods and materials A newly developed augmented reality interface was used, with projection of CT-imaging in multiplanar reconstruction and live rendering of the needle position, a bull`s eye view of the needle trajectory and a visualization of the distance to the target. Punctures were performed on a custom-made abdominal phantom by three interventional radiologists with different levels of expertise. Time and needle placement accuracy were measured. Two-tailed Wilcoxon signed rank test (p < 0.05) was performed to evaluate intraparticipant difference. Results Intraparticipant puncture times were significantly shorter for each operator in the augmented reality condition (< 0.001 for the resident, < 0.001 for the junior staff member and 0.027 for the senior staff member). The junior staff member had an improvement in accuracy of 1 mm using augmented reality (p 0.026); the other two participants showed no significant improvement regarding accuracy. Conclusion In this small series, it appears that the novel augmented reality system may improve the speed of CT-guided punctures in the phantom model compared to the free-hand procedure while maintaining a similar accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03195-y.
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Affiliation(s)
- Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | | | - Njin-Zu Chen
- Philips Research Europe, Eindhoven, The Netherlands
| | | | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, 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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Pedersoli F, Wilkmann C, Penzkofer T, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P, Isfort P. An accelerometer-based guidance device for CT-guided procedures: an improved wireless prototype. MINIM INVASIV THER 2021; 31:902-908. [PMID: 34865602 DOI: 10.1080/13645706.2021.2002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the study was to demonstrate the feasibility of a prototype for accelerometer-based guidance for percutaneous CT-guided punctures and compare it with free-hand punctures. MATERIAL AND METHODS The prototype enabled alignment with the CT coordinate system and a wireless connectivity. Its feasibility was tested in a swine cadaver model: 20 out-of-plane device-assisted punctures performed without intermittent control scans (one-step punctures) were evaluated regarding deviation to target and difference between planned and obtained angle. Thereafter, 22 device-assisted punctures were compared with 20 free-hand punctures regarding distance to target, deviation from the planned angle, number of control scans and procedure time. Differences were compared with the Mann-Whitney U-test (p < .05). RESULTS The one-step punctures revealed a deviation to target of 0.26 ± 0.37 cm (axial plane) and 0.21 ± 0.19 cm (sagittal plane) and differences between planned and performed puncture angles of 0.9 ± 1.09° (axial plane) and 1.15 ± 0.91° (sagittal planes). In the comparative study, device-assisted punctures showed a significantly higher accuracy, 0.20 ± 0.17 cm vs. 0.30 ± 0.21 cm (p < .05) and lower number of required control scans, 1.3 ± 1.1 vs. 3.7 ± 0.9 (p < .05) compared with free-hand punctures. CONCLUSION The accelerometer-based device proved to be feasible and demonstrated significantly higher accuracy and required significantly less control scans compared to free-hand puncture.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christoph Wilkmann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany.,Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Catherine Disselhorst-Klug
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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Impact of an Augmented Reality Navigation System (SIRIO) on Bone Percutaneous Procedures: A Comparative Analysis with Standard CT-Guided Technique. ACTA ACUST UNITED AC 2021; 28:1751-1760. [PMID: 34066651 PMCID: PMC8161791 DOI: 10.3390/curroncol28030163] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022]
Abstract
(1) Background: The purpose of this study is to evaluate the impact of an augmented reality navigation system (SIRIO) for percutaneous biopsies and ablative treatments on bone lesions, compared to a standard CT-guided technique. (2) Methods: Bioptic and ablative procedures on bone lesions were retrospectively analyzed. All procedures were divided into SIRIO and Non-SIRIO groups and in <2 cm and >2 cm groups. Number of CT-scans, procedural time and patient’s radiation dose were reported for each group. Diagnostic accuracy was obtained for bioptic procedures. (3) Results: One-hundred-ninety-three procedures were evaluated: 142 biopsies and 51 ablations. Seventy-four biopsy procedures were performed using SIRIO and 68 under standard CT-guidance; 27 ablative procedures were performed using SIRIO and 24 under standard CT-guidance. A statistically significant reduction in the number of CT-scans, procedural time and radiation dose was observed for percutaneous procedures performed using SIRIO, in both <2 cm and >2 cm groups. The greatest difference in all variables examined was found for procedures performed on lesions <2 cm. Higher diagnostic accuracy was found for all SIRIO-assisted biopsies. No major or minor complications occurred in any procedures. (4) Conclusions: The use of SIRIO significantly reduces the number of CT-scans, procedural time and patient’s radiation dose in CT-guided percutaneous bone procedures, particularly for lesions <2 cm. An improvement in diagnostic accuracy was also achieved in SIRIO-assisted biopsies.
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Davrieux CF, Giménez ME, González CA, Ancel A, Guinin M, Fahrer B, Serra E, Kwak JM, Marescaux J, Hostettler A. Mixed reality navigation system for ultrasound-guided percutaneous punctures: a pre-clinical evaluation. Surg Endosc 2019; 34:226-230. [DOI: 10.1007/s00464-019-06755-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/06/2019] [Indexed: 11/24/2022]
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Iannelli G, Caivano R, Villonio A, Semeraro V, Lucarelli NM, Ganimede MP, Gisone V, Dinardo G, Bruno S, Macarini L, Guglielmi G, Cammarota A. Percutaneous Computed Tomography-Guided Lung Biopsies using a Virtual Navigation Guidance: Our Experience. Cancer Invest 2018; 36:349-355. [PMID: 30095281 DOI: 10.1080/07357907.2018.1498877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a virtual CT-guided navigation system (Sirio-MASMEC Biomed) in performing lung biopsies, with greater attention to lesions smaller than 1 cm, compared to the traditional procedure. METHODS This study was approved by the Ethics Committee of our Institute. Two hundred patients were prospectively selected. Of these, 100 were subjected to percutaneous procedure with the use of Sirio and 100 to traditional CT-guided percutaneous procedure. The two methods were compared in terms of absorbed dose, procedure time, complications, and number of non-diagnostic specimens (diagnostic success). RESULTS Sirio has shown a significant reduction in the absorbed dose and procedure times (p < 0.05), with a lower incidence of complications compared to the traditional procedure. Sirio has also allowed to carry out biopsies of lesions' diameter ≤10 mm, obtaining fewer non diagnostic specimens thus resulting more effective in terms of diagnostic success. CONCLUSIONS The use of Sirio in sampling biopsy showed a statistically significant reduction in terms of performed scans and procedural time with lower incidence of post-procedural complications compared to the traditional percutaneous procedure, especially for lesions ≤10 mm. The best diagnostic result, the reduction of the dose absorbed and procedural complications makes the procedures more reliable, safety and less invasive. In addition, the reduction of execution time will increase the number of daily interventional procedures improving clinical management.
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Affiliation(s)
| | | | | | - Vittorio Semeraro
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Nicola Maria Lucarelli
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Maria Porzia Ganimede
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | - Vito Gisone
- b Department of Radiology-Neuroradiology , Ospedale SS Annunziata ASL Taranto , Taranto , Italy
| | | | | | - Luca Macarini
- c Radiology Department , University of Foggia , Foggia , Italy
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Shi C, Luo X, Guo J, Najdovski Z, Fukuda T, Ren H. Three-Dimensional Intravascular Reconstruction Techniques Based on Intravascular Ultrasound: A Technical Review. IEEE J Biomed Health Inform 2018; 22:806-817. [DOI: 10.1109/jbhi.2017.2703903] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schwein A, Kramer B, Chinnadurai P, Virmani N, Walker S, O'Malley M, Lumsden AB, Bismuth J. Electromagnetic tracking of flexible robotic catheters enables “assisted navigation” and brings automation to endovascular navigation in an in vitro study. J Vasc Surg 2018; 67:1274-1281. [DOI: 10.1016/j.jvs.2017.01.072] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/29/2017] [Indexed: 11/28/2022]
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Rouchy RC, Moreau-Gaudry A, Chipon E, Aubry S, Pazart L, Lapuyade B, Durand M, Hajjam M, Pottier S, Renard B, Logier R, Orry X, Cherifi A, Quehen E, Kervio G, Favelle O, Patat F, De Kerviler E, Hughes C, Medici M, Ghelfi J, Mounier A, Bricault I. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial. Trials 2017; 18:306. [PMID: 28683837 PMCID: PMC5501074 DOI: 10.1186/s13063-017-2049-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. METHODS/DESIGN This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. DISCUSSION This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01896219 . Registered on 5 July 2013.
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Affiliation(s)
- R C Rouchy
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France. .,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.
| | - A Moreau-Gaudry
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - E Chipon
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - S Aubry
- Service de Radiologie Ostéo-Articulaire, Centre Hospitalier Universitaire (CHU) Besançon, F-25000, Besançon, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - L Pazart
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - B Lapuyade
- Service d'Imagerie Diagnostique et Therapeutique, Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Durand
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1401, F-33000, Bordeaux, France.,Centre d'Investigation Clinique (CIC) 1401, University Bordeaux, F-33000, Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Hajjam
- Service de Radiologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92100, Boulogne-Billancourt, France
| | - S Pottier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1429, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92380, Garches, France
| | - B Renard
- Service de Radiologie, Centre Hospitalier Universitaire (CHU) Lille, F-59000, Lille, France
| | - R Logier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1403, Centre Hospitalier Universitaire (CHU) Lille, University Lille, F-59000, Lille, France
| | - X Orry
- Service de Radiologie, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - A Cherifi
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique - Centre de technologie innovante (CIC-IT) 1433, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - E Quehen
- Service Imagerie Abdominale et Générale, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - G Kervio
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1414, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - O Favelle
- Département Imagerie Médicale, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - F Patat
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1415, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - E De Kerviler
- Service de Radiologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75475, Paris, France
| | - C Hughes
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - M Medici
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - J Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - A Mounier
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - I Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
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Durand P, Moreau-Gaudry A, Silvent AS, Frandon J, Chipon E, Médici M, Bricault I. Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial. PLoS One 2017; 12:e0173751. [PMID: 28296957 PMCID: PMC5351986 DOI: 10.1371/journal.pone.0173751] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the accuracy and usability of an electromagnetic navigation system designed to assist Computed Tomography (CT) guided interventions. Materials and methods 120 patients requiring a percutaneous CT intervention (drainage, biopsy, tumor ablation, infiltration, sympathicolysis) were included in this prospective randomized trial. Nineteen radiologists participated. Conventional procedures (CT group) were compared with procedures assisted by a navigation system prototype using an electromagnetic localizer to track the position and orientation of a needle holder (NAV group). The navigation system displays the needle path in real-time on 2D reconstructed CT images extracted from the 3D CT volume. The regional ethics committee approved this study and all patients gave written informed consent. The main outcome was the distance between the planned trajectory and the achieved needle trajectory calculated from the initial needle placement. Results 120 patients were analyzable in intention-to-treat (NAV: 60; CT: 60). Accuracy improved when the navigation system was used: distance error (in millimeters: median[P25%; P75%]) with NAV = 4.1[2.7; 9.1], vs. with CT = 8.9[4.9; 15.1] (p<0.001). After the initial needle placement and first control CT, fewer subsequent CT acquisitions were necessary to reach the target using the navigation system: NAV = 2[2; 3]; CT = 3[2; 4] (p = 0.01). Conclusion The tested system was usable in a standard clinical setting and provided significant improvement in accuracy; furthermore, with the help of navigation, targets could be reached with fewer CT control acquisitions.
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Affiliation(s)
- Pierre Durand
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, University Grenoble Alpes, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, National Center for Scientific Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Anne-Sophie Silvent
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
- * E-mail:
| | - Julien Frandon
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
| | - Emilie Chipon
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Maud Médici
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Ivan Bricault
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, University Grenoble Alpes, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, National Center for Scientific Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
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12
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Aziz F. Invited commentary. J Vasc Surg 2017; 65:537. [DOI: 10.1016/j.jvs.2016.10.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
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13
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Beyer LP, Michalik K, Niessen C, Platz Batista da Silva N, Wiesinger I, Stroszczynski C, Wiggermann P. Evaluation of a Robotic Assistance-System For Percutaneous Computed Tomography-Guided (CT-Guided) Facet Joint Injection: A Phantom Study. Med Sci Monit 2016; 22:3334-9. [PMID: 27648509 PMCID: PMC5042119 DOI: 10.12659/msm.900686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background The aim of this study was to compare robotic assisted and freehand facet joint puncture on a phantom model in regards to time requirements and puncture accuracy. Material/Methods Forty facet joints were punctured, 20 using a robotic guidance system and 20 using a freehand procedure. Side and height of the facet joints were randomized and identical for both groups. Procedural accuracy, defined as axial and sagittal deviation, as well as the number of corrections were assessed. Procedure times for each step were documented and time requirements for pre-positioning, reconstruction, planning, and total intervention were calculated. Results Total procedure time for robotic guidance was 259±111 seconds versus 119±77 seconds for freehand procedure (p=1.0). Procedural accuracy for robotic guidance was significantly higher with 0 corrections versus 1.3 corrections for freehand procedure (p=0.02). Needle deviation in the robotics arm was 0.35±1.1 mm in the axial and 2.15±1.2 mm in the sagittal reconstruction. Conclusions Robotic assisted puncture of the facet joint allowed accurate positioning of the needle with a lower number of needle readjustments. Higher procedural accuracy was marginally offset by a slightly longer intervention time.
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Affiliation(s)
- Lukas Philipp Beyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Katharina Michalik
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Niessen
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Isabell Wiesinger
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Philipp Wiggermann
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Schwein A, Kramer B, Chinnadurai P, Walker S, O'Malley M, Lumsden A, Bismuth J. Flexible robotics with electromagnetic tracking improves safety and efficiency during in vitro endovascular navigation. J Vasc Surg 2016; 65:530-537. [PMID: 26994950 DOI: 10.1016/j.jvs.2016.01.045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/26/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE One limitation of the use of robotic catheters is the lack of real-time three-dimensional (3D) localization and position updating: they are still navigated based on two-dimensional (2D) X-ray fluoroscopic projection images. Our goal was to evaluate whether incorporating an electromagnetic (EM) sensor on a robotic catheter tip could improve endovascular navigation. METHODS Six users were tasked to navigate using a robotic catheter with incorporated EM sensors in an aortic aneurysm phantom. All users cannulated two anatomic targets (left renal artery and posterior "gate") using four visualization modes: (1) standard fluoroscopy mode (control), (2) 2D fluoroscopy mode showing real-time virtual catheter orientation from EM tracking, (3) 3D model of the phantom with anteroposterior and endoluminal view, and (4) 3D model with anteroposterior and lateral view. Standard X-ray fluoroscopy was always available. Cannulation and fluoroscopy times were noted for every mode. 3D positions of the EM tip sensor were recorded at 4 Hz to establish kinematic metrics. RESULTS The EM sensor-incorporated catheter navigated as expected according to all users. The success rate for cannulation was 100%. For the posterior gate target, mean cannulation times in minutes:seconds were 8:12, 4:19, 4:29, and 3:09, respectively, for modes 1, 2, 3 and 4 (P = .013), and mean fluoroscopy times were 274, 20, 29, and 2 seconds, respectively (P = .001). 3D path lengths, spectral arc length, root mean dimensionless jerk, and number of submovements were significantly improved when EM tracking was used (P < .05), showing higher quality of catheter movement with EM navigation. CONCLUSIONS The EM tracked robotic catheter allowed better real-time 3D orientation, facilitating navigation, with a reduction in cannulation and fluoroscopy times and improvement of motion consistency and efficiency.
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Affiliation(s)
- Adeline Schwein
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex.
| | - Ben Kramer
- Department of Mechanical Engineering, Rice University, Houston, Tex
| | | | | | - Marcia O'Malley
- Department of Mechanical Engineering, Rice University, Houston, Tex
| | - Alan Lumsden
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
| | - Jean Bismuth
- DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Tex
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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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Groetz S, Wilhelm K, Willinek W, Pieper C, Schild H, Thomas D. A new robotic assistance system for percutaneous CT-guided punctures: Initial experience. MINIM INVASIV THER 2015; 25:79-85. [DOI: 10.3109/13645706.2015.1110825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
Introduction Technical developments for improving the safety and accuracy of pedicle screw placement play an increasingly important role in spine surgery. In addition to the standard techniques of free-hand placement and fluoroscopic navigation, the rate of complications is reduced by 3D fluoroscopy, cone-beam CT, intraoperative CT/MRI, and various other navigation techniques. Another important aspect that should be emphasized is the reduction of intraoperative radiation exposure for personnel and patient. The aim of this study was to investigate the accuracy of a new navigation system for the spine based on an electromagnetic field. Material and Method Twenty pedicle screws were placed in the lumbar spine of human cadavers using EMF navigation. Navigation was based on data from a preoperative thin-slice CT scan. The cadavers were positioned on a special field generator and the system was matched using a patient tracker on the spinous process. Navigation was conducted using especially developed instruments that can be tracked in the electromagnetic field. Another thin-slice CT scan was made postoperatively to assess the result. The evaluation included the position of the screws in the direction of trajectory and any injury to the surrounding cortical bone. The results were classified in 5 groups: grade 1: ideal screw position in the center of the pedicle with no cortical bone injury; grade 2: acceptable screw position, cortical bone injury with cortical penetration ≤ 2 mm; grade 3: cortical bone injury with cortical penetration 2,1-4 mm, grad 4: cortical bone injury with cortical penetration 4,1-6 mm, grade 5: cortical bone injury with cortical penetration >6 mm. Results The initial evaluation of the system showed good accuracy for the lumbar spine (65% grade 1, 20% grade 2, 15% grade 3, 0% grade 4, 0% grade 5). A comparison of the initial results with other navigation techniques in literature (CT navigation, 2D fluoroscopic navigation) shows that the accuracy of this system is comparable. Conclusion EMF navigation offers a high accuracy in Pedicle screw placement with additional advantages compared to other techniques. The short set-up time and easy handling of EMF navigation should be emphasized. Additional advantages are the absence of intraoperative radiation exposure for the operator and surgical team in the current set-up and the operator’s free mobility without interfering with navigation. Further studies with navigation at higher levels of the spine, larger numbers of cases and studies with control group are planned.
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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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CT-guided liver biopsy with electromagnetic tracking: results from a single-center prospective randomized controlled trial. AJR Am J Roentgenol 2015; 203:W715-23. [PMID: 25415738 DOI: 10.2214/ajr.13.12061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The purpose of this study is to evaluate the effectiveness of electromagnetic tracking in assisting CT-guided liver biopsies. MATERIALS AND METHODS This was a single-center prospective randomized controlled trial comparing nonfluoroscopic CT-guided liver biopsy using an advance-and-scan technique with and without electromagnetic tracking. Fifty patients with a liver lesion referred for biopsy (women, 52%; mean age, 59.7 years; mean lesion size, 3.6 cm) were enrolled in the study and were randomly assigned to either arm. The primary and secondary objectives were to assess and quantify differences in the number of intraprocedural scans, cumulative effective radiation dose, number of needle manipulations, and procedure time from skin-stick to the target lesion with and without assistance. RESULTS Electromagnetic tracking significantly decreased the number of scans, effective radiation dose, number of manipulations per procedure, and time from skin-stick to the target lesion. The ratio of the number of scans (electromagnetic tracking to control) was 0.55 (95% CI, 0.42-0.73; p<0.0001). The mean difference in effective radiation dose (electromagnetic tracking-control) was -4.7 mSv (95% CI, -7.01 to -2.44 mSv; p=0.0001), and the median difference was -5.1 mSv (95% CI, -7.01 to -3.56 mSv; p<0.0001). The ratio of the number of manipulations (electromagnetic tracking to control) was 0.36 (95% CI, 0.24-0.54; p<0.0001). The mean difference for the time from skin-stick to the target lesion was -247.6 seconds (95% CI, -394.34 to -100.83 seconds; p=0.0014) and the median difference was -253.0 seconds (95% CI, -325.00 to -124.00 seconds; p=0.0001). CONCLUSION Electromagnetic tracking assistance has the potential to decrease the number of intraprocedural CT scans and needle manipulations and to reduce patient radiation dose during CT-guided liver biopsy.
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Navigation of pedicle screws in the thoracic spine with a new electromagnetic navigation system: a human cadaver study. BIOMED RESEARCH INTERNATIONAL 2015; 2015:183586. [PMID: 25759814 PMCID: PMC4339821 DOI: 10.1155/2015/183586] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 01/25/2015] [Accepted: 01/25/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Posterior stabilization of the spine is a standard procedure in spinal surgery. In addition to the standard techniques, several new techniques have been developed. The objective of this cadaveric study was to examine the accuracy of a new electromagnetic navigation system for instrumentation of pedicle screws in the spine. MATERIAL AND METHOD Forty-eight pedicle screws were inserted in the thoracic spine of human cadavers using EMF navigation and instruments developed especially for electromagnetic navigation. The screw position was assessed postoperatively by a CT scan. RESULTS The screws were classified into 3 groups: grade 1 = ideal position; grade 2 = cortical penetration <2 mm; grade 3 = cortical penetration ≥2 mm. The initial evaluation of the system showed satisfied positioning for the thoracic spine; 37 of 48 screws (77.1%, 95% confidence interval [62.7%, 88%]) were classified as group 1 or 2. DISCUSSION The screw placement was satisfactory. The initial results show that there is room for improvement with some changes needed. The ease of use and short setup times should be pointed out. Instrumentation is achieved without restricting the operator's mobility during navigation. CONCLUSION The results indicate a good placement technique for pedicle screws. Big advantages are the easy handling of the system.
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Ungi T, Beiko D, Fuoco M, King F, Holden MS, Fichtinger G, Siemens DR. Tracked ultrasonography snapshots enhance needle guidance for percutaneous renal access: a pilot study. J Endourol 2014; 28:1040-5. [PMID: 24745550 DOI: 10.1089/end.2014.0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Although ultrasonography-guided percutaneous nephrostomy is relatively safe, a number of factors make it challenging for inexperienced operators. A computerized needle navigation technique using tracked ultrasonography snapshots was investigated to determine whether performance of percutaneous nephrostomy by inexperienced users could be improved. METHODS Ten operators performed the procedure on a phantom model with alternating needle guidance between conventional ultrasonography and tracked ultrasonography snapshots. The needle was reinserted until fluid backflow confirmed calyceal access. Needle trajectories were recorded using the real time needle navigation system for offline evaluation of operator performance. Recorded needle trajectories were used to measure needle motion path length inside the phantom tissue, number of reinsertions, total procedure time, and needle insertion time as end points of this study. RESULTS Needle path length measured inside the phantom tissue was significantly lower with ultrasonography snapshots guidance (295.0±23.1 mm, average±standard error of the mean) compared with control procedures (977.9±144.4 mm, P<0.01). This was associated with a significantly lower number of needle insertion attempts with ultrasonography snapshots (average 1.27±0.10 vs 2.83±0.31, P<0.01). The total procedure time and the needle insertion time were also significantly lower with ultrasonography snapshots guidance. CONCLUSION Tracked ultrasonography snapshots appear to improve the performance of percutaneous nephrostomy in these preliminary investigations, justifying further validation studies. The presented navigation system is reproducible because of commercially available hardware and open-source software components, facilitating its potential role in clinical practice.
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Affiliation(s)
- Tamas Ungi
- 1 Laboratory for Percutaneous Surgery, School of Computing, Queen's University , Kingston, Ontario, Canada
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Rasoulian A, Rohling R, Abolmaesumi P. Lumbar spine segmentation using a statistical multi-vertebrae anatomical shape+pose model. IEEE TRANSACTIONS ON MEDICAL IMAGING 2013; 32:1890-1900. [PMID: 23771318 DOI: 10.1109/tmi.2013.2268424] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Segmentation of the spinal column from computed tomography (CT) images is a preprocessing step for a range of image-guided interventions. One intervention that would benefit from accurate segmentation is spinal needle injection. Previous spinal segmentation techniques have primarily focused on identification and separate segmentation of each vertebra. Recently, statistical multi-object shape models have been introduced to extract common statistical characteristics between several anatomies. These models can be used for segmentation purposes because they are robust, accurate, and computationally tractable. In this paper, we develop a statistical multi-vertebrae shape+pose model and propose a novel registration-based technique to segment the CT images of spine. The multi-vertebrae statistical model captures the variations in shape and pose simultaneously, which reduces the number of registration parameters. We validate our technique in terms of accuracy and robustness of multi-vertebrae segmentation of CT images acquired from lumbar vertebrae of 32 subjects. The mean error of the proposed technique is below 2 mm, which is sufficient for many spinal needle injection procedures, such as facet joint injections.
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Grasso RF, Cazzato RL, Luppi G, D’Agostino F, Schena E, Del Vescovo R, Giurazza F, Faiella E, Beomonte Zobel B. Percutaneous lung biopsies: performance of an optical CT-based navigation system with a low-dose protocol. Eur Radiol 2013; 23:3071-6. [PMID: 23783784 DOI: 10.1007/s00330-013-2932-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 05/09/2013] [Accepted: 05/25/2013] [Indexed: 10/26/2022]
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Moser C, Becker J, Deli M, Busch M, Boehme M, Groenemeyer DH. A novel Laser Navigation System reduces radiation exposure and improves accuracy and workflow of CT-guided spinal interventions: A prospective, randomized, controlled, clinical trial in comparison to conventional freehand puncture. Eur J Radiol 2013; 82:627-32. [DOI: 10.1016/j.ejrad.2012.10.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/12/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
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Grasso RF, Faiella E, Luppi G, Schena E, Giurazza F, Del Vescovo R, D’Agostino F, Cazzato RL, Beomonte Zobel B. Percutaneous lung biopsy: comparison between an augmented reality CT navigation system and standard CT-guided technique. Int J Comput Assist Radiol Surg 2013; 8:837-48. [DOI: 10.1007/s11548-013-0816-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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Ungi T, Abolmaesumi P, Jalal R, Welch M, Ayukawa I, Nagpal S, Lasso A, Jaeger M, Borschneck DP, Fichtinger G, Mousavi P. Spinal Needle Navigation by Tracked Ultrasound Snapshots. IEEE Trans Biomed Eng 2012; 59:2766-72. [DOI: 10.1109/tbme.2012.2209881] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Electromagnetic navigation system for CT-guided biopsy of small lesions. AJR Am J Roentgenol 2011; 196:1194-200. [PMID: 21512092 DOI: 10.2214/ajr.10.5151] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate an electromagnetic navigation system for CT-guided biopsy of small lesions. MATERIALS AND METHODS Standardized CT anthropomorphic phantoms were biopsied by two attending radiologists. CT scans of the phantom and surface electromagnetic fiducial markers were imported into the memory of the 3D electromagnetic navigation system. Each radiologist assessed the accuracy of biopsy using electromagnetic navigation alone by targeting sets of nine lesions (size range, 8-14 mm; skin to target distance, 5.7-12.8 cm) under eight different conditions of detector field strength and orientation (n = 117). As a control, each radiologist also biopsied two sets of five targets using conventional CT-guided technique. Biopsy accuracy, number of needle passes, procedure time, and radiation dose were compared. RESULTS Under optimal conditions (phantom perpendicular to the electromagnetic receiver at highest possible field strength), phantom accuracy to the center of the lesion was 2.6 ± 1.1 mm. This translated into hitting 84.4% (38/45) of targets in a single pass (1.1 ± 0.4 CT confirmations), which was significantly fewer than the 3.6 ± 1.3 CT checks required for conventional technique (p < 0.001). The mean targeting time was 38.8 ± 18.2 seconds per lesion. Including procedural planning (∼5.5 minutes) and final CT confirmation of placement (∼3.5 minutes), the full electromagnetic tracking procedure required significantly less time (551.6 ± 87.4 seconds [∼9 minutes]) than conventional CT (833.3 ± 283.8 seconds [∼14 minutes]) for successful targeting (p < 0.001). Less favorable conditions, including nonperpendicular relation between the axis of the machine and weaker field strength, resulted in statistically significant lower accuracy (3.7 ± 1 mm, p < 0.001). Nevertheless, first-pass biopsy accuracy was 58.3% (21/36) and second-pass (35/36) accuracy was 97.2%. Lesions farther from the skin than 20-25 cm were out of range for successful electromagnetic tracking. CONCLUSION Virtual electromagnetic tracking appears to have high accuracy in needle placement, potentially reducing time and radiation exposure compared with those of conventional CT techniques in the biopsy of small lesions.
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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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Musculoskeletal imaging: current and future trends. Eur Radiol 2010; 21:478-84. [PMID: 21181408 DOI: 10.1007/s00330-010-2024-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 10/14/2010] [Indexed: 12/31/2022]
Abstract
Advances in imaging technology and the increasing role of interventional procedures in musculoskeletal imaging have continued to stimulate research over recent years. This review summarises some recent articles on musculoskeletal radiology topics and looks forward to potential future developments in this exciting sub-speciality.
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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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Regalado S, Erickson SJ, Zhu B, Ge J, Godavarty A. Automated coregistered imaging using a hand-held probe-based optical imager. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2010; 81:023702. [PMID: 20192497 DOI: 10.1063/1.3271019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Near-infrared optical imaging holds a promise as a noninvasive technology toward cancer diagnostics and other tissue imaging applications. In recent years, hand-held based imagers are of great interest toward the clinical translation of the technology. However hand-held imagers developed to date are typically designed to obtain surface images and not tomography information due to lack of coregistration facilities. Herein, a recently developed hand-held probe-based optical imager in our Optical Imaging Laboratory has been implemented with novel coregistration facilities toward real-time and tomographic imaging of tissue phantoms. Continuous-wave fluorescence-enhanced optical imaging studies were performed using an intensified charge coupled device camera based imaging system in order to demonstrate the feasibility of automated coregistered imaging of flat phantom surfaces, using a flexible probe that can also contour to curvatures. Three-dimensional fluorescence tomographic reconstructions were also demonstrated using coregistered frequency-domain measurements obtained using the hand-held based optical imager. It was also observed from preliminary studies on cubical phantoms that multiple coregistered scans differentiated deeper targets (approximately 3 cm) from artifacts that were not feasible from a single coregistered scan, demonstrating the possibility of improved target depth detectability in the future.
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Affiliation(s)
- Steven Regalado
- Department of Biomedical Engineering, Optical Imaging Laboratory, Florida International University, Miami, Florida 33174, USA
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Kamath RS, Ouellette HA. The year in review: recent advances in musculoskeletal radiology and biology. Skeletal Radiol 2010; 39:93-6. [PMID: 19902209 DOI: 10.1007/s00256-009-0821-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ravi S Kamath
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Bova F. Computer Based Guidance in the Modern Operating Room: A Historical Perspective. IEEE Rev Biomed Eng 2010; 3:209-22. [DOI: 10.1109/rbme.2010.2089370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Image guidance for spinal facet injections using tracked ultrasound. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2009; 12:516-23. [PMID: 20426027 DOI: 10.1007/978-3-642-04268-3_64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Anesthetic nerve blocks are a common therapy performed in hospitals around the world to alleviate acute and chronic pain. Tracking systems have shown considerable promise in other forms of therapy, but little has been done to apply this technology in the field of anesthesia. We are developing a guidance system for combining tracked needles with non-invasive ultrasound (US) and patient-specific geometric models. In experiments with phantoms two augmented reality (AR) guidance systems were compared to the exclusive use of US for lumbar facet injection therapy. Anesthetists and anesthesia residents were able to place needles within 0.57 mm of the intended targets using our AR systems compared to 5.77 mm using US alone. A preliminary cadaver study demonstrated the system was able to accurately place radio opaque dye on targets. The combination of real time US with tracked tools and AR guidance has the potential to replace CT and fluoroscopic guidance, thus reducing radiation dose to patients and clinicians, as well as reducing health care costs.
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