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Liu Q, Guo X, Wang Z, Xu H, Huang W, Liu J, Wang Z, Yan F, Wu Z, Ding X. Computed Tomography-guided Percutaneous Lung Biopsy With Electromagnetic Navigation Compared With Conventional Approaches: An Open-label, Randomized Controlled Trial. J Thorac Imaging 2024; 39:247-254. [PMID: 37982518 DOI: 10.1097/rti.0000000000000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE The purpose of this study was to assess the efficiency and safety of computed tomography (CT)-guided percutaneous biopsy of lung lesions with electromagnetic (EM) navigation and compare them with those of conventional approaches. MATERIALS AND METHODS Seventy-nine patients with lung or liver lesions who needed biopsies were enrolled in this trial. All patients were randomly assigned to the E group underwent CT-guided percutaneous biopsies with the EM navigation system or to the C group treated with conventional approaches. RESULTS In total, 27 patients with lung lesions were assigned to the E group, and 20 patients were assigned to the C group. The diagnostic success rate was 92.6% and 95% in both groups, respectively ( P >0.9999). The median number of needle repositions in the E group was less than that in the C group (2.0 vs. 2.5, P =0.03). The positioning success rate with 1 or 2 needle repositions for the E group was significantly higher than the C group (81.5% vs. 50%, P =0.03). The median accuracy of the puncture location in the E group was better than that in the C group (2.0 vs. 6.6 mm, P <0.0001). The total procedure time lengthened in the E group compared with the C group (30.5±1.6 vs. 18.3±1.7 min, P <0.0001), but the number of CT acquisitions was not significantly different ( P =0.08). There was no significant difference in complication incidence between the 2 groups ( P =0.44). CONCLUSION The EM navigation system is an effective and safe auxiliary tool for CT-guided percutaneous lung biopsy, but lengthen the procedure time. TRIAL REGISTRATION ChiCTR2100043361, registered February 9, 2021-retrospectively registered ( http://www.medresman.org.cn/uc/project/projectedit.aspx?proj=7591 ).
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Affiliation(s)
- Qin Liu
- Departments of Interventional Radiology
| | | | | | - Hao Xu
- Departments of Interventional Radiology
- Department of Vascular Surgery and Interventional Radiology, Suzhou DuShu Lake Hospital, Soochow University, Suzhou, China
| | - Wei Huang
- Departments of Interventional Radiology
| | | | | | - Fuhua Yan
- Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Sorensen AM, Zlevor AM, Kisting MA, Couillard AB, Ziemlewicz TJ, Toia GV, Hinshaw JL, Woods M, Stratchko LM, Pickhardt PJ, Foltz ML, Peppler WW, Lee FT, Knavel Koepsel EM. CT Navigation for Percutaneous Needle Placement: How I Do It. Tech Vasc Interv Radiol 2023; 26:100911. [PMID: 38071032 DOI: 10.1016/j.tvir.2023.100911] [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] [Indexed: 12/18/2023]
Abstract
CT navigation (CTN) has recently been developed to combine many of the advantages of conventional CT and CT-fluoroscopic guidance for needle placement. CTN systems display real-time needle position superimposed on a CT dataset. This is accomplished by placing electromagnetic (EM) or optical transmitters/sensors on the patient and needle, combined with fiducials placed within the scan field to superimpose a known needle location onto a CT dataset. Advantages of CTN include real-time needle tracking using a contemporaneous CT dataset with the patient in the treatment position, reduced radiation to the physician, facilitation of procedures outside the gantry plane, fewer helical scans during needle placement, and needle guidance based on diagnostic-quality CT datasets. Limitations include the display of a virtual (vs actual) needle position, which can be inaccurate if the needle bends, the fiducial moves, or patient movement occurs between scans, and limitations in anatomical regions with a high degree of motion such as the lung bases. This review summarizes recently introduced CTN technologies in comparison to historical methods of CT needle guidance. A "How I do it" section follows, which describes how CT navigation has been integrated into the study center for both routine and challenging procedures, and includes step-by-step explanations, technical tips, and pitfalls.
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Affiliation(s)
- Anna M Sorensen
- Departments of Radiology, University of Wisconsin, Madison, WI
| | - Annie M Zlevor
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | | | - Giuseppe V Toia
- Departments of Radiology, University of Wisconsin, Madison, WI; Medical Physics, University of Wisconsin, Madison, WI
| | - J Louis Hinshaw
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI
| | - Michael Woods
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | | | - Marcia L Foltz
- Departments of Radiology, University of Wisconsin, Madison, WI
| | | | - Fred T Lee
- Departments of Radiology, University of Wisconsin, Madison, WI; Departments of Urology, University of Wisconsin, Madison, WI; Biomedical Engineering, University of Wisconsin, Madison, WI
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Zlevor AM, Kisting MA, Couillard AB, Rossebo AE, Szczykutowicz TP, Mao L, White JK, Hartung MP, Gettle LM, Hinshaw JL, Pickhardt PJ, Ziemlewicz TJ, Foltz ML, Lee FT. Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy. J Vasc Interv Radiol 2023; 34:910-918. [PMID: 36736821 DOI: 10.1016/j.jvir.2023.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis. MATERIALS AND METHODS A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm). RESULTS The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°. CONCLUSIONS Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - James K White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Marcia L Foltz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin.
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Fong KY, Tan ASM, Bin Sulaiman MS, Leong SH, Ng KW, Too CW. Phantom and Animal Study of a Robot-Assisted, CT-Guided Targeting System using Image-Only Navigation for Stereotactic Needle Insertion without Positional Sensors. J Vasc Interv Radiol 2022; 33:1416-1423.e4. [PMID: 35970505 DOI: 10.1016/j.jvir.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the feasibility and accuracy of a robotic system to integrate and map computed tomography (CT) and robotic coordinates, followed by automatic trajectory execution by a robotic arm. The system was hypothesized to achieve a targeting error of <5 mm without significant influence from variations in angulation or depth. MATERIALS AND METHODS An experimental study was conducted using a robotic system (Automated Needle Targeting device for CT [ANT-C]) for needle insertions into a phantom model on both moving patient table and moving gantry CT scanners. Eight spherical markers were registered as targets for 90 insertions at different trajectories. After a single ANT-C registration, the closed-loop software targeted multiple markers via the insertion of robotically aligned 18-gauge needles. Accuracy (distance from the needle tip to the target) was assessed by postinsertion CT scans. Similar procedures were repeated to guide 10 needle insertions into a porcine lung. A regression analysis was performed to test the effect of needle angulation and insertion depth on the accuracy of insertion. RESULTS In the phantom model, all needle insertions (median trajectory depth, 64.8 mm; range, 46.1-153 mm) were successfully performed in single attempts. The overall accuracy was 1.36 mm ± 0.53, which did not differ between the 2 types of CT scanners (1.39 mm ± 0.54 [moving patient table CT] vs 1.33 mm ± 0.52 [moving gantry CT]; P = .54) and was not significantly affected by the needle angulation and insertion depth. The accuracy for the porcine model was 9.09 mm ± 4.21. CONCLUSIONS Robot-assisted needle insertion using the ANT-C robotic device was feasible and accurate for targeting multiple markers in a phantom model.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexander Sheng Ming Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | | | | | - Ka Wei Ng
- NDR Medical Technology Pvt Ltd, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
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Xu H, Zhao Y, Yuan J, Li W, Ni J. A Novel Laser Angle Selection System for Computed Tomography-Guided Percutaneous Transthoracic Needle Biopsies. Can Assoc Radiol J 2022; 74:455-461. [PMID: 36301082 DOI: 10.1177/08465371221133482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To evaluate a novel laser angle selection system (LASS) for improving the efficiency of a computed tomography (CT)–guided percutaneous transthoracic needle biopsy (PTNB). Methods: Thirty-eight patients referred for CT-guided PTNB were randomly separated into a LASS-assisted puncture group (18 patients) or conventional freehand control group (20 patients). The puncture time, number of control CT scans, and patients’ radiation dose were compared for each group. Results: The lesion size, target-to-pleural distance, planned puncture depth, and angle of the two groups were not significantly different. LASS-assisted PTNB significantly reduced the number of control scans (1.7 ± 0.8 vs 3.5 ± 1.5, P < .001) and the mean operation time (12.0 ± 4.3 min vs 28.8 ± 13.3 min, P < .001) compared with the conventional method. The corresponding room time (27.1 ± 6.6 min vs 44.1 ± 14.4 min, P < .001) and total radiation dose (7.9 ± 1.0 mSv vs 10.1 ± 1.7 mSv, P < .001) of each procedure also decreased significantly. Fifty-six percent (10/18) of the operations hit the target on the first needle pass when using LASS compared with 10% (2/20) using the conventional method. Conclusions: Compared with a conventional method, this novel laser angle simulator improves puncture efficiency with fewer needle readjustments and reduces patient radiation dose.
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Affiliation(s)
- Huiting Xu
- Department of Radiology, Wuxi No. 2 Peolpe's Hospital, Affiliated Wuxi Clinical College of Nangtong University, Wuxi, Jiangsu 214042, China
| | - Yanjun Zhao
- Department of Radiology, Wuxi No. 2 Peolpe's Hospital, Affiliated Wuxi Clinical College of Nangtong University, Wuxi, Jiangsu 214042, China
| | - Jiaqi Yuan
- Department of Radiology, Wuxi No. 2 Peolpe's Hospital, Affiliated Wuxi Clinical College of Nangtong University, Wuxi, Jiangsu 214042, China
| | - Wei Li
- Department of Radiology, Wuxi No. 2 Peolpe's Hospital, Affiliated Wuxi Clinical College of Nangtong University, Wuxi, Jiangsu 214042, China
| | - Jianming Ni
- Department of Radiology, Wuxi No. 2 Peolpe's Hospital, Affiliated Wuxi Clinical College of Nangtong University, Wuxi, Jiangsu 214042, China
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Xu Y, Fu J, Cao W, Zhu L, Jin Y, Yin Q, Ye J, Zhou H. Efficacy and safety of a new disposable percutaneous positioning device invented to facilitate the precision of percutaneous core needle lung biopsies: a prospective, open and randomized controlled study. J Thorac Dis 2021; 13:4965-4976. [PMID: 34527335 PMCID: PMC8411179 DOI: 10.21037/jtd-20-3282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 07/23/2021] [Indexed: 11/06/2022]
Abstract
Background A new disposable percutaneous positioning device was developed which permits adjustment of the fixing puncture angle while performing a percutaneous core needle lung biopsy (CNLB). The aim of the study was to explore the positioning accuracy and clinical safety of the new device during CT-guided percutaneous CNLB. Methods A prospective, open and randomized controlled study with two parallel groups was conducted on 150 patients with pulmonary nodules between July 1, 2018 and June 30, 2019 including 101 males and 49 females who were divided (allocation ratio: 1:1) into a standard CNLB group without the percutaneous positioning device (control, n=75) and a new percutaneous positioning device group combined with CNLB (experimental, n=75). The efficacy was determined by the success rate of reaching the target location on the first percutaneous attempt, the number of CT scans performed and the time required for successful puncture positioning. Safety evaluations included complications related to percutaneous surgery and the new positioning device. Results The success rate of reaching the target location on the first percutaneous attempt in the experimental group was significantly higher than in the control group [96.0% (72/75) vs. 42.7% (32/75), P<0.001]. Patients in the experimental group received 3.05±0.28 times CT scans on average for successful percutaneous positioning, which was significantly lower than for the control group (3.95±1.03) (P<0.001). The time required to complete the percutaneous positioning was significantly lower in the experimental group compared to the control group (8.73±3.11 vs. 12.79±4.55 min, P<0.001). There was no significant difference in percutaneous-related complications between the two groups [48.0% (36/75) vs. 61.3% (46/75), P=0.101], except that the bleeding rate in the experimental group was lower than in the control group [26.7% (20/75) vs. 46.7% (35/75), P=0.032]. Conclusions The use of the optimized percutaneous technology with the new positioning device significantly improved the accuracy and precision of percutaneous lung biopsies. Trial Registration ChiCTR-INR-17010322.
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Affiliation(s)
- Yunhua Xu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Fu
- Department of Radiology, Shanghai Jing'an Mental Health Center, Shanghai, China
| | - Wenwei Cao
- Department of Science & Education, Shanghai Jing'an Mental Health Center, Shanghai, China
| | - Li Zhu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuehui Jin
- Shanghai Chest Medical Technological Co., Shanghai, China
| | - Qing Yin
- Shanghai Chest Medical Technological Co., Shanghai, China
| | - Jianding Ye
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Haiyan Zhou
- Shanghai Chest Medical Technological Co., Shanghai, China
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Lanouzière M, Varbédian O, Chevallier O, Griviau L, Guillen K, Popoff R, Aho-Glélé SL, Loffroy R. Computed Tomography-Navigation™ Electromagnetic System Compared to Conventional Computed Tomography Guidance for Percutaneous Lung Biopsy: A Single-Center Experience. Diagnostics (Basel) 2021; 11:diagnostics11091532. [PMID: 34573873 PMCID: PMC8470612 DOI: 10.3390/diagnostics11091532] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of our study was to assess the efficacy of a computed tomography (CT)-Navigation™ electromagnetic system compared to conventional CT methods for percutaneous lung biopsies (PLB). In this single-center retrospective study, data of a CT-Navigation™ system guided PLB (NAV-group) and conventional CT PLB (CT-group) performed between January 2017 and February 2020 were reviewed. The primary endpoint was the diagnostic success. Secondary endpoints were technical success, total procedure duration, number of CT acquisitions and the dose length product (DLP) during step ∆1 (from planning to initial needle placement), step ∆2 (progression to target), and the entire intervention (from planning to final control) and complications. Additional parameters were recorded, such as the lesion’s size and trajectory angles. Sixty patients were included in each group. The lesions median size and median values of the two trajectory angles were significantly lower (20 vs. 29.5 mm, p = 0.006) and higher in the NAV-group (15.5° and 10° vs. 6° and 1°; p < 0.01), respectively. Technical and diagnostic success rates were similar in both groups, respectively 95% and 93.3% in the NAV-group, and 93.3% and 91.6% in the CT-group. There was no significant difference in total procedure duration (p = 0.487) and total number of CT acquisitions (p = 0.066), but the DLP was significantly lower in the NAV-group (p < 0.01). There was no significant difference in complication rate. For PLB, CT-Navigation™ system is efficient and safe as compared to the conventional CT method.
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Affiliation(s)
- Morgane Lanouzière
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (M.L.); (O.C.); (K.G.)
| | - Olivier Varbédian
- Georges-François Leclerc Cancer Center, Department of Radiology, 1 Rue du Professeur Marion, 21000 Dijon, France; (O.V.); (L.G.)
| | - Olivier Chevallier
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (M.L.); (O.C.); (K.G.)
| | - Loïc Griviau
- Georges-François Leclerc Cancer Center, Department of Radiology, 1 Rue du Professeur Marion, 21000 Dijon, France; (O.V.); (L.G.)
| | - Kévin Guillen
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (M.L.); (O.C.); (K.G.)
| | - Romain Popoff
- Georges-François Leclerc Cancer Center, Department of Medical Physics, 1 Rue du Professeur Marion, 21000 Dijon, France;
| | - Serge-Ludwig Aho-Glélé
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France;
| | - Romaric Loffroy
- Image-Guided Therapy Center, Department of Vascular and Interventional Radiology, François-Mitterrand University Hospital, 14 Rue Paul Gaffarel, BP 77908, 21079 Dijon, France; (M.L.); (O.C.); (K.G.)
- Correspondence: ; Tel.: +33-380-293-677
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Ringe KI, Pöhler GH, Rabeh H, Wacker F. Electromagnetic Navigation System-Guided Microwave Ablation of Hepatic Tumors: A Matched Cohort Study. Cardiovasc Intervent Radiol 2021; 44:500-506. [PMID: 33409545 DOI: 10.1007/s00270-020-02761-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/24/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the accuracy and applicability of an electromagnetic navigation system (EMNS) for CT-guided microwave ablation (MWA) of hepatic tumors in comparison with conventional CT-guidance. MATERIALS AND METHODS 34 patients (m = 20/f = 14, mean age 34 y) with 34 liver tumors (primary = 22, metastases = 14, mean size 20 mm) referred for CT-guided MWA were included in this IRB-approved study. Interventions were performed prospectively using an EMNS in 17 patients (navigation group), and results were compared to a matched historic cohort of 17 patients using conventional CT-guidance (control group, t-test, p < 0.05 deemed significant). Primary outcome measurement: accuracy of antenna placement (deviation). Secondary outcome measurements: setup time, number of control scans, duration and radiation exposure for antenna placement. RESULTS Ablations were performed using a single or a double-angulated approach. Application of the EMNS was feasible in 14 cases (82%). Mean total deviation of the antenna feed point in the navigation and control group was 2.4 mm (range 0.2-4.8 mm) and 3.9 mm (range 0.4-7.8 mm), p < 0.05. Mean setup time for the EMNS was 6.75 ± 3.9 min (range 3-12 min). Mean number of control scans in the navigation and control group was 3 ± 0.9 (range 1-4) and 6 ± 1.3 (range 4-8), p < 0.0001; mean time for antenna placement was 9 ± 7.3 min (range 1.4-25.9 min) and 11.45 ± 6.1 min (range 3.9-27.4 min), p = 0.3164. Radiation exposure was significantly less in the navigation group. CONCLUSION Our experience in a limited number of patients suggests that EMNS enables intuitive CT-guided MWA of liver tumors with higher accuracy when compared to ablations performed without navigation and with fewer control scans needed.
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Affiliation(s)
- K I Ringe
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - G H Pöhler
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - H Rabeh
- IMACTIS, 20 Rue du Tour de l'Eau, Grenoble, 38400, Saint-Martin-d'Hères, France
| | - F Wacker
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals. Eur Radiol 2019; 30:1342-1349. [PMID: 31773299 PMCID: PMC7033049 DOI: 10.1007/s00330-019-06477-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/30/2019] [Accepted: 09/27/2019] [Indexed: 01/21/2023]
Abstract
Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student’s t test. In the animal experiment, 6 robotic out-of-plane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7° in the XY plane and 0.6°, 6.3°, and 0.6° in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p < 0.001) more accurate than smartphone-guided insertions. In the animal experiment, the overall mean distance accuracy of robotic insertions with and without adjustment of needle orientation was 2.5 mm and 5.0 mm, respectively. Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion. Key Points • Out-of-plane needle insertions performed using our robot were more accurate than smartphone-guided manual insertions in the phantom experiment and were also accurate in the in vivo procedure. • In the phantom experiment, the mean angle errors of the robotic and smartphone-guided manual out-of-plane needle insertions were 0.4° and 3.7° in the XY plane (p < 0.001) and 0.6° and 0.6° in the YZ plane (p = 0.65), respectively. • In the animal experiment, the overall mean distance accuracies of the robotic out-of-plane needle insertions with and without adjustments of needle orientation during insertion were 2.5 mm and 5.0 mm, respectively. Electronic supplementary material The online version of this article (10.1007/s00330-019-06477-1) contains supplementary material, which is available to authorized users.
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Franz AM, Seitel A, Cheray D, Maier-Hein L. Polhemus EM tracked Micro Sensor for CT-guided interventions. Med Phys 2018; 46:15-24. [PMID: 30414277 DOI: 10.1002/mp.13280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/10/2018] [Accepted: 10/11/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Electromagnetic (EM) tracking is a key technology in image-guided therapy. A new EM Micro Sensor was presented by Polhemus Inc.; it is the first to enable localization of medical instruments through their trackers. Different field generators (FGs) are available by Polhemus, one being almost as small as a sugar cube. As accuracy and robustness of tracking are known challenges to using EM trackers in clinical environments, the goal of this study was a standardized assessment of the Micro Sensor in both a laboratory (lab) and a computed tomography (CT) environment. METHODS The Micro Sensor was assessed by means of Hummel et al.'s standardized protocol; it was assessed in conjunction with a Polhemus Liberty tracker and three FGs - with edge lengths of 1 (TX1), 2 (TX2), and 4 (TX4) inches. Precision as well as positional and rotational accuracy were determined in a lab and a CT suite. Distortions by four different metallic cylinders and tracking of two typical medical instruments - a hypodermic needle and a flexible endoscope - were also tested. RESULTS A jitter of 0.02 mm or less was found for all FGs in the different environments, except for the TX2 FG for which no valid data could be obtained in the CT. Errors of 5 cm distance measurements were 0.6 mm or less for all FGs in the lab. While the distance errors of the TX1 FG were only slightly increased up to 1.6 mm in the CT, those of the TX4 FG were found to be up to around 10% of the measured distance (5.4 mm on average). The mean orientation error was found to be 0.9° /0.5° /0.1° for the TX4/TX2/TX1 FG in the lab. In the CT environment, rotation errors were in the same range: less than 1.2° /0.1° for the TX4/TX1 FG. Deviation under the presence of metallic cylinders stayed below 1 mm in most cases. Precision and orientational accuracy do not seem to be affected by instrument tracking and stayed in the same range as for the other measurements whereas distance errors were slightly increased up to 1.7 mm. CONCLUSION This study shows that accurate tracking of medical instruments is possible with the new Micro Sensor; it demonstrated a jitter of 0.01 mm or less, position errors below 2 mm, and rotation errors of less than 0.3° . As with other EM trackers, errors increase when large tracking volumes with ranges of up to 50 cm are required in clinical environments. For smaller tracking volumes with ranges of up to 15 cm, a high accuracy and robustness was found. This is interesting especially for the TX1 FG which can easily be placed in close vicinity to the region of interest.
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Affiliation(s)
- Alfred M Franz
- Department of Computer Science, Ulm University of Applied Sciences, Ulm, Germany.,Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Seitel
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dominique Cheray
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lena Maier-Hein
- Division of Computer Assisted Medical Interventions, German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Schwalbe M, Williamson T, Paolucci I, Fuss T, Baumgartner I, Candinas D, Weber S, Tinguely P. A concept for electromagnetic navigated targeting of liver tumors using an angiographic approach. MINIM INVASIV THER 2017; 27:51-59. [PMID: 29179633 DOI: 10.1080/13645706.2017.1407798] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The benefits of using navigation technology for percutaneous local ablation of selected hepatocellular carcinoma (HCC) have been shown. Due to additional efforts in the procedural workflow, barriers to introducing navigation systems on a broad clinical level remain high. In this work, initial steps toward a novel concept for simple and precise targeting of HCC are evaluated. MATERIAL AND METHODS The proposed technique is based on an angiographic approach using an intrahepatic electromagnetic (EM) reference, for consecutive percutaneous navigated positioning of ablation probes. We evaluated the environmental influence of the angiography suite on EM tracking accuracy, the measurement of a 3 D offset from two 2 D fluoroscopy images, and the accuracy and efficiency of the proposed approach in a porcine liver model. RESULTS The C-arm had a major influence on EM tracking accuracy, with an error up to 3.8 mm. The methodology applied for measurement of a 3 D offset from 2 D fluoroscopy images was confirmed to be feasible with a mean error of 0.76 mm. In the porcine liver model experiment, the overall target positioning error (TPE) was 2.0 mm and time for navigated targeting was 17.9 seconds, when using a tracked ablation probe. CONCLUSIONS The initial methodology of the proposed technique was confirmed to be feasible, introducing a novel concept for simple and precise navigated targeting of HCC.
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Affiliation(s)
- Marius Schwalbe
- a ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland
| | - Tom Williamson
- a ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland
| | - Iwan Paolucci
- a ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland
| | - Torsten Fuss
- b Division of Clinical and Interventional Angiology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Iris Baumgartner
- b Division of Clinical and Interventional Angiology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Daniel Candinas
- c Department of Visceral Surgery and Medicine , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Stefan Weber
- a ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland
| | - Pascale Tinguely
- c Department of Visceral Surgery and Medicine , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
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12
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Marcelin C, Ambrosetti D, Bernhard J, Roy C, Grenier N, Cornelis F. Percutaneous image-guided biopsies of small renal tumors: Current practice and perspectives. Diagn Interv Imaging 2017; 98:589-599. [DOI: 10.1016/j.diii.2017.07.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 12/30/2022]
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13
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Beyer LP, Wiggermann P. Planning and guidance: New tools to enhance the human skills in interventional oncology. Diagn Interv Imaging 2017; 98:583-588. [PMID: 28818346 DOI: 10.1016/j.diii.2017.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
Abstract
Navigation systems have the potential to achieve a high accuracy for percutaneous ablation of tumors even for those in difficult locations. In the last years, successful research has been conducted to make navigation devices applicable to percutaneous tumor ablation with special planning software that now allows high accuracy even for deep-located small lesions close to critical structures. Because of the high number of available navigation systems, this review focuses on those with preexisting clinical studies.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - P Wiggermann
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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14
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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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15
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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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16
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Ultrasound-navigated radiofrequency ablation of thyroid nodules with integrated electromagnetic tracking: comparison with conventional ultrasound guidance in gelatin models. Int J Comput Assist Radiol Surg 2017; 12:1635-1642. [PMID: 28271358 DOI: 10.1007/s11548-017-1544-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/20/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE A thyroid-like gelatin model was used to determine potential superiority of a new navigation system for ultrasound (US)-guided electrode insertion called EchoTrack, featuring a US probe with an integrated electromagnetic field generator, in comparison with conventional US when performing radiofrequency ablation. METHODS In order to compare 20 navigated ablations with 20 ablations under conventional US guidance, a thyroid-like gelatin model was used. In each group, 10 in-plane and 10 out-of-plane punctures were performed. Metal seeds measuring 8.5 [Formula: see text] 1.8 mm served as ablation targets. The number of redirections until final electrode placement, targeting accuracy and electrode placement time were measured. RESULTS The number of redirections could be significantly ([Formula: see text]) reduced from 2.7 ± 1.3 in the conventional group to 0.2 ± 0.5 in the EchoTrack group. Accuracy increased from 3.9 ± 4.7 to 2.0 ± 1.9 mm. The total placement time increased from 39 ± 20.5 to 79.2 ± 26 s. CONCLUSIONS EchoTrack is able to reduce the redirections needed to place the electrode in comparison with conventional US and provides high placement accuracy. Our new navigation system has high potential to reduce the risk of harming critical structures and to improve guidance during ablation of difficult nodules, as treatment planning as well as the safety of out-of-plane punctures are improved.
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17
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Mavrovi E, Pialat JB, Beji H, Kalenderian AC, Vaz G, Richioud B. Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur. Diagn Interv Imaging 2017; 98:483-489. [PMID: 28126418 DOI: 10.1016/j.diii.2016.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/28/2016] [Accepted: 12/31/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur. MATERIALS AND METHODS The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years±13 (SD) (range: 35-82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score≥8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay. RESULTS No patients treated with RPOC had a fracture during a mean follow-up time of 382 days±274 (SD) (range: 11-815 days). RPOC was performed under general (n=10) or locoregional (n=2) anesthesia. The average duration of the procedure was 95min±17 (SD) (range: 73-121min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4days ±3 (SD) (range: 2-10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n=7), VAS score decreased from 6.8±1.2 (SD) (range: 5-9) before treatment, to 2.3±1.1 (SD) (range: 1-4) one month later. CONCLUSION Preventive RPOC for pathological fracture of the proximal femur is a reliable alternative for cancer patients who are not candidates for surgical stabilization. Studies involving more patients are needed to confirm our preliminary experience.
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Affiliation(s)
- E Mavrovi
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France.
| | - J-B Pialat
- Department of Radiology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
| | - H Beji
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - A-C Kalenderian
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - G Vaz
- Department of Oncologic Surgery, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
| | - B Richioud
- Department of Radiology, Centre Léon-Bérard, 28, rue Laënnec, 69008 Lyon, France
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18
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Stereotactic CT-Guided Percutaneous Microwave Ablation of Liver Tumors With the Use of High-Frequency Jet Ventilation: An Accuracy and Procedural Safety Study. AJR Am J Roentgenol 2016; 208:193-200. [PMID: 27762601 DOI: 10.2214/ajr.15.15803] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of the present study is to evaluate the accuracy and safety of antenna placement performed with the use of a CT-guided stereotactic navigation system for percutaneous ablation of liver tumors and to assess the safety of high-frequency jet ventilation for target motion control. MATERIALS AND METHODS Twenty consecutive patients with malignant liver lesions for which surgical resection was contraindicated or that were not readily visible on ultrasound or not accessible by ultrasound guidance were included in the study. Patients were treated with percutaneous microwave ablation performed using a CT-guided stereotactic navigation system. High-frequency jet ventilation was used to reduce liver motion during all interventions. The accuracy of antenna placement, the number of needle readjustments required, overall safety, and the radiation doses were assessed. RESULTS Microwave ablation was completed for 20 patients (28 lesions). Performance data could be evaluated for 17 patients with 25 lesions (mean [± SD] lesion diameter, 14.9 ± 5.9 mm; mean lesion location depth, 87.5 ± 27.3 mm). The antennae were placed with a mean lateral error of 4.0 ± 2.5 mm, a depth error of 3.4 ± 3.2 mm, and a total error of 5.8 ± 3.2 mm in relation to the intended target. The median number of antenna readjustments required was zero (range, 0-1 adjustment). No major complications were related to either the procedure or the use of high-frequency jet ventilation. The mean total patient radiation dose was 957.5 ± 556.5 mGy × cm, but medical personnel were not exposed to irradiation. CONCLUSION Percutaneous microwave ablation performed with CT-guided stereotactic navigation provides sufficient accuracy and requires almost no repositioning of the needle. Therefore, it is technically feasible and applicable for safe treatments.
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Soyer P. Facts and evidences. Diagn Interv Imaging 2016; 97:3-4. [DOI: 10.1016/j.diii.2015.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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