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Scharll Y, Letrari S, Laimer G, Schullian P, Bale R. Puncture accuracy of an optical tracked robotic aiming device-a phantom study. Eur Radiol 2022; 32:6769-6776. [PMID: 35678863 PMCID: PMC9474375 DOI: 10.1007/s00330-022-08915-z] [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: 03/13/2022] [Revised: 05/05/2022] [Accepted: 05/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the targeting accuracy of stereotactic punctures based on a hybrid robotic device in combination with optical tracking-a phantom study. METHODS CT data sets of a gelatin-filled plexiglass phantom with 1-, 3-, and 5-mm slice thickness were acquired. An optical navigation device served for planning of a total of 150 needle trajectories. All punctures were carried out semi-automatically with help of the trackable iSYS-1 robotic device. Conically shaped targets inside the phantom were punctured using Kirschner wires. Up to 8 K-wires were positioned sequentially based on the same planning CT and placement accuracy was assessed by taking control CTs and measuring the Euclidean (ED) and normal distances (NDs) between the wire and the entry and target point. RESULTS Using the StealthStation S7, the accomplished mean ND at the target for the 1-mm, 3-mm, and 5-mm slice thickness was 0.89 mm (SD ± 0.42), 0.93 mm (SD ± 0.45), and 0.73 mm (SD ± 0.50), respectively. The corresponding mean ED was 1.61 mm (SD ± 0.36), 2.04 mm (SD ± 0.59), and 1.76 mm (SD ± 0.45). The mean duration of the total procedure was 27.9 min, including image acquisition, trajectory planning, registration, placement of 8 wires, and the control-CT. CONCLUSIONS The optically tracked iSYS-1 robot allows for precise punctures in a phantom. The StealthStation S7 provided acceptable results and may be helpful for interventions in difficult anatomical regions and for those requiring complex multi-angle trajectories. In combination with our optical navigation tool, the trackable robot unit allows to cover a large treatment field and the compact design facilitates placement of needle-like instruments. KEY POINTS • The use of a robotic targeting device in combination with optical tracking (hybrid system) allows for accurate placement of needle-like instruments without repeated control imaging. • The compact robotic positioning unit in combination with a camera for optical tracking facilitates sequential placement of multiple K-wires in a large treatment volume.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Sofia Letrari
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Robotic Assistance System for Cone-Beam Computed Tomography-Guided Percutaneous Needle Placement. Cardiovasc Intervent Radiol 2021; 45:62-68. [PMID: 34414495 PMCID: PMC8716352 DOI: 10.1007/s00270-021-02938-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 11/03/2022]
Abstract
Purpose The study aimed to evaluate a new robotic assistance system (RAS) for needle placement in combination with a multi-axis C-arm angiography system for cone-beam computed tomography (CBCT) in a phantom setting. Materials and Methods The RAS consisted of a tool holder, dedicated planning software, and a mobile platform with a lightweight robotic arm to enable image-guided needle placement in conjunction with CBCT imaging. A CBCT scan of the phantom was performed to calibrate the robotic arm in the scan volume and to plan the different needle trajectories. The trajectory data were sent to the robot, which then positioned the tool holder along the trajectory. A 19G needle was then manually inserted into the phantom. During the control CBCT scan, the exact needle position was evaluated and any possible deviation from the target lesion measured. Results In total, 16 needle insertions targeting eight in- and out-of-plane sites were performed. Mean angular deviation from planned trajectory to actual needle trajectory was 1.12°. Mean deviation from target point and actual needle tip position was 2.74 mm, and mean deviation depth from the target lesion to the actual needle tip position was 2.14 mm. Mean time for needle placement was 361 s. Only differences in time required for needle placement between in- and out-of-plane trajectories (337 s vs. 380 s) were statistically significant (p = 0.0214). Conclusion Using this RAS for image-guided percutaneous needle placement with CBCT was precise and efficient in the phantom setting.
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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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Rathmann N, Kostrzewa M, Kara K, Bartling S, Haubenreisser H, Schoenberg SO, Diehl SJ. Radiation exposure of the interventional radiologist during percutaneous biopsy using a multiaxis interventional C-arm CT system with 3D laser guidance: a phantom study. Br J Radiol 2015; 88:20150151. [PMID: 26370153 DOI: 10.1259/bjr.20150151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Evaluation of absolute radiation exposure values for interventional radiologists (IRs) using a multiaxis interventional flat-panel C-arm cone beam CT (CBCT) system with three-dimensional laser guidance for biopsy in a triple-modality, abdominal phantom. METHODS In the phantom, eight lesions were punctured in two different angles (in- and out-of-plane) using CBCT. One C-arm CT scan was performed to plan the intervention and one for post-procedural evaluation. Thermoluminescent dosemeters (TLDs) were used for dose measurement at the level of the eye lens, umbilicus and ankles on a pole representing the IRs. All measurements were performed without any lead protection. In addition, the dose-area product (DAP) and air kerma at the skin entrance point was documented. RESULTS Mean radiation values of all TLDs were 190 µSv for CBCT (eye lens: 180 µS, umbilicus: 230 µSv, ankle: 150 µSv) without a significant difference (p > 0.005) between in- and out-of-plane biopsies. In terms of radiation exposure of the phantom, the mean DAP was not statistically significantly different (p > 0.05) for in- and out-of-plane biopsies. Fluoroscopy showed a mean DAP of 7 or 6 μGym(2), respectively. C-arm CT showed a mean DAP of 5150 or 5130 μGym(2), respectively. CONCLUSION In our setting, the radiation dose to the IR was distinctly high using CBCT. For dose reduction, it is advisable to pay attention to lead shielding, to increase the distance to the X-ray source and to leave the intervention suite for C-arm CT scans. ADVANCES IN KNOWLEDGE The results indicate that using modern navigation tools and CBCT can be accompanied with a relative high radiation dose for the IRs since detector angulation can make the use of proper lead shielding difficult.
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Affiliation(s)
- Nils Rathmann
- 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Kerim Kara
- 2 Fraunhofer Project Group for Automation in Medicine and Biotechnology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Soenke Bartling
- 3 Department of Medical Physics in Radiology, German Cancer Research Center-DKFZ, Heidelberg, Germany
| | - Holger Haubenreisser
- 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- 1 Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Rathmann N, Haeusler U, Diezler P, Weiss C, Kostrzewa M, Sadick M, Schoenberg SO, Diehl SJ. Evaluation of radiation exposure of medical staff during CT-guided interventions. J Am Coll Radiol 2014; 12:82-9. [PMID: 25086959 DOI: 10.1016/j.jacr.2014.04.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The purpose of this prospective study was to investigate absolute radiation exposure values and factors that influence radiation exposure of interventionists during CT-guided interventions (CTGIs). To our knowledge, no data exist regarding the radiation dose to which the interventionist is exposed during these procedures. METHODS Absolute radiation dose values from a total of 131 CTGIs were analyzed. Radiation dose values were collected by thermoluminescent dosimeters that were positioned above the lead protection being worn, on the forehead, thyroid, chest, gonads, and right and left hand and foot. The radiation doses were analyzed with respect to the experience level of the person performing the procedure, the degree of difficulty measured on a 4-point Likert scale, the lesion size measured on a 3-point Likert scale, and the CT system used. RESULTS Median whole-body dose was 12 μSv. With the exception of the forehead, all whole-body radiation doses were statistically significantly lower in CTGIs performed using the modern dual-source CT system compared with the 16-slice multi-detector CT. For CTGIs rated as more complex, the radiation exposure of the radiologist performing the procedure was statistically significantly higher, with the exception of the left hand. A statistically significantly lower median whole-body dose was measured for inexperienced compared with experienced radiologists. However, a few dose measurements of more than 1 mSv were found at the right hand. CONCLUSIONS Radiation exposure measured during CTGIs is low (<50 μSv). Because the radiation dose was higher in more-complex interventions and for 16-slice multi-detector row CT, inexperienced radiologists should focus on less-complex procedures.
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Affiliation(s)
- Nils Rathmann
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany.
| | - Uwe Haeusler
- Department of Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Berlin, Germany
| | - Patricius Diezler
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Christel Weiss
- Department of Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Kostrzewa
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Maliha Sadick
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Stefan O Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
| | - Steffen J Diehl
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim-Heidelberg University, Mannheim, Germany
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Wallner J, Reinbacher KE, Pau M, Feichtinger M. Intermuscular pterygoid-temporal abscess following inferior alveolar nerve block anesthesia-A computer tomography based navigated surgical intervention: Case report and review. Ann Maxillofac Surg 2014; 4:110-4. [PMID: 24987612 PMCID: PMC4073452 DOI: 10.4103/2231-0746.133090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Inferior alveolar nerve block (IANB) anesthesia is a common local anesthetic procedure. Although IANB anesthesia is known for its safety, complications can still occur. Today immediately or delayed occurring disorders following IANB anesthesia and their treatment are well-recognized. We present a case of a patient who developed a symptomatic abscess in the pterygoid region as a result of several inferior alveolar nerve injections. Clinical symptoms included diffuse pain, reduced mouth opening and jaw's hypomobility and were persistent under a first step conservative treatment. Since image-based navigated interventions have gained in importance and are used for various procedures a navigated surgical intervention was initiated as a second step therapy. Thus precise, atraumatic surgical intervention was performed by an optical tracking system in a difficult anatomical region. A symptomatic abscess was treated by a computed tomography-based navigated surgical intervention at our department. Advantages and disadvantages of this treatment strategy are evaluated.
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Affiliation(s)
- Jürgen Wallner
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
| | | | - Mauro Pau
- Department of Maxillofacial Surgery, Medical University of Graz, Graz, Austria
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Meyer BC, Brost A, Kraitchman DL, Gilson WD, Strobel N, Hornegger J, Lewin JS, Wacker FK. Percutaneous punctures with MR imaging guidance: comparison between MR imaging-enhanced fluoroscopic guidance and real-time MR Imaging guidance. Radiology 2013; 266:912-9. [PMID: 23297324 DOI: 10.1148/radiol.12120117] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate and compare the technical accuracy and feasibility of magnetic resonance (MR) imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance for percutaneous puncture procedures in phantoms and animals. MATERIALS AND METHODS The experimental protocol was approved by the institutional animal care and use committee. Punctures were performed in phantoms, aiming for markers (20 each for MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance), and pigs, aiming for anatomic landmarks (10 for MR imaging-enhanced fluoroscopic guidance and five for MR imaging guidance). To guide the punctures, T1-weighted three-dimensional (3D) MR images of the phantom or pig were acquired. Additional axial and coronal T2-weighted images were used to visualize the anatomy in the animals. For MR imaging-enhanced fluoroscopic guidance, phantoms and pigs were transferred to the fluoroscopic system after initial MR imaging and C-arm computed tomography (CT) was performed. C-arm CT and MR imaging data sets were coregistered. Prototype navigation software was used to plan a puncture path with use of MR images and to superimpose it on fluoroscopic images. For real-time MR imaging, an interventional MR imaging prototype for interactive real-time section position navigation was used. Punctures were performed within the magnet bore. After completion, 3D MR imaging was performed to evaluate the accuracy of insertions. Puncture durations were compared by using the log-rank test. The Mann-Whitney U test was applied to compare the spatial errors. RESULTS In phantoms, the mean total error was 8.6 mm ± 2.8 with MR imaging-enhanced fluoroscopic guidance and 4.0 mm ± 1.2 with real-time MR imaging guidance (P < .001). The mean puncture time was 2 minutes 10 seconds ± 44 seconds with MR imaging-enhanced fluoroscopic guidance and 37 seconds ± 14 with real-time MR imaging guidance (P < .001). In the animal study, a tolerable distance (<1 cm) between target and needle tip was observed for both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance. The mean total error was 7.7 mm ± 2.4 with MR imaging-enhanced fluoroscopic guidance and 7.9 mm ± 4.9 with real-time MR imaging guidance (P = .77). The mean puncture time was 5 minutes 43 seconds ± 2 minutes 7 seconds with MR imaging-enhanced fluoroscopic guidance and 5 minutes 14 seconds ± 2 minutes 25 seconds with real-time MR imaging guidance (P = .68). CONCLUSION Both MR imaging-enhanced fluoroscopic guidance and real-time MR imaging guidance demonstrated reasonable and similar accuracy in guiding needle placement to selected targets in phantoms and animals.
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Meyer BC, Wolf KJ, Wacker FK. [Flat-detector CT-based electromagnetic navigation]. Radiologe 2009; 49:856-61. [PMID: 19730807 DOI: 10.1007/s00117-009-1867-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Flat-detector CT coupled to an angiography device provides an imaging technique for interventions which can be used for electromagnetically navigated percutaneous punctures. This report explains the functionality of an electromagnetic navigation system and describes the course of an electromagnetically navigated puncture and the capabilities of such a system in the clinical routine.
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Affiliation(s)
- B C Meyer
- Klinik und Hochschulambulanz für Radiologie und Nuklearmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin.
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Abstract
Diagnostic and therapeutic CT- guided percutaneous interventions are clinical routine in interventional radiology. Image-guided navigation systems visualize the internal anatomy during interventions in real time not necessitating continuous image acquisition. Although multiple 3D image-guidance devices have been developed and used by several surgical disciplines in the last few years, they have not yet been fully applied by the interventional radiologist. The aim of this article is to review the currently performed methods of CT-guided percutaneous interventions and to discuss the potential benefits of newly developed 3D- navigation systems.
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Affiliation(s)
- Reto Bale
- Interdisciplinary Stereotactic Intervention and Planning Laboratory (SIP-Lab), Department of Radiology I, Medical University Innsbruck, Innsbruck, Austria.
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Electromagnetic tracking for CT-guided spine interventions: phantom, ex-vivo and in-vivo results. Eur Radiol 2008; 19:990-4. [PMID: 19043720 DOI: 10.1007/s00330-008-1227-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 10/20/2008] [Indexed: 01/25/2023]
Abstract
An electromagnetic-based tracking and navigation system was evaluated for interventional radiology. The electromagnetic tracking system (CAPPA IRAD EMT, CASinnovations, Erlangen, Germany) was used for real-time monitoring of punctures of the lumbar facet joints and intervertebral disks in a spine phantom, three pig cadavers and three anaesthesized pigs. Therefore, pre-interventional computed tomography (CT) datasets were transferred to the navigation system and puncture trajectories were planned. A coaxial needle was advanced along the trajectories while the position of the needle tip was monitored in real time. After puncture tracts were marked with pieces of wire another CT examination was performed and distances between wires and anatomical targets were measured. Performing punctures of the facet joints mean needle positioning errors were 0.4 +/- 0.8 mm in the spine phantom, 2.8 +/- 2.1 mm ex vivo and 3.0 +/- 2.0 mm in vivo with mean length of the puncture tract of 54.0 +/- 10.4 mm (phantom), 51.6 +/- 12.6 mm (ex vivo) and 50.9 +/- 17.6 mm (in vivo). At first attempt, intervertebral discs were successfully punctured in 15/15 in the phantom study, in 12/15 in the ex-vivo study and 14/15 in the in-vivo study, respectively. Immobilization of the patient and optimal positioning of the field generator are essential to achieve a high accuracy of needle placement in a clinical CT setting.
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Meyer BC, Peter O, Nagel M, Hoheisel M, Frericks BB, Wolf KJ, Wacker FK. Electromagnetic field-based navigation for percutaneous punctures on C-arm CT: experimental evaluation and clinical application. Eur Radiol 2008; 18:2855-64. [DOI: 10.1007/s00330-008-1063-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/26/2008] [Indexed: 11/29/2022]
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Moche M, Trampel R, Kahn T, Busse H. Navigation concepts for MR image-guided interventions. J Magn Reson Imaging 2008; 27:276-91. [DOI: 10.1002/jmri.21262] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Banovac F, Wilson E, Zhang H, Cleary K. Needle biopsy of anatomically unfavorable liver lesions with an electromagnetic navigation assist device in a computed tomography environment. J Vasc Interv Radiol 2007; 17:1671-5. [PMID: 17057009 DOI: 10.1097/01.rvi.0000236589.74137.f6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Emerging interventional radiology assistance systems that incorporate electromagnetic navigation (EMN) can help the operator guide a needle or other instrument toward a target along preplanned oblique trajectories while avoiding critical structures. A proof-of-concept study was conducted to assess the use of EMN, and EMN was compared with the standard computed tomographic (CT) fluoroscopy guidance technique. MATERIALS AND METHODS A total of 14 needle passes, seven each with EMN and CT fluoroscopy guidance, were performed into an artificially created liver lesion of a single swine. The accuracy of needle placement for each pass was verified with a confirmatory CT scan. The total radiation dose and time of procedure was compared between the EMN and conventional CT fluoroscopy methods. RESULTS All needle passes were successful, and all passes conducted with EMN were completed with a single insertion, whereas multiple passes (mean, 2.9) with needle repositioning were required with CT fluoroscopic guidance. Statistically significant reduction in procedure time and overall radiation dose for EMN punctures was shown. Accuracy of needle placement was statistically equivalent for the two methods. CONCLUSIONS This proof-of-concept study shows that EMN guidance has equivalent accuracy of needle placement to conventional CT fluoroscopy-guided methods in swine. EMN is also associated with favorable radiation-dose and time-of-procedure profiles for biopsy of liver lesions. Clinical studies are needed to evaluate the safety and efficacy of this technology in the biopsy of lesions in anatomically challenging locations that require steep angles of needle insertion.
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Affiliation(s)
- Filip Banovac
- Imaging Science and Information Systems (ISIS) Center, Georgetown University, 2115 Wisconsin Avenue Northwest, Suite 603, Washington, DC 20007, USA
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Khan MF, Dogan S, Maataoui A, Wesarg S, Gurung J, Ackermann H, Schiemann M, Wimmer-Greinecker G, Vogl TJ. Navigation-Based Needle Puncture of a Cadaver Using a Hybrid Tracking Navigational System. Invest Radiol 2006; 41:713-20. [PMID: 16971794 DOI: 10.1097/01.rli.0000236910.75905.cc] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to determine the puncture accuracy of a navigational system, Medarpa, in a soft tissue environment using augmented overlay imaging. MATERIALS AND METHODS Medarpa is an optical electromagnetic tracking system, which allows tracking of instruments, the radiologist's head position, and the transparent display. The display superimposes a computed tomography scan of a cadaver chest on a human cadaver in real time. In group A, needle puncture was performed using the Medarpa system. Three targets located inside the cadaver chest were selected. In group B, the same targets were used to perform standard computed tomography-guided puncture using a single-slice technique. A total of 42 punctures were performed in each group. Postpuncture computed tomography scans were made to verify needle tip positions. RESULTS Mean deviation from targets was 8.42 mm +/- 1.78 mm for group A and 8.90 mm +/- 1.71 mm for group B. No significant difference was found between group A and B in any target (P > 0.05). No significant difference was found between the targets of the same group (P > 0.05). Procedural time for 42 punctures was 160 minutes in group A versus 289 minutes in group B (P < 0.05). CONCLUSION Needle puncture in a soft tissue environment using the navigational system Medarpa can be reliably performed and matches the accuracy achieved by a computed tomography-guided puncture technique.
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Affiliation(s)
- M Fawad Khan
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Frankfurt/Main, Germany.
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Wacker FK, Vogt S, Khamene A, Jesberger JA, Nour SG, Elgort DR, Sauer F, Duerk JL, Lewin JS. An Augmented Reality System for MR Image–guided Needle Biopsy: Initial Results in a Swine Model. Radiology 2006; 238:497-504. [PMID: 16436814 DOI: 10.1148/radiol.2382041441] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate an augmented reality (AR) system in combination with a 1.5-T closed-bore magnetic resonance (MR) imager as a navigation tool for needle biopsies. MATERIALS AND METHODS The experimental protocol had institutional animal care and use committee approval. Seventy biopsies were performed in phantoms by using 20 tube targets, each with a diameter of 6 mm, and 50 virtual targets. The position of the needle tip in AR and MR space was compared in multiple imaging planes, and virtual and real needle tip localization errors were calculated. Ten AR-guided biopsies were performed in three pigs, and the duration of each procedure was determined. After successful puncture, the distance to the target was measured on MR images. The confidence limits for the achieved in-plane hit rate and for lateral deviation were calculated. A repeated measures analysis of variance was used to determine whether the placement error in a particular dimension (x, y, or z) differed from the others. RESULTS For the 50 virtual targets, a mean error of 1.1 mm +/- 0.5 (standard deviation) was calculated. A repeated measures analysis of variance indicated no statistically significant difference (P > .99) in the errors in any particular orientation. For the real targets, all punctures were inside the 6-mm-diameter tube in the transverse plane. The needle depth was within the target plane in 11 biopsy procedures; the mean distance to the center of the target was 2.55 mm (95% confidence interval: 1.77 mm, 3.34 mm). For nine biopsy procedures, the needle tip was outside the target plane, with a mean distance to the edge of the target plane of 1.5 mm (range, 0.07-3.46 mm). In the animal experiments, the puncture was successful in all 10 cases, with a mean target-needle distance of 9.6 mm +/- 4.85. The average procedure time was 18 minutes per puncture. CONCLUSION Biopsy procedures performed with a combination of a closed-bore MR system and an AR system are feasible and accurate.
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Affiliation(s)
- Frank K Wacker
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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Wacker FK, Vogt S, Khamene A, Sauer F, Wendt M, Duerk JL, Lewin JS, Wolf KJ. MR image-guided needle biopsies with a combination of augmented reality and MRI: A pilot study in phantoms and animals. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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17
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Khan MF, Dogan S, Maataoui A, Gurung J, Schiemann M, Ackermann H, Wesarg S, Sakas G, Vogl TJ. Accuracy of biopsy needle navigation using the Medarpa system—computed tomography reality superimposed on the site of intervention. Eur Radiol 2005; 15:2366-74. [PMID: 15754161 DOI: 10.1007/s00330-005-2708-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2004] [Accepted: 02/07/2005] [Indexed: 10/25/2022]
Abstract
The aim of this work was to determine the accuracy of a new navigational system, Medarpa, with a transparent display superimposing computed tomography (CT) reality on the site of intervention. Medarpa uses an optical and an electromagnetic tracking system which allows tracking of instruments, the radiologist and the transparent display. The display superimposes a CT view of a phantom chest on a phantom chest model, in real time. In group A, needle positioning was performed using the Medarpa system. Three targets (diameter 1.5 mm) located inside the phantom were punctured. In group B, the same targets were used to perform standard CT-guided puncturing using the single-slice technique. The same needles were used in both groups (15 G, 15 cm). A total of 42 punctures were performed in each group. Post puncture, CT scans were made to verify needle tip positions. The mean deviation from the needle tip to the targets was 6.65+/-1.61 mm for group A (range 3.54-9.51 mm) and 7.05+/-1.33 mm for group B (range 4.10-9.45 mm). No significant difference was found between group A and group B for any target (p>0.05). No significant difference was found between the targets of the same group (p>0.05). The accuracy in needle puncturing using the augmented reality system, Medarpa, matches the accuracy achieved by CT-guided puncturing technique.
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Affiliation(s)
- M Fawad Khan
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
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Affiliation(s)
- Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, J.W. Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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