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Widmann G, Deeg J, Andreas F, Josef K, Feuchtner G, Freund M. Micro-robotic percutaneous targeting of type II endoleaks in the angio-suite. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03195-y. [PMID: 38811484 DOI: 10.1007/s11548-024-03195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/17/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE Endovascular aneurysm repair has emerged as the standard therapy for abdominal aortic aneurysms. In 9-30% of cases, retrograde filling of the aneurysm sac through patent branch arteries may result in persistence of blood flow outside the graft and within the aneurysm sac. This condition is called an endoleak type II, which may be treated by catheter-based embolization in case of continued sac enlargement. If an endovascular access is not possible, percutaneous targeting of the perfused nidus remains the only option. However, this can be very challenging due to the difficult access and deep puncture with risk of organ perforation and bleeding. Innovative targeting techniques such as robotics may provide a promising option for safe and successful targeting. METHODS In nine consecutive patients, percutaneous embolization of type II endoleaks was performed using a table-mounted micro-robotic targeting platform. The needle path from the skin entry to the perfused nidus was planned based on the C-arm CT image data in the angio-suite. Entry point and path angle were aligned using the joystick-operated micro-robotic system under fluoroscopic control, and the coaxial needle was introduced until the target point within the perfused nidus was reached. RESULTS All punctures were successful, and there were no puncture-related complications. The pre-operative C-arm CT was executed in 11-15 s, and pathway planning required 2-3 min. The robotic setup and sterile draping were performed in 1-2 min, and the alignment to the surgical plan took no longer than 30 s. CONCLUSION Due to the small size, the micro-robotic platform seamlessly integrated into the routine clinical workflow in the angio-suite. It offered significant benefits to the planning and safe execution of double-angulated deeply localized targets, such as type II endoleaks.
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Affiliation(s)
- Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Johannes Deeg
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Frech Andreas
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Klocker Josef
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Martin Freund
- Department of Radiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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Charalampopoulos G, Bale R, Filippiadis D, Odisio BC, Wood B, Solbiati L. Navigation and Robotics in Interventional Oncology: Current Status and Future Roadmap. Diagnostics (Basel) 2023; 14:98. [PMID: 38201407 PMCID: PMC10795729 DOI: 10.3390/diagnostics14010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/12/2024] Open
Abstract
Interventional oncology (IO) is the field of Interventional Radiology that provides minimally invasive procedures under imaging guidance for the diagnosis and treatment of malignant tumors. Sophisticated devices can be utilized to increase standardization, accuracy, outcomes, and "repeatability" in performing percutaneous Interventional Oncology techniques. These technologies can reduce variability, reduce human error, and outperform human hand-to-eye coordination and spatial relations, thus potentially normalizing an otherwise broad diversity of IO techniques, impacting simulation, training, navigation, outcomes, and performance, as well as verification of desired minimum ablation margin or other measures of successful procedures. Stereotactic navigation and robotic systems may yield specific advantages, such as the potential to reduce procedure duration and ionizing radiation exposure during the procedure and, at the same time, increase accuracy. Enhanced accuracy, in turn, is linked to improved outcomes in many clinical scenarios. The present review focuses on the current role of percutaneous navigation systems and robotics in diagnostic and therapeutic Interventional Oncology procedures. The currently available alternatives are presented, including their potential impact on clinical practice as reflected in the peer-reviewed medical literature. A review of such data may inform wiser investment of time and resources toward the most impactful IR/IO applications of robotics and navigation to both standardize and address unmet clinical needs.
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Affiliation(s)
- Georgios Charalampopoulos
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital “ATTIKON”, Medical School, National and Kapodistrian University of Athens, 1 Rimini Str, 12462 Athens, Greece;
| | - Bruno C. Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | - Bradford Wood
- Interventional Radiology and Center for Interventional Oncology, NIH Clinical Center and National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Luigi Solbiati
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano (Milano), Italy and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milano), 20072 Milano, Italy;
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Bale R, Laimer G, Schullian P, Alzaga A. Stereotactic ablation: A game changer? J Med Imaging Radiat Oncol 2023; 67:886-894. [PMID: 37401185 DOI: 10.1111/1754-9485.13555] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/23/2023] [Indexed: 07/05/2023]
Abstract
For both primary and metastatic liver cancer, thermal ablation represents an interesting alternative to surgery. However, except for a small fraction of patients, conventional ultrasound- and CT-guided single-probe approaches have not achieved oncologic outcomes comparable with surgery. In this overview, we describe our stereotactic ablation workflow and discuss the short- and long-term results of stereotactic radiofrequency ablation (SRFA) and stereotactic microwave ablation (SMWA) for the treatment of primary and secondary liver tumours. The advantages of this method are discussed together with a summary of the existing stereotactic techniques for thermal ablation and the clinical data that support them. Stereotactic ablation is based on an optical navigation system and a specialized aiming tool. The workflow includes advanced three-dimensional planning, precise needle/probe placements according to the plan and intraoperative image fusion to check the needle positions and the ablation margins. Stereotactic ablation offers all the advantages of a minimally invasive procedure while producing oncological results comparable with surgery. The number of locally treatable liver cancers may be significantly expanded with these cutting-edge instruments and methods. We firmly believe that it can become a cornerstone in the treatment of liver cancers.
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Affiliation(s)
- Reto Bale
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gregor Laimer
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Interventional Oncology/Stereotaxy and Robotics, Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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Scharll Y, Böhler D, Laimer G, Schullian P, Bale R. Laser Target System in Combination with an Aiming Device for Percutaneous CT-Guided Interventions - An Accuracy Study. Acad Radiol 2023; 30:3047-3055. [PMID: 37117142 DOI: 10.1016/j.acra.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/19/2023] [Accepted: 03/20/2023] [Indexed: 04/30/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the targeting accuracy of laser-guided punctures in combination with an aiming device for computed tomography (CT) interventions during in vitro experiments. MATERIALS AND METHODS: A total of 600 CT-guided punctures were performed using a laser target system, half of them with the additional help of an aiming device. Conically shaped targets in a plexiglass phantom were punctured. The planning CT data sets were acquired with 1.25, 2.5 and 5 mm slice thickness. Needle placement accuracy, as well as procedural time, was assessed. The Euclidean (ED) and normal distances (ND) were calculated at the target point. RESULTS Using the aiming device, the accomplished mean ND at the target for the 1.25, 2.5 and 5 mm slice thickness was 1.76 mm (SD ± 0.92), 2.09 mm (SD ± 1.06) and 1.93 mm (SD ± 1.38), respectively. Without aiming device, the corresponding results were 2.55 mm (SD ± 1.42), 2.7 mm (SD ± 1.43) and 2.31 mm (SD ± 1.64). At a slice thickness of 1.25 mm and 2.5 mm, punctures with the aiming device were significantly more accurate for both the ED and ND as compared to the punctures without aiming device (p < 0.001). The mean time required to complete the procedure, including image acquisition, trajectory planning, the placement of 10 needles, and the control-CT scan was 24.8 min without and 29.8 min with the aiming device. CONCLUSION The additional use of the aiming device in combination with the commercially available laser guidance system significantly increased the level of accuracy during this in vitro experiment compared to freehand passes.
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Affiliation(s)
- Yannick Scharll
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Daniel Böhler
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Gregor Laimer
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Peter Schullian
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.)
| | - Reto Bale
- Interventional Oncology-Microinvasive Therapy (SIP), Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria (Y.S., D.B., G.L., P.S., R.B.).
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Siegfarth M, Lutz R, Iseke NC, Moviglia J, Sadi F, Stallkamp J. A semi-automated robotic system for percutaneous interventions. Int J Comput Assist Radiol Surg 2023; 18:1571-1575. [PMID: 37058232 PMCID: PMC10491544 DOI: 10.1007/s11548-023-02882-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/17/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE A robotic assistive device is developed for needle-based percutaneous interventions. The aim is a hybrid system using both manual and actuated robotic operation in order to obtain a device that has a large workspace but can still fit in the gantry opening of a CT scanner. This will enable physicians to perform precise and time-efficient CT-guided percutaneous interventions. The concept of the mechanics and software of the device is presented in this work. METHODS The approach is a semi-automated robotic assistive device, which combines manual and robotic positioning to reduce the number and size of necessary motors. The system consists of a manual rough positioning unit, a robotic fine positioning unit and an optical needle tracking unit. The resulting system has eight degrees of freedom, of which four are manual, which comprise encoders to monitor the position of each axis. The remaining four axes are actuated axes for fine positioning of the needle. Cameras are attached to the mechanical structure for 3D tracking of the needle pose. The software is based on open-source software, mainly ROS2 as robotic middleware, Moveit2 for trajectory calculation and 3D Slicer for needle path planning. RESULTS The communication between the components was successfully tested with a clinical CT scanner. In a first experiment, four needle insertions were planned and the deviation of the actual needle path from the planned path was measured. The mean deviation from the needle path to the target point was 21.9 mm, which is mainly caused both by translational deviation (15.4 mm) and angular deviation (6.8°) of the needle holder. The optical tracking system was able to detect the needle position with a mean deviation of 3.9 mm. CONCLUSION The first validation of the system was successful which proves that the proposed concept for both the hardware and software is feasible. In a next step, an automatic position correction based on the optical tracking system will be integrated, which is expected to significantly improve the system accuracy.
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Affiliation(s)
- Marius Siegfarth
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany.
| | - Raffael Lutz
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
| | - Nils-Christian Iseke
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
| | - Javier Moviglia
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
| | - Fabian Sadi
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
| | - Jan Stallkamp
- Mannheim Institute for Intelligent Systems in Medicine, Heidelberg University, Mannheim, Germany
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Improving puncture accuracy in percutaneous CT-guided needle insertion with wireless inertial measurement unit: a phantom study. Eur Radiol 2023; 33:3156-3164. [PMID: 36826496 DOI: 10.1007/s00330-023-09467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/07/2022] [Accepted: 01/22/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVES A novel method applying inertial measurement units (IMUs) was developed to assist CT-guided puncture, which enables real-time displays of planned and actual needle trajectories. The method was compared with freehand and laser protractor-assisted methods. METHODS The phantom study was performed by three operators with 8, 2, and 0 years of experience in CT-guided procedure conducted five consecutive needle placements for three target groups using three methods (freehand, laser protractor-assisted, or IMU-assisted method). The endpoints included mediolateral angle error and caudocranial angle error of the first pass, the procedure time, the total number of needle passes, and the radiation dose. RESULTS There was a significant difference in the number of needle passes (IMU 1.2 ± 0.42, laser protractor 2.9 ± 1.6, freehand 3.6 ± 2.0 time, p < 0.001), the procedure time (IMU 3.0 ± 1.2, laser protractor 6.4 ± 2.9, freehand 6.2 ± 3.1 min, p < 0.001), the mediolateral angle error of the first pass (IMU 1.4 ± 1.2, laser protractor 1.6 ± 1.3, freehand 3.7 ± 2.5 degree, p < 0.001), the caudocranial angle error of the first pass (IMU 1.2 ± 1.2, laser protractor 5.3 ± 4.7, freehand 3.9 ± 3.1 degree, p < 0.001), and the radiation dose (IMU 250.5 ± 74.1, laser protractor 484.6 ± 260.2, freehand 561.4 ± 339.8 mGy-cm, p < 0.001) among three CT-guided needle insertion methods. CONCLUSION The wireless IMU improves the angle accuracy and speed of CT-guided needle punctures as compared with laser protractor guidance and freehand techniques. KEY POINTS • The IMU-assisted method showed a significant decrease in the number of needle passes (IMU 1.2 ± 0.42, laser protractor 2.9 ± 1.6, freehand 3.6 ± 2.0 time, p < 0.001). • The IMU-assisted method showed a significant decrease in the procedure time (IMU 3.0 ± 1.2, laser protractor 6.4 ± 2.9, freehand 6.2 ± 3.1 min, p < 0.001). • The IMU-assisted method showed a significant decrease in the mediolateral angle error of the first pass and the caudocranial angle error of the first pass.
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Identification and characterization of patients being exposed to computed-tomography associated radiation-doses above 100 mSv in a real-life setting. Eur J Radiol Open 2022; 10:100470. [PMID: 36590327 PMCID: PMC9800257 DOI: 10.1016/j.ejro.2022.100470] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale and objectives Patients receiving high cumulative effective doses (CED) from recurrent computed tomography (CT) in a real-life setting are not well identified. Evaluation of causes and patient characteristics may help to define individuals potentially at risk of radiation-induced secondary malignancies. Materials and methods Patients who received a CED > 100 mSv from CT scans during October 2012 and April 2020 at a tertiary university center were identified with the help of a radiological radiation dose monitoring system. The primary disease and referral diagnosis, number of CT exams, time period, age, BMI and gender distribution of the 1000 patients with the highest CED were analysed. Results 3431 patients had a CED of more than 100 mSv, which corresponded to 2.75% of all patients who received a CT exam. From the 1000 patients with the highest CED, mean number of CT exams per patient was 14.6, mean CED was 257 mSv (SD 98, range 177-1339). Mean age of patients was 63.9 years (SD 10.6), male to female ratio 3:2, and mean BMI 28.7 kg/m2 (SD 5.5). 728 (72.9%) patients had cancer. The leading primary diagnosis was liver cirrhosis in 197 patients and 103 patients had a liver transplantation. In patients with liver cirrhosis, 750 exams were indicated for the follow-up of the disease, 662 for the clarification of an acute clinical condition, and 202 for CT-guided stereotactic radiofrequency ablation. Conclusion Recurrent CT scans of patients with cancer, liver cirrhosis and liver transplantation may lead to critically high CED.
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Hao MZ, Hu YB, Chen QZ, Chen ZX, Lin HL. Efficacy and safety of computed tomography-guided microwave ablation with fine needle-assisted puncture positioning technique for hepatocellular carcinoma. World J Gastrointest Oncol 2022; 14:1727-1738. [PMID: 36187402 PMCID: PMC9516651 DOI: 10.4251/wjgo.v14.i9.1727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/18/2022] [Accepted: 08/01/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In microwave ablation (MWA), although computed tomography (CT) scanning can overcome gas interference, it cannot achieve real-time localization. Therefore, the puncture technique is more important in CT-guided ablation.
AIM To compare the fine needle-assisted puncture (FNP) positioning technique and the conventional puncture (CP) technique for the safety and efficacy of CT-guided MWA in treating hepatocellular carcinoma (HCC).
METHODS This retrospective study included 124 patients with 166 tumor nodules from February 2018 and June 2021. Seventy patients received CT-guided MWA under the FNP technique (FNP group), and 54 patients received MWA under the CP technique (CP group). Intergroup comparisons were made regarding local tumor progression (LTP), recurrence-free survival (RFS), overall survival (OS), and complications. The influencing variables of LTP and RFS were analyzed through univariate and multivariate regressions.
RESULTS The 1-, 2-, and 3-year cumulative incidences of LTP in the FNP group were significantly lower than those in the CP group (7.4%, 12.7%, 21.3% vs 13.7%, 32.9%, 36.4%; P = 0.038). The 1-, 2-, and 3-year RFS rates in the FNP group were significantly higher than those in the CP group (80.6%, 73.3%, 64.0% vs 83.3%, 39.4%, and 32.5%, respectively; P = 0.008). The FNP technique independently predicted LTP and RFS. Minor complications in the FNP group were lower than those in the CP group (P < 0.001). The difference in median OS was insignificant between the FNP and CP groups (P = 0.229).
CONCLUSION The FNP technique used in CT-guided MWA may improve outcomes in terms of LTP, RFS, and procedure-related complications for HCC.
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Affiliation(s)
- Ming-Zhi Hao
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
- Department of Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Yu-Bin Hu
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Qi-Zhong Chen
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Zhang-Xian Chen
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
| | - Hai-Lan Lin
- Department of Tumor Interventional Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou 350014, Fujian Province, China
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Boekestijn I, Azargoshasb S, van Oosterom MN, Slof LJ, Dibbets-Schneider P, Dankelman J, van Erkel AR, Rietbergen DDD, van Leeuwen FWB. Value-assessment of computer-assisted navigation strategies during percutaneous needle placement. Int J Comput Assist Radiol Surg 2022; 17:1775-1785. [PMID: 35934773 PMCID: PMC9468110 DOI: 10.1007/s11548-022-02719-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/04/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
Navigational strategies create a scenario whereby percutaneous needle-based interventions of the liver can be guided using both pre-interventional 3D imaging datasets and dynamic interventional ultrasound (US). To score how such technologies impact the needle placement process, we performed kinematic analysis on different user groups.
Methods
Using a custom biopsy phantom, three consecutive exercises were performed by both novices and experts (n = 26). The exercise came in three options: (1) US-guidance, (2) US-guidance with pre-interventional image-registration (US + Reg) and (3) US-guidance with pre-interventional image-registration and needle-navigation (US + Reg + Nav). The traveled paths of the needle were digitized in 3D. Using custom software algorithms, kinematic metrics were extracted and related to dexterity, decision making indices to obtain overall performance scores (PS).
Results
Kinematic analysis helped quantifying the visual assessment of the needle trajectories. Compared to US-guidance, novices yielded most improvements using Reg (PSavg(US) = 0.43 vs. PSavg(US+Reg) = 0.57 vs. PSavg(US+Reg+Nav) = 0.51). Interestingly, the expert group yielded a reversed trend (PSavg(US) = 0.71 vs PSavg(US+Reg) = 0.58 vs PSavg(US+Reg+Nav) = 0.59).
Conclusion
Digitizing the movement trajectory allowed us to objectively assess the impact of needle-navigation strategies on percutaneous procedures. In particular, our findings suggest that these advanced technologies have a positive impact on the kinematics derived performance of novices.
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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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Pedersoli F, Wilkmann C, Penzkofer T, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P, Isfort P. An accelerometer-based guidance device for CT-guided procedures: an improved wireless prototype. MINIM INVASIV THER 2021; 31:902-908. [PMID: 34865602 DOI: 10.1080/13645706.2021.2002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the study was to demonstrate the feasibility of a prototype for accelerometer-based guidance for percutaneous CT-guided punctures and compare it with free-hand punctures. MATERIAL AND METHODS The prototype enabled alignment with the CT coordinate system and a wireless connectivity. Its feasibility was tested in a swine cadaver model: 20 out-of-plane device-assisted punctures performed without intermittent control scans (one-step punctures) were evaluated regarding deviation to target and difference between planned and obtained angle. Thereafter, 22 device-assisted punctures were compared with 20 free-hand punctures regarding distance to target, deviation from the planned angle, number of control scans and procedure time. Differences were compared with the Mann-Whitney U-test (p < .05). RESULTS The one-step punctures revealed a deviation to target of 0.26 ± 0.37 cm (axial plane) and 0.21 ± 0.19 cm (sagittal plane) and differences between planned and performed puncture angles of 0.9 ± 1.09° (axial plane) and 1.15 ± 0.91° (sagittal planes). In the comparative study, device-assisted punctures showed a significantly higher accuracy, 0.20 ± 0.17 cm vs. 0.30 ± 0.21 cm (p < .05) and lower number of required control scans, 1.3 ± 1.1 vs. 3.7 ± 0.9 (p < .05) compared with free-hand punctures. CONCLUSION The accelerometer-based device proved to be feasible and demonstrated significantly higher accuracy and required significantly less control scans compared to free-hand puncture.
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Affiliation(s)
- Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Christoph Wilkmann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany.,Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Tobias Penzkofer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Catherine Disselhorst-Klug
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Thomas Schmitz-Rode
- Institute of Applied Medical Engineering, Deptartment of Rehabilitation & Prevention Engineering, RWTH Aachen University, Aachen, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany
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12
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Hale GR, Pesapane F, Xu S, Bakhutashvili I, Glossop N, Turkbey B, Pinto PA, Wood BJ. Tracked Foley catheter for motion compensation during fusion image-guided prostate procedures: a phantom study. Eur Radiol Exp 2020; 4:24. [PMID: 32300896 PMCID: PMC7163002 DOI: 10.1186/s41747-020-00147-4] [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: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncorrected patient or prostate motion may impair targeting prostate areas during fusion image-guided procedures. We evaluated if a prototype "tracked Foley catheter" (TFC) could maintain fusion image alignment after simulated organ motion. METHODS A pelvic phantom model underwent magnetic resonance imaging (MRI), and the prostate was segmented. The TFC was placed in the phantom. MRI/ultrasound (US) fusion was performed. Four trials were performed varying motion and TFC presence/absence: (1) TFC/no-motion, (2) TFC/motion, (3) no-TFC/no-motion, and (4) no-TFC/motion. To quantify image alignment, screen captures generated Dice similarity coefficient (DSC) and offset distances (ODs) (maximal US-to-MRI distance between edges on fusion images). Three anatomical targets were identified for placement of a needle under fusion guidance. A computed tomography scan was used to measure system error (SE), i.e., the distance from needle tip to intended target. RESULTS The TFC presence improved MRI/US alignment by DSC 0.88, 0.88, 0.74, and 0.61 in trials 1, 2, 3, and 4, respectively. Both OD (trial 2 versus trial 4, 4.85 ± 1.60 versus 25.29 ± 6.50 mm, p < 0.001) and SE (trial 2 versus trial 4, 6.35 ± 1.31 versus 32.16 ± 6.50 mm, p < 0.005) were significantly lower when the TFC was present after artificial motion, and significantly smaller OD when static (trial 1 versus trial 3, 4.29 ± 1.24 versus 6.42 ± 2.29 mm, p < 0.001). CONCLUSION TFC provided better image alignment with or without simulated motion. This may overcome system limitations, allowing for more accurate fusion image alignment during fusion-guided biopsy, ablation, or robotic prostatectomy.
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Affiliation(s)
- Graham R Hale
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Filippo Pesapane
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. .,Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy.
| | - Sheng Xu
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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13
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Laimer G, Schullian P, Jaschke N, Putzer D, Eberle G, Alzaga A, Odisio B, Bale R. Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation. Eur Radiol 2020; 30:2463-2472. [PMID: 32002642 PMCID: PMC7160081 DOI: 10.1007/s00330-019-06609-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/22/2019] [Accepted: 12/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives To assess the minimal ablative margin (MAM) by image fusion of intraprocedural pre- and post-ablation contrast-enhanced CT images and to evaluate if it can predict local tumor progression (LTP) independently. Furthermore, to determine a MAM with which a stereotactic radiofrequency ablation (SRFA) can be determined successful and therefore used as an intraprocedural tool to evaluate treatment success. Methods A total of 110 patients (20 women, 90 men; mean age 63.7 ± 10.2) with 176 hepatocellular carcinomas were assessed by retrospective analysis of prospectively collected data. The MAM was determined through image fusion of intraprocedural pre- and post-ablation images using commercially available rigid imaging registration software. LTP was assessed in contrast-enhanced CTs or MR scans at 3–6-month intervals. Results The MAM was the only significant independent predictor of LTP (p = 0.036). For each millimeter increase of the MAM, a 30% reduction of the relative risk for LTP was found (OR = 0.7, 95% CI 0.5–0.98, p = 0.036). No LTP was detected in lesions with a MAM > 5 mm. The overall LTP rate was 9 of 110 (8.2%) on a patient level and 10 of 173 (5.7%) on a lesion level. The median MAM was 3.4 (1.7–6.9) mm. The mean overall follow-up period was 26.0 ± 10.3 months. Conclusions An immediate assessment of the minimal ablative margin (MAM) can be used as an intraprocedural tool to evaluate the treatment success in patients treated with stereotactic RFA. A MAM > 5 mm has to be achieved to consider an ablation as successful. Key Points • An intraoperatively measured minimal ablative margin (MAM) > 5 mm correlates with complete remission. • MAM is the only significant independent predictor of LTP (OR = 0.7, 95% CI 0.5–0.98, p = 0.036) after stereotactic RFA of hepatocellular carcinoma. • Image fusion using commercially available rigid imaging registration software is possible, even though considerably complex. Therefore, improved (semi-)automatic fusion software is highly desirable.
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Affiliation(s)
- Gregor Laimer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nikolai Jaschke
- Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Daniel Putzer
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Gernot Eberle
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Amilcar Alzaga
- Siemens Healthineers, Siemensstraße 3, 91301, Forchheim, Germany
| | - Bruno Odisio
- Division of Diagnostic Imaging, Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reto Bale
- Department of Radiology, Interventional Oncology-Microinvasive Therapy (SIP), Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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14
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Putzer D, Schullian P, Bale R. Locoregional ablative treatment of melanoma metastases. Int J Hyperthermia 2019; 36:59-63. [DOI: 10.1080/02656736.2019.1647353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Daniel Putzer
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Peter Schullian
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Reto Bale
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
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15
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Lundberg J, Grankvist R, Holmin S. The creation of an endovascular exit through the vessel wall using a minimally invasive working channel in order to reach all human organs. J Intern Med 2019; 286:309-316. [PMID: 31108016 DOI: 10.1111/joim.12939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since the establishment of the Seldinger technique for secure entry to the vascular system, there has been a rapid evolution in imaging and catheters that has made the arteries and veins internal routes to any place in the body for interventions. It is curious that a general exit from the vasculature in a similar manner has not been proposed earlier. Possibly, the simplest reason is that accidental perforation of the vasculature by guide wire or catheter is a feared adverse event in endovascular intervention. Most places in the body can be reached by ultrasonography or computed tomography-guided intervention. Some organs such as the central nervous system, the heart and pancreas are harder to access and, in some organs, like the kidney, repeated percutaneous punctions to cover large areas is not suitable. We present a new general purpose micro-endovascular device creating a working channel to these 'hard to reach' organs by an inverted Seldinger technique. This review details this trans-vessel wall technique, which has been studied in pancreas for transplantation of insulin-producing cells, for injection of contrast agent to the heart and to the brain, bowels and kidney in rat, rabbit, swine and macaque monkeys with up to one year of follow-up without adverse events. Furthermore, the payloads that can be given through such a system are briefly discussed. Drugs, cells, gene vectors and other therapeutic substances may be injected directly to the tissue to increase efficacy and decrease risk of off-site adverse effects.
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Affiliation(s)
- J Lundberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - R Grankvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - S Holmin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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16
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Venturi D, Glossop N, Bale R. Patient-specific templates for image-guided intervention - a phantom study. MINIM INVASIV THER 2019; 29:251-260. [PMID: 31204536 DOI: 10.1080/13645706.2019.1626251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To evaluate the in vitro accuracy of a new device and method for simultaneous stereotactic CT-guided punctures.Material and methods: 240 needle paths were planned in 1 mm, 1.5 mm and 3 mm slice thickness with a custom-designed software. The data were transferred to a three-axis tabletop CNC machine that then drilled the hole pattern for the needles into square plastic plates. Kirschner wires were slid through the holes of the two parallel fixed plates to aim at the chosen targets inside the phantom. The accuracy was calculated by taking control CTs and measuring the Euclidean distance and the normal distance between the wire and the entry and target point.Results: The mean Euclidean distance of the wire tip to the target for the 1 mm, 1.5mm and 3 mm slice thickness were 2.5 mm (SD ± 0.64), 2.71mm (SD ± 0.78) and 2.8 mm (SD ± 1.0). The mean normal distance was 1.42 mm (SD ± 0.65), 1.43mm (SD ± 0.75) and 1.9 mm (SD ± 1.1), respectively.Conclusion: The system yields satisfactory accuracy comparable to other image-guided intervention systems. Involuntary movements of the patient need to be taken into account in a clinical setting.
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Affiliation(s)
- David Venturi
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Neil Glossop
- Queen's University School of Computing, Kingston, Canada.,ArciTrax Inc, Toronto, Canada
| | - Reto Bale
- Interventional Oncology - Microinvasive Therapy (SIP), Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
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17
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Widmann G, Bale R, Ulmer H, Putzer D, Schullian P, Wiedermann FJ, Lederer W. Systemic Hypotension Following Intravenous Administration of Nonionic Contrast Medium During Computed Tomography: Iopromide Versus Iodixanol. Anesth Analg 2018; 126:769-775. [PMID: 28806208 DOI: 10.1213/ane.0000000000002346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In light of the increasing number of radiologic interventions performed under general anesthesia, the effects of contrast media (CM) on circulation and organ perfusion are of paramount importance. The objectives of this study were to systematically quantify effects on blood pressure, heart rate, and kidney function following intravenous administration of nonionic CM with normal and low osmolality. METHODS In this controlled, double-blinded phase IV clinical trial, 40 consecutive patients were randomly assigned to receive repeated measures of either low-osmolar iopromide or iso-osmolar iodixanol. Normal saline solution (NSS) served as control. Blood pressure and heart rate were measured continuously from 1 minute before until 3 minutes after administration of CM and NSS. Urine output was recorded hourly. RESULTS Administration of iopromide resulted in systemic hypotension lasting up to 300 seconds (105 ± 61 seconds) with the lowest mean arterial pressure of 39 mm Hg (56.7 ± 12.2 mm Hg). Iopromide caused a systolic/diastolic decrease of 31/26 mm Hg (P < .001), significant increase in heart rate (P = .042), and significant diuresis with a 2-fold higher per-hour urine output (P = .010). Administration of iodixanol and NSS had no significant influence on blood pressure (P > .640). CONCLUSIONS Administration of low-osmolar iopromide was followed by a significant transient decrease in blood pressure and a rise in heart rate. Anesthetists and radiologists should be aware of these effects in patients in whom short episodes of disturbed tissue microcirculation may pose a clinical risk.
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Affiliation(s)
| | | | - Hanno Ulmer
- Medical Statistics, Informatics and Health Economy
| | | | | | - Franz-Josef Wiedermann
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Lederer
- Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
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18
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Putzer D, Schullian P, Braunwarth E, Fodor M, Primavesi F, Cardini B, Resch T, Oberhuber R, Maglione M, Margreiter C, Schneeberger S, Stättner S, Öfner-Velano D, Jaschke W, Bale RJ. Integrating interventional oncology in the treatment of liver tumors. Eur Surg 2018; 50:117-124. [PMID: 29875800 PMCID: PMC5968075 DOI: 10.1007/s10353-018-0521-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/23/2018] [Indexed: 12/17/2022]
Abstract
Background Percutaneous ablation techniques offer a vast armamentarium for local, minimally invasive treatment of liver tumors, nowadays representing an established therapeutic option, which is integrated in treatment algorithms, especially for non-resectable liver tumors. The results of ablative treatment compare very well to surgical treatment in liver lesions, and confirm that these techniques are a valuable option for bridging for transplantation. Different techniques have been established to perform tumor ablation, and the feasibility varies according to the procedure and technical skills of the operator, depending on the size and location of the liver lesion. In recent years, stereotactic multi-needle techniques using 3D trajectory planning, general anesthesia, and tube disconnection during needle placement have had a strong impact on the application range of ablation for liver tumors. Conclusion It is well known that creating a sufficient ablation margin and overlapping ablation zones is one key issue to enable ablation of large liver lesions with tumor-free margins (A0 ablation in analogy to R0 resection). Image fusion during treatment and follow-up assure highly accurate staging procedures and interventional planning. Novel aspects Review on the standards in ablation techniques for the treatment of liver tumors. Update on different ablation techniques, indications, and contraindications for percutaneous liver tumor treatment. Summary of recently published reports on liver tumor ablation.
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Affiliation(s)
- D Putzer
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - P Schullian
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - E Braunwarth
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Fodor
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - F Primavesi
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - B Cardini
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - T Resch
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - M Maglione
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - C Margreiter
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - S Stättner
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - D Öfner-Velano
- 2Department of Surgery, Medical University Innsbruck, Innsbruck, Austria
| | - W Jaschke
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - R J Bale
- 1Department of Radiology, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
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19
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Performance of a Robotic Assistance Device in Computed Tomography-Guided Percutaneous Diagnostic and Therapeutic Procedures. Cardiovasc Intervent Radiol 2017; 41:639-644. [PMID: 29159685 DOI: 10.1007/s00270-017-1841-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/13/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate a commercially available robotic assistance device for computed tomography-guided diagnostic and therapeutic interventions, compared to regular, manually performed CT scan-guided interventions in terms of precision, exposure to radiation to the patient and intervention time. MATERIALS AND METHODS Over a period of 6 months, 55 consecutive patients were recruited and treated using robotic assistance and compared to a control group of 101 patients previously treated with a regular CT scan-guided, manual approach. Evaluated parameters were precision (deviation from planned target and number of needle replacements), radiation exposure to the patient and intervention time. Evaluations were performed with regard to complexity (in-plane vs out-of-plane interventions) and type of anesthesia (general vs local). RESULTS Parameters related to precision were in general significantly better in the robotic assistance group (p < 0.01) with a mean deviation of 1.2 mm (± 1.6 mm) compared to 2.6 mm (± 1.1 mm) in the comparison group. Compared to manual procedure, the mean intervention time was reduced by 15 min (± 5.4 min) on average for an out-of-plane needle placement in the robotic group. There was no increase of exposure to radiation to the patient while radiation exposure for the physician was reduced to zero when the navigation system was used. CONCLUSION Compared to manual placement, the use of a robotic assistance device in out-of-plane CT-guided interventions under general anesthesia allows for probe placement with high precision. Intervention time is reduced with no increase of exposure to radiation to the patient.
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20
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Kuyumcu G, Sundaram M, Schils JP, Ilaslan H. Osteoid osteoma of the hand and foot in children successfully treated with radiofrequency neurotomy probes. Skeletal Radiol 2017; 46:1561-1565. [PMID: 28689337 DOI: 10.1007/s00256-017-2702-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/05/2017] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
Osteoid osteoma is a common benign tumor that is typically found in young adults and children, usually in the long bones of the lower extremity. Radiofrequency ablation (RFA) under computed tomography guidance is the standard of care for symptomatic osteoid osteomas. However, patients with osteoid osteoma of the hand or foot are often treated with open surgery because of the risk of injury to vascular and neural structures from RFA. This risk is more pronounced in pediatric patients because of the small lesion size and proximity of lesions to important neurovascular structures. Here, we present 2 pediatric patients, one with an osteoid osteoma in the hand and the other with an osteoid osteoma in the foot. In both patients, a 22-gauge, 2.5-mm active tip ablation probe was used. The smaller ablation volume achieved with this probe protected neighboring neurovascular structures while effectively ablating the osteoid osteoma nidus. Based on our success in these cases, we recommend the application of this method for cases in which neurovascular proximity to the osteoid osteoma lesion makes ablation challenging.
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Affiliation(s)
- Gokhan Kuyumcu
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Murali Sundaram
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Jean P Schils
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Hakan Ilaslan
- Cleveland Clinic Imaging Institute, 9500 Euclid Avenue, Cleveland, OH, 44106, USA
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21
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Miner RC. Image-Guided Neurosurgery. J Med Imaging Radiat Sci 2017; 48:328-335. [PMID: 31047466 DOI: 10.1016/j.jmir.2017.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/27/2017] [Indexed: 01/21/2023]
Abstract
Image-guided surgery provides more precise targeting, is less invasive, and has improved outcomes when compared with conventional surgical approaches. Imaging is used to plan, monitor progress, and assess results. Because no one modality offers real-time physiological and anatomical information, a wide range of imaging modalities are used at each phase of the surgery. This article will discuss how various modalities are used in image-guided neurosurgery for common brain pathologies.
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Affiliation(s)
- Robert C Miner
- Carleton University, Ottawa, Ontario, Canada; Ottawa Heart Institute, Ottawa, Ontario, Canada.
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22
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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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23
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Givehchi S, Wong YH, Yeong CH, Abdullah BJJ. Optimal approach for complete liver tumor ablation using radiofrequency ablation: a simulation study. MINIM INVASIV THER 2017; 27:81-89. [DOI: 10.1080/13645706.2017.1330757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Sogol Givehchi
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yin How Wong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chai Hong Yeong
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University of Malaya Research Imaging Center, Faculty of Medicine, University of Malaya, Kuala Lumour, Malaysia
| | - Basri Johan Jeet Abdullah
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- University of Malaya Research Imaging Center, Faculty of Medicine, University of Malaya, Kuala Lumour, Malaysia
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24
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Gruber-Rouh T, Lee C, Bolck J, Naguib NNN, Schulz B, Eichler K, Aschenbach R, Wichmann JL, Vogl TJ, Zangos S. Intervention Planning Using a Laser Navigation System for CT-Guided Interventions: A Phantom and Patient Study. Korean J Radiol 2015; 16:729-35. [PMID: 26175571 PMCID: PMC4499536 DOI: 10.3348/kjr.2015.16.4.729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 05/13/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the accuracy, efficiency and radiation dose of a novel laser navigation system (LNS) compared to those of free-handed punctures on computed tomography (CT). Materials and Methods Sixty punctures were performed using a phantom body to compare accuracy, timely effort, and radiation dose of the conventional free-handed procedure to those of the LNS-guided method. An additional 20 LNS-guided interventions were performed on another phantom to confirm accuracy. Ten patients subsequently underwent LNS-guided punctures. Results The phantom 1-LNS group showed a target point accuracy of 4.0 ± 2.7 mm (freehand, 6.3 ± 3.6 mm; p = 0.008), entrance point accuracy of 0.8 ± 0.6 mm (freehand, 6.1 ± 4.7 mm), needle angulation accuracy of 1.3 ± 0.9° (freehand, 3.4 ± 3.1°; p < 0.001), intervention time of 7.03 ± 5.18 minutes (freehand, 8.38 ± 4.09 minutes; p = 0.006), and 4.2 ± 3.6 CT images (freehand, 7.9 ± 5.1; p < 0.001). These results show significant improvement in 60 punctures compared to freehand. The phantom 2-LNS group showed a target point accuracy of 3.6 ± 2.5 mm, entrance point accuracy of 1.4 ± 2.0 mm, needle angulation accuracy of 1.0 ± 1.2°, intervention time of 1.44 ± 0.22 minutes, and 3.4 ± 1.7 CT images. The LNS group achieved target point accuracy of 5.0 ± 1.2 mm, entrance point accuracy of 2.0 ± 1.5 mm, needle angulation accuracy of 1.5 ± 0.3°, intervention time of 12.08 ± 3.07 minutes, and used 5.7 ± 1.6 CT-images for the first experience with patients. Conclusion Laser navigation system improved accuracy, duration of intervention, and radiation dose of CT-guided interventions.
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Affiliation(s)
- Tatjana Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Clara Lee
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Jan Bolck
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Nagy N N Naguib
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany. ; Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria 21514, Egypt
| | - Boris Schulz
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Katrin Eichler
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Rene Aschenbach
- Department of Radiology, HELIOS Klinikum Erfurt, Erfurt 99089, Germany
| | - Julian L Wichmann
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Thomas J Vogl
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, Germany
| | - Stephan Zangos
- Institute for Diagnostic and Interventional Radiology, J. W. Goethe University of Frankfurt, Frankfurt 60590, 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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26
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Schullian P, Weiss H, Klaus A, Widmann G, Kranewitter C, Mittermair C, Margreiter R, Bale R. Laparoscopic liver packing to protect surrounding organs during thermal ablation. MINIM INVASIV THER 2014; 23:294-301. [DOI: 10.3109/13645706.2014.897956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Martin CM, Roach VA, Nguyen N, Rice CL, Wilson TD. Comparison of 3D reconstructive technologies used for morphometric research and the translation of knowledge using a decision matrix. ANATOMICAL SCIENCES EDUCATION 2013; 6:393-403. [PMID: 23633266 DOI: 10.1002/ase.1367] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/12/2013] [Accepted: 03/14/2013] [Indexed: 06/02/2023]
Abstract
The use of three-dimensional (3D) models for education, pre-operative assessment, presurgical planning, and measurement have become more prevalent. With the increase in prevalence of 3D models there has also been an increase in 3D reconstructive software programs that are used to create these models. These software programs differ in reconstruction concepts, operating system requirements, user features, cost, and no one program has emerged as the standard. The purpose of this study was to conduct a systematic comparison of three widely available 3D reconstructive software programs, Amira(®), OsiriX, and Mimics(®) , with respect to the software's ability to be used in two broad themes: morphometric research and education to translate morphological knowledge. Cost, system requirements, and inherent features of each program were compared. A novel concept selection tool, a decision matrix, was used to objectify comparisons of usability of the interface, quality of the output, and efficiency of the tools. Findings indicate that Mimics was the best-suited program for construction of 3D anatomical models and morphometric analysis, but for creating a learning tool the results were less clear. OsiriX was very user-friendly; however, it had limited capabilities. Conversely, although Amira had endless potential and could create complex dynamic videos, it had a challenging interface. These results provide a resource for morphometric researchers and educators to assist the selection of appropriate reconstruction programs when starting a new 3D modeling project.
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Affiliation(s)
- Charys M Martin
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Georgia Regents University, Augusta, Georgia
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Angiographic C-Arm CT– Versus MDCT-Guided Stereotactic Punctures of Liver Lesions: Nonrigid Phantom Study. AJR Am J Roentgenol 2013; 201:1136-40. [DOI: 10.2214/ajr.12.10405] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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29
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Karall D, Scholl-Bürgi S, Widmann G, Albrecht U, Niedermayr K, Maurer K, Ausserer B, Huemer M, Bale R. Stereotactic Radiofrequency Ablation for Liver Tumors in Inherited Metabolic Disorders. Cardiovasc Intervent Radiol 2013; 37:1027-33. [DOI: 10.1007/s00270-013-0756-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/21/2013] [Indexed: 02/04/2023]
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30
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Qin S, Fite BZ, Gagnon MKJ, Seo JW, Curry FR, Thorsen F, Ferrara KW. A physiological perspective on the use of imaging to assess the in vivo delivery of therapeutics. Ann Biomed Eng 2013; 42:280-98. [PMID: 24018607 DOI: 10.1007/s10439-013-0895-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 08/14/2013] [Indexed: 12/25/2022]
Abstract
Our goal is to provide a physiological perspective on the use of imaging to optimize and monitor the accumulation of nanotherapeutics within target tissues, with an emphasis on evaluating the pharmacokinetics of organic particles. Positron emission tomography (PET), magnetic resonance imaging (MRI) and ultrasound technologies, as well as methods to label nanotherapeutic constructs, have created tremendous opportunities for preclinical optimization of therapeutics and for personalized treatments in challenging disease states. Within the methodology summarized here, the accumulation of the construct is estimated directly from the image intensity. Particle extravasation is then estimated based on classical physiological measures. Specifically, the transport of nanotherapeutics is described using the concept of apparent permeability, which is defined as the net flux of solute across a blood vessel wall per unit surface area of the blood vessel and per unit solute concentration difference across the blood vessel wall. The apparent permeability to small molecule MRI constructs is accurately shown to be far larger than that estimated for proteins such as albumin or nanoconstructs such as liposomes. Further, the quantitative measurements of vascular permeability are shown to facilitate detection of the transition from a pre-malignant to a malignant cancer and to quantify the delivery enhancement resulting from interventions such as ultrasound. While PET-based estimates facilitate quantitative comparisons of many constructs, high field MRI proves useful in the visualization of model drugs within small lesions and in the evaluation of the release and intracellular trafficking of nanoparticles and cargo.
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Affiliation(s)
- Shengping Qin
- Department of Biomedical Engineering, University of California, Davis, Davis, CA, USA,
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31
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Lu T, Liang P, Wu WB, Xue J, Lei CL, Li YY, Sun YN, Liu FY. Integration of the Image-Guided Surgery Toolkit (IGSTK) into the Medical Imaging Interaction Toolkit (MITK). J Digit Imaging 2013; 25:729-37. [PMID: 22535192 DOI: 10.1007/s10278-012-9477-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The development cycle of an image-guided surgery navigation system is too long to meet current clinical needs. This paper presents an integrated system developed by the integration of two open-source software (IGSTK and MITK) to shorten the development cycle of the image-guided surgery navigation system and save human resources simultaneously. An image-guided surgery navigation system was established by connecting the two aforementioned open-source software libraries. It used the Medical Imaging Interaction Toolkit (MITK) as a framework providing image processing tools for the image-guided surgery navigation system of medical imaging software with a high degree of interaction and used the Image-Guided Surgery Toolkit (IGSTK) as a library that provided the basic components of the system for location, tracking, and registration. The electromagnetic tracking device was used to measure the real-time position of surgical tools and fiducials attached to the patient's anatomy. IGSTK was integrated into MITK; at the same time, the compatibility and the stability of this system were emphasized. Experiments showed that an integrated system of the image-guided surgery navigation system could be developed in 2 months. The integration of IGSTK into MITK is feasible. Several techniques for 3D reconstruction, geometric analysis, mesh generation, and surface data analysis for medical image analysis of MITK can connect with the techniques for location, tracking, and registration of IGSTK. This integration of advanced modalities can decrease software development time and emphasize the precision, safety, and robustness of the image-guided surgery navigation system.
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Affiliation(s)
- Tong Lu
- Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
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32
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Abramczyk H, Brozek-Pluska B. Raman imaging in biochemical and biomedical applications. Diagnosis and treatment of breast cancer. Chem Rev 2013; 113:5766-81. [PMID: 23697873 DOI: 10.1021/cr300147r] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Halina Abramczyk
- Laboratory of Laser Molecular Spectroscopy, Institute of Applied Radiation Chemistry, Lodz University of Technology , Wroblewskiego 15, 93-590 Lodz, Poland
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Moser C, Becker J, Deli M, Busch M, Boehme M, Groenemeyer DH. A novel Laser Navigation System reduces radiation exposure and improves accuracy and workflow of CT-guided spinal interventions: A prospective, randomized, controlled, clinical trial in comparison to conventional freehand puncture. Eur J Radiol 2013; 82:627-32. [DOI: 10.1016/j.ejrad.2012.10.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Revised: 10/12/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
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[Radiofrequency ablation of hepatocellular carcinoma]. Wien Med Wochenschr 2013; 163:132-6. [PMID: 23515886 DOI: 10.1007/s10354-013-0176-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/08/2013] [Indexed: 01/21/2023]
Abstract
Percutaneous radiofrequency ablation (RFA) is well established in the treatment of hepatocellular carcinoma (HCC). Due to its curative potential, it is the method of choice for non resectable BCLC (Barcelona Liver Clinic) 0 and A. RFA challenges surgical resection for small HCC and is the method of choice in bridging for transplantation and recurrence after resection or transplantation. The technical feasibility of RFA depends on the size and location of the HCC and the availability of ablation techniques (one needle techniques, multi-needle techniques). More recently, stereotactic multi-needle techniques with 3D trajectory planning and guided needle placement substantially improve the spectrum of treatable lesions including large volume tumors. Treatment success depends on the realization of ablations with large intentional margins of tumor free tissue (A0 ablation in analogy to R0 resection), which has to be documented by fusion of post- with pre-ablation images, and confirmed during follow-up imaging.
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CT-Guided Interventions Using a Free-Hand, Optical Tracking System: Initial Clinical Experience. Cardiovasc Intervent Radiol 2012; 36:1055-62. [DOI: 10.1007/s00270-012-0527-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
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36
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Case report: Third-degree skin and soft tissue burn after radiofrequency ablation of an osteoid osteoma guided through a triple-crown biopsy cannula. Skeletal Radiol 2012; 41:1627-30. [PMID: 22669730 DOI: 10.1007/s00256-012-1448-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 02/02/2023]
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37
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Niederwanger C, Widmann G, Knoflach M, Schullian P, Hoermann R, Bale R. Kirschner wire placement in scaphoid bones using intraoperative CT-guided stereotaxy. MINIM INVASIV THER 2012; 22:165-70. [PMID: 23033958 DOI: 10.3109/13645706.2012.724688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Minimally invasive ostesynthesis of scaphoid fractures may reduce the risk of fracture non-union and shorten the duration of illness. The aim of this study was to analyze the technical feasibility and targeting accuracy of computed tomography (CT) - guided stereotactic Kirschner (K)-wire positioning in the scaphoid. METHODS Nineteen Formalin preserved cadaveric upper extremities (10 right, 9 left) were fixed in 90 degree dorsal extension for percutaneous access from palmar. An ideal central position of the K-wire was planned on the computer adapted from intraoperative CT data. A 3D navigation system and stereotactic targeting device were used for K-wire placement. Target positioning errors were evaluated by fusion of the control CT with the K-wire in place with the planning CT. RESULTS The procedure allowed for an easy and rigid wrist fixation. K-wire placement showed mean ± SD lateral targeting errors of 0.9 ± 0.5 mm at the scaphoid bone entry and 1.2 ± 0.7 mm at the K-wire tip. The mean angular error was 1.3° ± 1.1° . Total duration of the intervention ranged between 19 and 23 min. CONCLUSION CT-guided stereotactic K-wire placement in scaphoid bones is highly accurate. The technique may guide minimally invasive screw-osteosynthesis of scaphoid fractures.
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Affiliation(s)
- Christian Niederwanger
- Section of Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
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Rassweiler MC, Ritter M, Michel MS, Häcker A. Influence of endourological devices on 3D reconstruction image quality using the Uro Dyna-CT. World J Urol 2012; 31:1291-5. [PMID: 23011255 DOI: 10.1007/s00345-012-0917-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 07/16/2012] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The urological Dyna-CT (Uro Dyna-CT) was established in clinical use for classical imaging as well as for interventional surgery. To evaluate whether irradiation artefacts may occur during interventional surgery, we analysed the impact of different instruments on 3D reconstruction in the Uro Dyna-CT. MATERIALS AND METHODS Ten different endourological instruments [ureterorenoscope (URS)-fibrescope, percutaneous nephrolithotomy (PCNL) working sheath] and accessory equipments such as ureteral catheter, guide wires and stents (DJ, MJ) were introduced in a porcine renal pelvis either retrograde via the ureter or transparenchymally. Subsequently, digital fluoroscopy, standard X-ray and an Uro Dyna-CT were performed. Three colleagues evaluated the image quality independent from each other. RESULTS There were basically no limitations regarding image quality in digital fluoroscopy and standard X-ray. In the Uro Dyna-CT, only with the URS fiberscope and the PCNL working sheath, small artefacts and irradiations were detected, whereas ureteric catheter with and without wire, as well as the hydrophilic guide wire, showed no artefacts at all. The remaining material demonstrated minimal artefacts, which did not affect the image quality. CONCLUSIONS The Uro Dyna-CT can be used for all interventional endourological procedures using the common armamentarium and instruments without significant limitation of image quality. There are only minor limitations according a PCNL working sheath and the rigid URS. These instruments should be removed out of the examination field before performing the computed tomography and be replaced afterwards by using a safety wire.
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Affiliation(s)
- M-C Rassweiler
- UMM Urology Mannheim, University of Heidelberg, Mannheim, Germany,
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Widmann G, Schullian P, Fasser M, Niederwanger C, Bale R. CT-guided stereotactic targeting accuracy of osteoid osteoma. Int J Med Robot 2012; 9:274-9. [PMID: 22539415 DOI: 10.1002/rcs.1435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the CT-guided stereotactic targeting accuracy for radiofrequency ablation of osteoid osteoma (OO), a small, benign but painful osseous lesion. METHODS Patient and extremity were fixed in a vacuum cushion. The OO was targeted using an optical navigation system with a stereotactic targeting device. For evaluation of targeting errors, the control CT with the needle in place was fused with the planning CT. RESULTS In 16 consecutive patients, nine OOs in the femur, four in the tibia, one in the spine, one in the ulna and one in the pubic bone were successfully targeted without complications. The mean ± SD lateral targeting error was 2.6 ± 1.7 mm at the needle entry and 1.9 ± 1.2 mm at the needle tip, and the mean angular error was 2.0 ± 1.3°. CONCLUSION Stereotaxy allows for accurate and safe targeting of OOs in various bone regions.
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Affiliation(s)
- Gerlig Widmann
- Section of Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Austria
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Bale R, Widmann G, Jaschke W. Stereotaxie und Robotik zur Ablation – Spielzeug oder Werkzeug? Radiologe 2012; 52:56-62. [DOI: 10.1007/s00117-011-2212-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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41
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Rassweiler JJ, Müller M, Fangerau M, Klein J, Goezen AS, Pereira P, Meinzer HP, Teber D. iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 2011; 61:628-31. [PMID: 22209052 DOI: 10.1016/j.eururo.2011.12.024] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022]
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Lin ML, Yang BD, Wang YH, Yang CL, Wang JL. A miniature patient-mount navigation system for assisting needle placement in CT-guided intervention. Int J Med Robot 2011; 7:423-30. [PMID: 21815240 DOI: 10.1002/rcs.412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2011] [Indexed: 12/23/2022]
Abstract
BACKGROUND CT-guided intervention is routinely performed in an iterative fashion that often leads to lengthy operation and high X-ray exposure to patients. To streamline the workflow, we develop a patient-mount navigation system for assisting needle placement in CT-guided interventions. METHODS The system comprises three components, a miniature patient-mount tracking unit, an auto-registered reference-frame unit and an intuitive image-processing unit. The system is operated like a virtual biplane fluoroscopy with augmented CT reconstructed images to streamline the conventional CT-guided intervention workflow. Surgery efficiency and safety can be increased, while radiation for patients and surgeons can be reduced. Two preclinical validations were conducted to evaluate the technical applicability and accuracy of the system. RESULTS The results of the rigid physical phantom test showed a machine position error of 1.6 mm and a tilting error of 1.5°. The results of the deformable porcine phantom test showed the operation position error to be 3.6 mm and tilting error to be 2.9°. CONCLUSIONS We concluded that the accuracy of our system is within the comparable range of the existing navigation systems.
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Affiliation(s)
- Mu-Lien Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, Republic of China
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Widmann G, Schullian P, Haidu M, Bale R. Stereotactic radiofrequency ablation (SRFA) of liver lesions: technique effectiveness, safety, and interoperator performance. Cardiovasc Intervent Radiol 2011; 35:570-80. [PMID: 21671150 DOI: 10.1007/s00270-011-0200-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/22/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate technique effectiveness, safety, and interoperator performance of stereotactic radiofrequency ablation (SRFA) of liver lesions. METHODS Retrospective review including 90 consecutive patients from January 2008 to January 2010 with 106 computed tomography-guided SRFA sessions using both single and multiple electrodes for the treatment of 177 lesions: 72 hepatocellular carcinoma (HCC) and 105 metastases with a mean size of 2.9 cm (range 0.5-11 cm). Technique effectiveness and 1-year local recurrence were evaluated by computed tomographic scans. Complications, mortality, and hospital days were recorded. The performance between an experienced and inexperienced interventional radiologist was compared. RESULTS The overall technique effectiveness after a single SRFA was 95.5% (93.1% for HCC and 97.1% for metastases). Four of the eight unsuccessfully treated lesions could be retreated (secondary technique effectiveness of 97.7%). Local recurrence at 1 year was 2.9%. Technique effectiveness was significantly different for lesions<5 cm (96.7%) and >5 cm (87.5%) (P=0.044) but not for lesions<3 cm (95.9%) and 3-5 cm (100%). Compared to clear parenchymal property (97.3%), vessel vicinity (93.3%) (P=0.349) and subcapsular (95.2%) (P=0.532) had no, but hollow viscera vicinity (83.3%) had a significantly lower technique effectiveness (P=0.020). Mortality rate was 0.9%. Major complications and hospital days were higher for cirrhosis Child-Pugh B (20%, 7.2 days) than Child-Pugh A (3.1%, 4.7 days) patients and for metastases (5.1%, 4.3 days). There was no significant difference in interoperator performance. CONCLUSION SRFA allowed for efficient, reliable, and safe ablation of large-volume liver disease.
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Affiliation(s)
- Gerlig Widmann
- Department of Radiology, SIP-Department of Microinvasive Therapy, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
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Schullian P, Widmann G, Lang TB, Knoflach M, Bale R. Accuracy and diagnostic yield of CT-guided stereotactic liver biopsy of primary and secondary liver tumors. ACTA ACUST UNITED AC 2011; 16:181-7. [PMID: 21612328 DOI: 10.3109/10929088.2011.578367] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE CT-guided biopsy still plays a decisive role in the management of liver tumors, especially if the lesions are not visible or accessible by ultrasound. As CT-guided stereotaxy appears to be a very accurate targeting technique, the aim of this study was to evaluate the targeting accuracy, diagnostic yield, and complications of CT-guided stereotactic liver biopsy of primary and secondary liver tumors. METHODS AND MATERIALS Prior to stereotactic liver biopsy, patients under general anesthesia were immobilized using a vacuum cushion. Respiratory motion was controlled by temporary disconnections of the endotracheal tube. An optical-based navigation system was used for 3D trajectory planning and placement of a 15-G coaxial needle via a stereotactic aiming device. The histological samples were obtained using a 16-G Tru-Cut(™) biopsy needle system. For evaluation of targeting accuracy the control CT image with the needles in place was fused with the planning CT image. The lateral error at the tip and skin entry point and the angular error were calculated. In addition, the skin-to-liver-surface (SL) distance, the needle-to-liver-surface (NL) angle, and the presence of liver cirrhosis were evaluated. The diagnostic yield was evaluated by histological reports from the institutional pathologists. RESULTS The median lateral error was 2.5 mm (range: 0-6.5 mm) at the needle entry point and 3.2 mm (range: 0.01-9.4 mm) at the needle tip. The median angular error was 1.06° (range: 0-6.64°). Liver cirrhosis, NL angle and SL distance showed no significant impact on the targeting accuracy. Forty-five of the 46 liver biopsies (97.8%) were diagnostic according to the histological reports. No puncture-related complications such as bleeding or perforation of intestinal organs or lung tissue were recorded.
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Affiliation(s)
- Peter Schullian
- Department of Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Austria
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Widmann G, Schullian P, Haidu M, Fasser M, Bale R. Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours. MINIM INVASIV THER 2011; 20:218-25. [DOI: 10.3109/13645706.2010.533923] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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46
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Penzkofer T, Bruners P, Isfort P, Schoth F, Günther RW, Schmitz-Rode T, Mahnken AH. Free-hand CT-based electromagnetically guided interventions: Accuracy, efficiency and dose usage. MINIM INVASIV THER 2011; 20:226-33. [DOI: 10.3109/13645706.2011.553256] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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A patient-mount navigated intervention system for spinal diseases and its clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion. Spine (Phila Pa 1976) 2010; 35:E1126-32. [PMID: 20838268 DOI: 10.1097/brs.0b013e3181e11d73] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Development of a patient-mount navigated intervention (PaMNI) system for spinal diseases. An in vivo clinical human trial was conducted to validate this system. OBJECTIVE To verify the feasibility of the PaMNI system with the clinical trial on percutaneous pulsed radiofrequency stimulation of dorsal root ganglion (PRF-DRG). SUMMARY OF BACKGROUND DATA Two major image guiding techniques, i.e., computed tomography (CT)-guided and fluoro-guided, were used for spinal intervention. The CT-guided technique provides high spatial resolution, and is claimed to be more accurate than the fluoro-guided technique. Nevertheless, the CT-guided intervention usually reaches higher radiograph exposure than the fluoro-guided counterpart. Some navigated intervention systems were developed to reduce the radiation of CT-guided intervention. Nevertheless, these systems were not popularly used due to the longer operation time, a new protocol for surgeons, and the availability of such a system. METHODS The PaMNI system includes 3 components, i.e., a patient-mount miniature tracking unit, an auto-registered reference frame unit, and a user-friendly image processing unit. The PRF-DRG treatment was conducted to find the clinical feasibility of this system. RESULTS The in vivo clinical trial showed that the accuracy, visual analog scale evaluation after surgery, and radiograph exposure of the PaMNI-guided technique are comparable to the one of conventional fluoro-guided technique, while the operation time is increased by 5 minutes. CONCLUSION Combining the virtues of fluoroscopy and CT-guided techniques, our navigation system is operated like a virtual fluoroscopy with augmented CT images. This system elevates the performance of CT-guided intervention and reduces surgeons' radiation exposure risk to a minimum, while keeping low radiation dose to patients like its fluoro-guided counterpart. The clinical trial of PRF-DRG treatment showed the clinical feasibility and efficacy of this system.
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Doros A. [Interventional radiological treatment of hepatocellular carcinoma]. Orv Hetil 2010; 151:1204-8. [PMID: 20650810 DOI: 10.1556/oh.2010.28914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
During the last years, interventional radiological treatment of hepatocellular cancer has changed dramatically. The percutaneous ethanol infiltration is partly replaced by thermoablative methods, mainly by radiofrequency ablation. Cooled-tip electrodes and volumetric therapy planning increased the treatment success. Embolisation beads made vessel occlusion more precise and predictable, while the development of the drug eluting beads led to the most effective way of chemoembolisation. The so called radioembolisation with Yttrium 90 isotopes filled into glass microbeads is slowly gaining acceptance worldwide. Thermoablation and embolisation or chemoembolisation are the main tools for downstaging tumors, or avoiding disease progression in liver transplant recipients on the waiting list. All of these therapeutic options have their well established places in well known and worldwide accepted protocols, such as the algorithm of the Barcelona group (BCLC). In the near future, further results can be expected from the combination of available treatments, including sorafenib medication.
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Affiliation(s)
- Attila Doros
- Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika, Budapest.
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Rosenberger RE, Bale RJ, Kneisl C, Krappinger D, Knoflach M, Attal R. Two-dimensional fluoroscopic navigation in posterior cruciate ligament reconstruction: a preclinical cadaver study. Arch Orthop Trauma Surg 2010; 130:971-6. [PMID: 20049604 DOI: 10.1007/s00402-009-1037-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the feasibility and accuracy of frameless stereotactic two-dimensional fluoroscopy-assisted guide pin (GP) placement in posterior cruciate ligament (PCL) reconstruction in human cadavers. MATERIALS AND METHODS A total of 13 pins were placed in 7 cadaver specimens, using a fluoroscopic-based navigation technique. The knees were fixed noninvasively on a carbon baseplate. Interventions were planned on intraoperatively acquired perpendicular fluoroscopic images. A stereotactic aiming device was mounted to the carbon baseplate and adjusted according to the planned trajectories. GPs were advanced through the aiming device to the precalculated depth. GP positions were verified by image fusion of the fluoroscopic planning and control data, respectively. Measurements were scored on three occasions by one independent observer. In order to assess interobserver reliability, measurements were scored by two further independent observers on one occasion. RESULTS The femoral cohort included seven GP placements in seven cadavers. Mean GP placement accuracy according to plan was 1.3 mm (SD 0.9 mm, range 0.3-3.8 mm) at the target point. The recorded femoral angular misalignment of GPs was 1.1 degrees (SD 0.9 degrees , range 0.2 degrees -3.3 degrees ). The tibial cohort included six GP placements in six cadavers. Mean GP placement accuracy according to the plan was 1.8 mm (SD 2.1 mm, range 0.3-9.5 mm). The recorded tibial angular misalignment of GPs was 1.4 degrees (SD 1.1 degrees , range 0.1 degrees -5 degrees ). Navigated GP implantation, as planned, was optimal in six out of seven cases in the femoral cohort and in four out of six cases in the tibial cohort. CONCLUSION Our preliminary cadaver study suggests that the use of fluoroscopic-based navigation combined with a stereotactic targeting device may be a helpful tool to improve PCL reconstruction. In addition, this method may also be used for other minimal invasive skeletal interventions.
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Affiliation(s)
- Ralf E Rosenberger
- Department of Trauma Surgery and Sports Medicine, Medical University Innsbruck, Innsbruck, Austria.
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