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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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Vuka I, Došenović S, Marciuš T, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L. Efficacy and safety of pulsed radiofrequency as a method of dorsal root ganglia stimulation for treatment of non-neuropathic pain: a systematic review. BMC Anesthesiol 2020; 20:105. [PMID: 32366286 PMCID: PMC7199300 DOI: 10.1186/s12871-020-01023-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 04/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We systematically reviewed the evidence on the efficacy and safety of dorsal root ganglion (DRG) targeted pulsed radiofrequency (PRF) versus any comparator for treatment of non-neuropathic pain. METHODS We searched MEDLINE, CINAHL, Embase, PsycINFO, clinicaltrials.gov and WHO clinical trial register until January 8, 2019. All study designs were eligible. Two authors independently conducted literature screening. Primary outcomes were pain intensity and serious adverse events (SAEs). Secondary outcomes were any other pain-related outcome and any other safety outcome that was reported. We assessed the risk of bias using the Cochrane tool and Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I). We conducted narrative evidence synthesis and assessed the conclusiveness of included studies regarding efficacy and safety. RESULTS We included 17 studies with 599 participants, which analyzed various pain syndromes. Two studies were randomized controlled trials; both included participants with low back pain (LBP). Non-randomized studies included patients with the following indications: LBP, postsurgical pain, pain associated with herpes zoster, cervicogenic headache, complex regional pain syndrome type 1, intractable vertebral metastatic pain, chronic scrotal and inguinal pain, occipital radiating pain in rheumatoid arthritis and chronic migraine. In these studies, the PRF was usually initiated after other treatments have failed. Eleven studies had positive conclusive statements (11/17) about efficacy; the remaining had positive inconclusive statements. Only three studies provided conclusiveness of evidence statements regarding safety - two indicated that the evidence was positive conclusive, and one positive inconclusive. The risk of bias was predominantly unclear in randomized and serious in non-randomized studies. CONCLUSION Poor quality and few participants characterize evidence about benefits and harms of DRG PRF in patients with non-neuropathic pain. Results from available studies should only be considered preliminary. Not all studies have reported data regarding the safety of the intervention, but those that did, indicate that the intervention is relatively safe. As the procedure is non-destructive and early results are promising, further comparative studies about PRF in non-neuropathic pain syndromes would be welcomed.
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Affiliation(s)
- Ivana Vuka
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Svjetlana Došenović
- Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, Spinčićeva 1, 21000, Split, Croatia
| | - Tihana Marciuš
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Lejla Ferhatović Hamzić
- Center for Translational and Clinical Research, Department of Proteomics, University of Zagreb School of Medicine, Šalata 3, 10000, Zagreb, Croatia
| | - Katarina Vučić
- Department for Safety and Efficacy Assessment of Medicinal Products, Agency for Medicinal Products and Medical Devices, Ksaverska cesta 4, 10000, Zagreb, Croatia
| | - Damir Sapunar
- Laboratory for Pain Research, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia
| | - Livia Puljak
- Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, Ilica 242, 10000, Zagreb, Croatia.
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Groetz S, Wilhelm K, Willinek W, Pieper C, Schild H, Thomas D. A new robotic assistance system for percutaneous CT-guided punctures: Initial experience. MINIM INVASIV THER 2015; 25:79-85. [DOI: 10.3109/13645706.2015.1110825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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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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Computer-assisted fluoroscopic navigation of percutaneous spinal interventions. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:642-7. [PMID: 22972603 DOI: 10.1007/s00586-012-2495-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 07/20/2012] [Accepted: 08/28/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Percutaneous spine procedures may occasionally be difficult and subject to complications. Navigation using a dynamic reference base (DRB) may ease the procedure. Yet, besides other shortcomings, its fixation demands additional incisions and thereby defies the percutaneous character of the procedure. METHODS A new concept of atraumatic referencing was invented including a special epiDRB. The accuracy of navigated needle placement in soft tissue and bone was experimentally scrutinised. Axial and pin-point deviations from the planned trajectory were investigated with a CT-based 3D computer system. Clinical evaluation in a series of ten patients was also done. RESULTS The new epiDRB proved convenient and reliable. Its fixation to the skin with adhesive foil provided a stable reference for navigation that improves the workflow of percutaneous interventions, reduces radiation exposure and helps avoid complications. CONCLUSIONS Percutaneous spine interventions can be safely and accurately navigated using epiDRB with minimal trauma or radiation exposure and without additional skin incisions.
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