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Busse H, Kahn T, Moche M. Techniques for Interventional MRI Guidance in Closed-Bore Systems. Top Magn Reson Imaging 2018; 27:9-18. [PMID: 29406410 DOI: 10.1097/rmr.0000000000000150] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Efficient image guidance is the basis for minimally invasive interventions. In comparison with X-ray, computed tomography (CT), or ultrasound imaging, magnetic resonance imaging (MRI) provides the best soft tissue contrast without ionizing radiation and is therefore predestined for procedural control. But MRI is also characterized by spatial constraints, electromagnetic interactions, long imaging times, and resulting workflow issues. Although many technical requirements have been met over the years-most notably magnetic resonance (MR) compatibility of tools, interventional pulse sequences, and powerful processing hardware and software-there is still a large variety of stand-alone devices and systems for specific procedures only.Stereotactic guidance with the table outside the magnet is common and relies on proper registration of the guiding grids or manipulators to the MR images. Instrument tracking, often by optical sensing, can be added to provide the physicians with proper eye-hand coordination during their navigated approach. Only in very short wide-bore systems, needles can be advanced at the extended arm under near real-time imaging. In standard magnets, control and workflow may be improved by remote operation using robotic or manual driving elements.This work highlights a number of devices and techniques for different interventional settings with a focus on percutaneous, interstitial procedures in different organ regions. The goal is to identify technical and procedural elements that might be relevant for interventional guidance in a broader context, independent of the clinical application given here. Key challenges remain the seamless integration into the interventional workflow, safe clinical translation, and proper cost effectiveness.
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Affiliation(s)
- Harald Busse
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Leipzig, Germany
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An J, Webb AG, Shah DJ, Chin K, Tsekos NV. Manipulator-driven selection of semi-active MR-visible markers. Int J Med Robot 2017; 14. [PMID: 28660676 DOI: 10.1002/rcs.1846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 04/18/2017] [Accepted: 05/06/2017] [Indexed: 11/12/2022]
Abstract
BACKGROUND A method for the identification of semi-active fiducial magnetic resonance (MR) markers is presented based on selectively optically tuning and detuning them. METHODS Four inductively coupled solenoid coils with photoresistors were connected to light sources. A microcontroller timed the optical tuning/detuning of coils and image collection. The markers were tested on an MR manipulator linking the microcontroller to the manipulator control to visibly select the marker subset according to the actuated joint. RESULTS In closed-loop control, the average and maximum were 0.76° ± 0.41° and 1.18° errors for a rotational joint, and 0.87 mm ± 0.26 mm and 1.13 mm for the prismatic joint. CONCLUSIONS This technique is suitable for MR-compatible actuated devices that use semi-active MR-compatible markers.
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Affiliation(s)
- Junmo An
- Medical Robotics Laboratory, University of Houston, Houston, TX, USA
| | - Andrew G Webb
- C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, Netherlands
| | - Dipan J Shah
- Methodist DeBakey Cardiology Associates, Houston Methodist, Houston, TX, USA
| | - Karen Chin
- Methodist DeBakey Cardiology Associates, Houston Methodist, Houston, TX, USA
| | - Nikolaos V Tsekos
- Medical Robotics Laboratory, University of Houston, Houston, TX, USA
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Nagaraj Y, Benedicks C, Matthies P, Friebe M. Advanced inside-out tracking approach for real-time combination of MRI and US images in the radio-frequency shielded room using combination markers. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2016:2558-2561. [PMID: 28268844 DOI: 10.1109/embc.2016.7591252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
For the real-time fusion of different modalities, a variety of tracking methods are available including the optical, electromagnetic (EM) and image-based tracking. But as a drawback optical tracking suffers from line of sight issues and EM tracking requires the manual referencing for the fusion procedure and is not usable in Magnetic Resonance Imaging (MRI) environment. To avoid these issues, we propose a real-time setup containing a camera capable of inside-Out tracking using combined circular markers attached to Ultrasound (US) probe and a suitable platform for automatic overlay of MRI and US image using markers. This new approach could help clinicians carry out successful surgical procedures by requiring least system interaction and solving line of sight issues. As a proof-of-concept, we show our first result by mimicking common liver tumor intervention using framed marker fusion technique in a candle gel phantom. We evaluated the tracking error distances using the combination of special markers with Inside-Out approach and conventional optical tracking. The results achieved show comparable performance to the standard Outside-In tracking and manual reference approach, while easing the interventional procedure in terms of hardware and line of sight requirements.
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Navigated MRI-guided liver biopsies in a closed-bore scanner: experience in 52 patients. Eur Radiol 2015; 26:2462-70. [PMID: 26563349 PMCID: PMC4927599 DOI: 10.1007/s00330-015-4097-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/26/2015] [Accepted: 10/28/2015] [Indexed: 11/01/2022]
Abstract
OBJECTIVES To evaluate clinical effectiveness and diagnostic efficiency of a navigation device for MR-guided biopsies of focal liver lesions in a closed-bore scanner. METHODS In 52 patients, 55 biopsies were performed. An add-on MR navigation system with optical instrument tracking was used for image guidance and biopsy device insertion outside the bore. Fast control imaging allowed visualization of the true needle position at any time. The biopsy workflow and procedure duration were recorded. Histological analysis and clinical course/outcome were used to calculate sensitivity, specificity and diagnostic accuracy. RESULTS Fifty-four of 55 liver biopsies were performed successfully with the system. No major and four minor complications occurred. Mean tumour size was 23 ± 14 mm and the skin-to-target length ranged from 22 to 177 mm. In 39 cases, access path was double oblique. Sensitivity, specificity and diagnostic accuracy were 88 %, 100 % and 92 %, respectively. The mean procedure time was 51 ± 12 min, whereas the puncture itself lasted 16 ± 6 min. On average, four control scans were taken. CONCLUSIONS Using this navigation device, biopsies of poorly visible and difficult accessible liver lesions could be performed safely and reliably in a closed-bore MRI scanner. The system can be easily implemented in clinical routine workflow. KEY POINTS • Targeted liver biopsies could be reliably performed in a closed-bore MRI. • The navigation system allows for image guidance outside of the scanner bore. • Assisted MRI-guided biopsies are helpful for focal lesions with a difficult access. • Successful integration of the method in clinical workflow was shown. • Subsequent system installation in an existing MRI environment is feasible.
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Targeting Accuracy, Procedure Times and User Experience of 240 Experimental MRI Biopsies Guided by a Clinical Add-On Navigation System. PLoS One 2015. [PMID: 26222443 PMCID: PMC4519044 DOI: 10.1371/journal.pone.0134370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES MRI is of great clinical utility for the guidance of special diagnostic and therapeutic interventions. The majority of such procedures are performed iteratively ("in-and-out") in standard, closed-bore MRI systems with control imaging inside the bore and needle adjustments outside the bore. The fundamental limitations of such an approach have led to the development of various assistance techniques, from simple guidance tools to advanced navigation systems. The purpose of this work was to thoroughly assess the targeting accuracy, workflow and usability of a clinical add-on navigation solution on 240 simulated biopsies by different medical operators. METHODS Navigation relied on a virtual 3D MRI scene with real-time overlay of the optically tracked biopsy needle. Smart reference markers on a freely adjustable arm ensured proper registration. Twenty-four operators - attending (AR) and resident radiologists (RR) as well as medical students (MS) - performed well-controlled biopsies of 10 embedded model targets (mean diameter: 8.5 mm, insertion depths: 17-76 mm). Targeting accuracy, procedure times and 13 Likert scores on system performance were determined (strong agreement: 5.0). RESULTS Differences in diagnostic success rates (AR: 93%, RR: 88%, MS: 81%) were not significant. In contrast, between-group differences in biopsy times (AR: 4:15, RR: 4:40, MS: 5:06 min:sec) differed significantly (p<0.01). Mean overall rating was 4.2. The average operator would use the system again (4.8) and stated that the outcome justifies the extra effort (4.4). Lowest agreement was reported for the robustness against external perturbations (2.8). CONCLUSIONS The described combination of optical tracking technology with an automatic MRI registration appears to be sufficiently accurate for instrument guidance in a standard (closed-bore) MRI environment. High targeting accuracy and usability was demonstrated on a relatively large number of procedures and operators. Between groups with different expertise there were significant differences in experimental procedure times but not in the number of successful biopsies.
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Galassi F, Brujic D, Rea M, Lambert N, Desouza N, Ristic M. Fast and accurate localization of multiple RF markers for tracking in MRI-guided interventions. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2014; 28:33-48. [PMID: 24802620 PMCID: PMC4315881 DOI: 10.1007/s10334-014-0446-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 04/07/2014] [Accepted: 04/07/2014] [Indexed: 11/01/2022]
Abstract
OBJECT A new method for 3D localization of N fiducial markers from 1D projections is presented and analysed. It applies to semi-active markers and active markers using a single receiver channel. MATERIALS AND METHODS The novel algorithm computes candidate points using peaks in three optimally selected projections and removes fictitious points by verifying detected peaks in additional projections. Computational complexity was significantly reduced by avoiding cluster analysis, while higher accuracy was achieved by using optimal projections and by applying Gaussian interpolation in peak detection. Computational time, accuracy and robustness were analysed through Monte Carlo simulations and experiments. The method was employed in a prototype MRI guided prostate biopsy system and used in preclinical experiments. RESULTS The computational time for 6 markers was better than 2 ms, an improvement of up to 100 times, compared to the method by Flask et al. (J Magn Reson Imaging 14(5):617-627, 2001). Experimental maximum localization error was lower than 0.3 mm; standard deviation was 0.06 mm. Targeting error was about 1 mm. Tracking update rate was about 10 Hz. CONCLUSION The proposed method is particularly suitable in systems requiring any of the following: high frame rate, tracking of three or more markers, data filtering or interleaving.
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Affiliation(s)
- Francesca Galassi
- Mechanical Engineering Department, Imperial College London, London, UK,
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Huang C, Ackerman JL, Petibon Y, Normandin MD, Brady TJ, El Fakhri G, Ouyang J. Motion compensation for brain PET imaging using wireless MR active markers in simultaneous PET-MR: phantom and non-human primate studies. Neuroimage 2014; 91:129-37. [PMID: 24418501 DOI: 10.1016/j.neuroimage.2013.12.061] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Revised: 12/16/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022] Open
Abstract
Brain PET scanning plays an important role in the diagnosis, prognostication and monitoring of many brain diseases. Motion artifacts from head motion are one of the major hurdles in brain PET. In this work, we propose to use wireless MR active markers to track head motion in real time during a simultaneous PET-MR brain scan and incorporate the motion measured by the markers in the listmode PET reconstruction. Several wireless MR active markers and a dedicated fast MR tracking pulse sequence module were built. Data were acquired on an ACR Flangeless PET phantom with multiple spheres and a non-human primate with and without motion. Motions of the phantom and monkey's head were measured with the wireless markers using a dedicated MR tracking sequence module. The motion PET data were reconstructed using list-mode reconstruction with and without motion correction. Static reference was used as gold standard for quantitative analysis. The motion artifacts, which were prominent on the images without motion correction, were eliminated by the wireless marker based motion correction in both the phantom and monkey experiments. Quantitative analysis was performed on the phantom motion data from 24 independent noise realizations. The reduction of bias of sphere-to-background PET contrast by active marker based motion correction ranges from 26% to 64% and 17% to 25% for hot (i.e., radioactive) and cold (i.e., non-radioactive) spheres, respectively. The motion correction improved the channelized Hotelling observer signal-to-noise ratio of the spheres by 1.2 to 6.9 depending on their locations and sizes. The proposed wireless MR active marker based motion correction technique removes the motion artifacts in the reconstructed PET images and yields accurate quantitative values.
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Affiliation(s)
- Chuan Huang
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
| | - Jerome L Ackerman
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA; Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.
| | - Yoann Petibon
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Laboratoire d'imagerie fonctionnelle (LIF), UMRS-678, INSERM, Université Pierre et Marie Curie, CHU Pitié-Salpêtrière, Paris, France.
| | - Marc D Normandin
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
| | - Thomas J Brady
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
| | - Georges El Fakhri
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
| | - Jinsong Ouyang
- Center for Advanced Medical Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Department of Imaging, Massachusetts General Hospital, Boston, MA 02114, USA; Department of Radiology, Harvard Medical School, Boston, MA 02115, USA.
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Thörmer G, Garnov N, Moche M, Haase J, Kahn T, Busse H. Simultaneous 3D localization of multiple MR-visible markers in fully reconstructed MR images: proof-of-concept for subsecond position tracking. Magn Reson Imaging 2012; 30:371-81. [DOI: 10.1016/j.mri.2011.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/26/2011] [Accepted: 10/21/2011] [Indexed: 11/27/2022]
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