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Saeed S, Niehoff JH, Boriesosdick J, Michael A, Schönbeck D, Wöltjen MM, Haag NP, Mönninghoff C, Borggrefe J, Kroeger JR. Gyroscope-Assisted CT-Guided Puncture Improves Accuracy and Hit Rate Compared with Free-Hand Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03832-8. [PMID: 39237781 DOI: 10.1007/s00270-024-03832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 07/30/2024] [Indexed: 09/07/2024]
Abstract
PURPOSE To evaluate gyroscope-assisted CT-guided needle puncture (GAP) compared to free hand puncture (FHP) in a phantom. MATERIAL AND METHODS A simple, low-cost gyroscope was equipped with a magnetic rail to attach it to common puncture needles. 18 radiologists with different levels of training and experience in CT-guided punctures first punctured three targets in free hand technique in a special biopsy phantom with different difficulty levels of the puncture path (T1: not angulated, needle path 7.3 cm, size 15 mm in diameter, T2: single angulated 41°, needle path 11.3 cm, size 9 mm in diameter, T3: double angulated 38°/26°, needle path 7 cm, size 8 mm in diameter). Without knowing the result of the puncture, a second puncture was performed directly afterwards with the aid of the gyroscope. Punctures were performed in a continuous procedure without intermediate control. The hit rate and the distance between the needle tip and the center of the lesion were evaluated. Additionally, the time needed for the procedure was measured. RESULTS Thirty-three of 54 insertions (61.1%) hit the target in GAP compared to 20 of 54 (37%) in FHP (p = 0.002). The mean distance of the needle tip to the lesion center was 7.49 ± 5.31 mm in GAP compared to 13.37 ± 10.24 mm in FHP (p < 0.001). Puncture time was not significantly different between GAP (36.72 ± 20.38 s) and FHP (37.83 ± 20.53 s) (p = 0.362). CONCLUSION Needle guidance with a gyroscope enables an improved hit rate and puncture accuracy in CT-guided punctures without prolonging the puncture time. The needle guidance by gyroscope is inexpensive and easy to establish.
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Affiliation(s)
- Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
- Johannes Wesling Klinikum, Muehlenkreiskliniken, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Julius Henning Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Denise Schönbeck
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias Michael Wöltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Nina P Haag
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Mönninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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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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3
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Bruners P. [CT-guided local ablative interventions]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00117-023-01164-1. [PMID: 37306751 DOI: 10.1007/s00117-023-01164-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Applicator-based local ablations under computed tomography (CT) guidance for the treatment of malignant tumors have found their way into clinical routine. OBJECTIVES The basic principles of the different ablation technologies and their specific clinical field of application are described. MATERIALS AND METHODS A comprehensive literature review regarding applicator-based ablation techniques was carried out. RESULTS Radiofrequency (RFA) and microwave ablation (MWA) represent two image-guided hyperthermal treatment modalities that have been established for the treatment of primary and secondary liver malignancies. In addition, both techniques are also applied for local ablative therapy of lung- and kidney tumors. Cryoablation is mainly used for the local ablation of T1 kidney cancer and due to its intrinsic analgetic characteristics for application in the musculoskeletal system. Nonresectable pancreatic tumors and centrally located liver malignancies can be treated with irreversible electroporation. This nonthermal ablation modality preserves the structure of the extracellular matrix including blood vessels and ducts. Technical advancements in the field of CT-guided interventions include the use of robotics, different tracking and navigation technologies and the use of augmented reality with the goal to achieve higher precision, shorter intervention time and thereby reduce radiation exposure. CONCLUSION Percutaneous ablation techniques under CT guidance are an essential part of interventional radiology and they are suited for local treatment of malignancies in most organ systems.
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Affiliation(s)
- Philipp Bruners
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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4
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Zlevor AM, Kisting MA, Couillard AB, Rossebo AE, Szczykutowicz TP, Mao L, White JK, Hartung MP, Gettle LM, Hinshaw JL, Pickhardt PJ, Ziemlewicz TJ, Foltz ML, Lee FT. Percutaneous CT-Guided Abdominal and Pelvic Biopsies: Comparison of an Electromagnetic Navigation System and CT Fluoroscopy. J Vasc Interv Radiol 2023; 34:910-918. [PMID: 36736821 DOI: 10.1016/j.jvir.2023.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/09/2023] [Accepted: 01/22/2023] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To compare electromagnetic navigation (EMN) with computed tomography (CT) fluoroscopy for guiding percutaneous biopsies in the abdomen and pelvis. MATERIALS AND METHODS A retrospective matched-cohort design was used to compare biopsies in the abdomen and pelvis performed with EMN (consecutive cases, n = 50; CT-Navigation; Imactis, Saint-Martin-d'Hères, France) with those performed with CT fluoroscopy (n = 100). Cases were matched 1:2 (EMN:CT fluoroscopy) for target organ and lesion size (±10 mm). RESULTS The population was well-matched (age, 65 vs 65 years; target size, 2.0 vs 2.1 cm; skin-to-target distance, 11.4 vs 10.7 cm; P > .05, EMN vs CT fluoroscopy, respectively). Technical success (98% vs 100%), diagnostic yield (98% vs 95%), adverse events (2% vs 5%), and procedure time (33 minutes vs 31 minutes) were not statistically different (P > .05). Operator radiation dose was less with EMN than with CT fluoroscopy (0.04 vs 1.2 μGy; P < .001), but patient dose was greater (30.1 vs 9.6 mSv; P < .001) owing to more helical scans during EMN guidance (3.9 vs 2.1; P < .001). CT fluoroscopy was performed with a mean of 29.7 tap scans per case. In 3 (3%) cases, CT fluoroscopy was performed with gantry tilt, and the mean angle out of plane for EMN cases was 13.4°. CONCLUSIONS Percutaneous biopsies guided by EMN and CT fluoroscopy were closely matched for technical success, diagnostic yield, procedure time, and adverse events in a matched cohort of patients. EMN cases were more likely to be performed outside of the gantry plane. Radiation dose to the operator was higher with CT fluoroscopy, and patient radiation dose was higher with EMN. Further study with a wider array of procedures and anatomic locations is warranted.
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Affiliation(s)
- Annie M Zlevor
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Meridith A Kisting
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Annika E Rossebo
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Timothy P Szczykutowicz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin
| | - James K White
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Michael P Hartung
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - J Louis Hinshaw
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Marcia L Foltz
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Fred T Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin; Department of Urology, University of Wisconsin-Madison, Madison, Wisconsin.
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Floridi C, Cellina M, Irmici G, Bruno A, Rossini N, Borgheresi A, Agostini A, Bruno F, Arrigoni F, Arrichiello A, Candelari R, Barile A, Carrafiello G, Giovagnoni A. Precision Imaging Guidance in the Era of Precision Oncology: An Update of Imaging Tools for Interventional Procedures. J Clin Med 2022; 11:4028. [PMID: 35887791 PMCID: PMC9322069 DOI: 10.3390/jcm11144028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/02/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023] Open
Abstract
Interventional oncology (IO) procedures have become extremely popular in interventional radiology (IR) and play an essential role in the diagnosis, treatment, and supportive care of oncologic patients through new and safe procedures. IR procedures can be divided into two main groups: vascular and non-vascular. Vascular approaches are mainly based on embolization and concomitant injection of chemotherapeutics directly into the tumor-feeding vessels. Percutaneous approaches are a type of non-vascular procedures and include percutaneous image-guided biopsies and different ablation techniques with radiofrequency, microwaves, cryoablation, and focused ultrasound. The use of these techniques requires precise imaging pretreatment planning and guidance that can be provided through different imaging techniques: ultrasound, computed tomography, cone-beam computed tomography, and magnetic resonance. These imaging modalities can be used alone or in combination, thanks to fusion imaging, to further improve the confidence of the operators and the efficacy and safety of the procedures. This article aims is to provide an overview of the available IO procedures based on clinical imaging guidance to develop a targeted and optimal approach to cancer patients.
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Affiliation(s)
- Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
| | - Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20122 Milan, Italy;
| | - Giovanni Irmici
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Nicolo’ Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Alessandra Borgheresi
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
| | - Andrea Agostini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Francesco Arrigoni
- Emergency and Interventional Radiology, San Salvatore Hospital, 67100 L’Aquila, Italy;
| | - Antonio Arrichiello
- Post-Graduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (G.I.); (A.A.)
| | - Roberto Candelari
- Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, 60126 Ancona, Italy;
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (F.B.); (A.B.)
| | - Gianpaolo Carrafiello
- Operative Unit of Radiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy;
- Department of Health Sciences, Università degli Studi di Milano, 20122 Milan, Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (A.B.); (N.R.); (A.A.); (A.G.)
- Division of Special and Pediatric Radiology, Department of Radiology, University Hospital “Umberto I—Lancisi—Salesi”, 60126 Ancona, Italy;
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Van den Bosch V, Salim HS, Chen NZ, Stroosma O, Bruners P, Kuhl CK, Pedersoli F, Isfort P. Augmented Reality-Assisted CT-Guided Puncture: A Phantom Study. Cardiovasc Intervent Radiol 2022; 45:1173-1177. [PMID: 35750863 PMCID: PMC9307551 DOI: 10.1007/s00270-022-03195-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/31/2022] [Indexed: 11/28/2022]
Abstract
Purpose To investigate the feasibility of a novel augmented reality system for CT-guided liver interventions and to compare it with free-hand interventions in a phantom setting. Methods and materials A newly developed augmented reality interface was used, with projection of CT-imaging in multiplanar reconstruction and live rendering of the needle position, a bull`s eye view of the needle trajectory and a visualization of the distance to the target. Punctures were performed on a custom-made abdominal phantom by three interventional radiologists with different levels of expertise. Time and needle placement accuracy were measured. Two-tailed Wilcoxon signed rank test (p < 0.05) was performed to evaluate intraparticipant difference. Results Intraparticipant puncture times were significantly shorter for each operator in the augmented reality condition (< 0.001 for the resident, < 0.001 for the junior staff member and 0.027 for the senior staff member). The junior staff member had an improvement in accuracy of 1 mm using augmented reality (p 0.026); the other two participants showed no significant improvement regarding accuracy. Conclusion In this small series, it appears that the novel augmented reality system may improve the speed of CT-guided punctures in the phantom model compared to the free-hand procedure while maintaining a similar accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00270-022-03195-y.
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Affiliation(s)
- Vincent Van den Bosch
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | | | - Njin-Zu Chen
- Philips Research Europe, Eindhoven, The Netherlands
| | | | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Federico Pedersoli
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany
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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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Tarantino S, Clemente F, De Simone A, Cipriani C. Feasibility of Tracking Multiple Implanted Magnets With a Myokinetic Control Interface: Simulation and Experimental Evidence Based on the Point Dipole Model. IEEE Trans Biomed Eng 2019; 67:1282-1292. [PMID: 31425017 DOI: 10.1109/tbme.2019.2935229] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The quest for an intuitive and physiologically appropriate human-machine interface for the control of dexterous prostheses is far from being completed. To control a hand prosthesis, a possible approach could consist in using information related to the displacement of forearm muscles of an amputee during contraction. We recently proposed that muscle displacement could be monitored by implanting passive magnetic markers (MMs- i.e., permanent magnets) in them. We dubbed this the myokinetic interface. However, besides the system feasibility, how much its accuracy, precision and computation time are affected by the number and distribution of both the MMs and the sensors used to record the MF was not quantified. METHODS Here we investigated, through simulations validated with a physical system, the performance of a system capable to track position and orientation of up to 9 MMs using information from up to 112 sensors in a volume resembling the dimensions of the human forearm. RESULTS The system was able to track up to 7 MMs in 450 ms, demonstrating position/orientation accuracies in the range of 1 mm/5°. The comparison with the experimental recordings demonstrated a median difference with the simulations in the order of 0.45 mm. CONCLUSION We were able to formulate general guidelines for the implementation of magnetic tracking systems. SIGNIFICANCE Our results pave the way towards the development of new human-machine interfaces for the control of artificial limbs, but they are also interesting for the whole range of biomedical engineering applications exploiting magnetic tracking.
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9
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Zhang Z, Shao G, Zheng J, Wen S, Zeng H, Hao W, Luo J, Guo L. Electromagnetic navigation to assist with computed tomography-guided thermal ablation of liver tumors. MINIM INVASIV THER 2019; 29:275-282. [PMID: 31393746 DOI: 10.1080/13645706.2019.1649699] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Purpose: To evaluate the advantages and primary technical efficacy of an electromagnetic (EM) navigation system for computed tomography (CT)-guided thermal ablation of liver tumors.Material and methods: From August 2016 to January 2018, 40 patients scheduled for CT- guided thermal ablation were prospectively enrolled and divided into two groups. Twenty patients underwent CT-guided thermal ablation with an EM navigation system (navigation group), while the other 20 patients underwent conventional CT-guided thermal ablation (control group). Data on skin punctures, instrument adjustments, puncture time to target, CT scans, CT fluoroscopy time and dose-length-product (DLP) were compared between the two groups. Any postoperative complications were recorded and the primary technical efficacy was evaluated four to six weeks after the procedure.Results: All 20 patients in the navigation group successfully underwent EM navigation. Compared to the control group, there were fewer instrument adjustments (mean 2.40 vs. 4.95; p = .003), fewer CT scans (mean 7.10 vs. 10.30; p = .006), less CT fluoroscopy time (mean 40.47 vs. 59.98 s, p = .046), and less DLP (mean 807.39 vs. 1578.67 mGy × cm; p = .001). Although not statistically significant, EM navigation resulted in fewer skin punctures (mean 1.20 vs. 1.25; p = .803) and slightly longer puncture time to target (mean 16.50 vs. 15.20 min; p = .725). No patients experienced major complications and the primary efficacy rate was 90% and 84.21% in the navigation and control groups, respectively (p = .661).Conclusions: EM navigation system optimizes the thermal ablation process and reduces radiation exposure in patients. However, further studies are warranted to determine whether an EM navigation system can improve procedure time, complication rates, and primary technical efficiacy of thermal ablation.
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Affiliation(s)
- Zhewei Zhang
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Guoliang Shao
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jiaping Zheng
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Song Wen
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Hui Zeng
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Weiyuan Hao
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Jun Luo
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Liwen Guo
- Department of Interventional Radiology, Zhejiang Cancer Hospital, Hangzhou, China
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Bing F, Vappou J, Breton E, Enescu I, Garnon J, Gangi A. Accuracy of a CT-Ultrasound Fusion Imaging Guidance System Used for Hepatic Percutaneous Procedures. J Vasc Interv Radiol 2019; 30:1013-1020. [PMID: 30922795 DOI: 10.1016/j.jvir.2018.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/10/2018] [Accepted: 11/10/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE To evaluate the accuracy of a fusion imaging guidance system using ultrasound (US) and computerized tomography (CT) as a real-time imaging modality for the positioning of a 22-gauge needle in the liver. MATERIALS AND METHODS The spatial coordinates of 23 spinal needles placed at the border of hepatic tumors before radiofrequency thermal ablation were determined in 23 patients. Needles were inserted up to the border of the tumor with the use of CT-US fusion imaging. A control CT scan was carried out to compare real (x, y, z) and virtual (x', y', z') coordinates of the tip of the needle (D for distal) and of a point on the needle located 3 cm proximally to the tip (P for proximal). RESULTS The mean Euclidian distances were 8.5 ± 4.7 mm and 10.5 ± 5.3 mm for D and P, respectively. The absolute value of mean differences of the 3 coordinates (|x' - x|, |y' - y|, and |z' - z|) were 4.06 ± 0.9, 4.21 ± 0.84, and 4.89 ± 0.89 mm for D and 3.96 ± 0.60, 4.41 ± 0.86, and 7.66 ± 1.27 mm for P. X = |x' - x| and Y = |y' - y| coordinates were <7 mm with a probability close to 1. Z = |z' - z| coordinate was not considered to be larger nor smaller than 7 mm (probability >7 mm close to 50%). CONCLUSIONS Positioning errors with the use of US-CT fusion imaging used in this study are not negligible for the insertion of a 22-gauge needle in the liver. Physicians must be aware of such possible errors to adapt the treatment when used for thermal ablation.
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Affiliation(s)
- Fabrice Bing
- Department of Radiology, Hôpital d'Annecy, 1 avenue de l'Hôpital, 74374 Metz-Tessy, France; ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France.
| | - Jonathan Vappou
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Elodie Breton
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France
| | - Iulian Enescu
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julien Garnon
- Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Afshin Gangi
- ICUBE Laboratory, Université de Strasbourg, Centre National de la Recherche Scientifique, Strasbourg, France; Interventional Radiology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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11
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Origami Lesion-Targeting Device for CT-Guided Interventions. J Imaging 2019; 5:jimaging5020023. [PMID: 34460471 PMCID: PMC8320902 DOI: 10.3390/jimaging5020023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to preliminarily evaluate a lesion-targeting device for CT-guided interventions. The device is created by laser cutting the structure from a sheet of medical grade paperboard, 3D printing two radiocontrast agent grids onto the surface and folding the structure into a rectangular prism with a viewing window. An abdominal imaging phantom was used to evaluate the device through CT imaging and the targeting of lesions for needle insertion. The lesion-targeting trials resulted in a mean targeting error of 2.53 mm (SD 0.59 mm, n = 30). The device is rigid enough to adequately support standard biopsy needles, and it attaches to the patient, reducing the risk of tissue laceration by needles held rigidly in place by an external manipulator. Additional advantages include adequate support for the insertion of multiple surgical tools at once for procedures such as composite ablation and the potential to guide off-axial needle insertion. The low-cost and disposability of the device make it well-suited for the minimally invasive image-guided therapy environment.
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12
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Li R, Xu S, Pritchard WF, Karanian JW, Krishnasamy VP, Wood BJ, Tse ZTH. AngleNav: MEMS Tracker to Facilitate CT-Guided Puncture. Ann Biomed Eng 2018; 46:452-463. [PMID: 29305735 DOI: 10.1007/s10439-017-1968-4] [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: 08/23/2017] [Accepted: 11/21/2017] [Indexed: 12/20/2022]
Abstract
As a low-cost needle navigation system, AngleNav may be used to improve the accuracy, speed, and ease of CT-guided needle punctures. The AngleNav hardware includes a wireless device with a microelectromechanical (MEMS) tracker that can be attached to any standard needle. The physician defines the target, desired needle path and skin entry point on a CT slice image. The accuracy of AngleNav was first tested in a 3D-printed calibration platform in a benchtop setting. An abdominal phantom study was then performed in a CT scanner to validate the accuracy of the device's angular measurement. Finally, an in vivo swine study was performed to guide the needle towards liver targets (n = 8). CT scans of the targets were used to quantify the angular errors and needle tip-to-targeting distance errors between the planned needle path and the final needle position. The MEMS tracker showed a mean angular error of 0.01° with a standard deviation (SD) of 0.62° in the benchtop setting. The abdominal phantom test showed a mean angular error of 0.87° with an SD of 1.19° and a mean tip-to-target distance error of 4.89 mm with an SD of 1.57 mm. The animal experiment resulted in a mean angular error of 6.6° with an SD of 1.9° and a mean tip-to-target distance error of 8.7 mm with an SD of 3.1 mm. These results demonstrated the feasibility of AngleNav for CT-guided interventional workflow. The angular and distance errors were reduced by 64.4 and 54.8% respectively if using AngleNav instead of freehand insertion, with a limited number of operators. AngleNav assisted the physicians to deliver accurate needle insertion during CT-guided intervention. The device could potentially reduce the learning curve for physicians to perform CT-guided needle targeting.
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Affiliation(s)
- Rui Li
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA
| | - Sheng Xu
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - William F Pritchard
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - John W Karanian
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | | | - Bradford J Wood
- Center for Interventional Oncology, National Institute of Health, Bethesda, MD, USA
| | - Zion Tsz Ho Tse
- School of Electrical and Computer Engineering, The University of Georgia, Athens, GA, 30602, USA. .,3T Technologies, LLC, Marietta, GA, 30067, USA.
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13
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Park BK. Low-dose CT protocols for guiding radiofrequency ablation for the treatment of small renal cell carcinomas. Int J Hyperthermia 2017; 34:877-882. [PMID: 28847190 DOI: 10.1080/02656736.2017.1373408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Computed tomography (CT)-guided radiofrequency ablation (RFA) results in a high radiation dose. This study aimed to assess low-dose CT protocols for guiding RFA and oncologic outcomes for the treatment of small renal cell carcinoma (RCC). MATERIALS AND METHODS Between December 2011 and December 2014, CT-guided RFA was performed in 31 patients with 31 biopsy-proven RCCs (median, 2.1 cm). RFA included planning, targeting, monitoring and survey phases. The dose length product (DLP), CT dose index volume (CTDIvol), effective dose, number of scans, scan range, tube current and exposure time of RFA phases were compared. The 3-year recurrence-free survival rate was recorded. Nonparametric or parametric repeated-measures ANOVA with Dunn's or Tukey-Kramer multiple comparisons and Kaplan-Meier analysis were used for statistical analysis. RESULTS The median total DLP, CTDIvol and effective dose of CT-guided RFA procedures per session were 1238.8 mGy (range 517.4-3391.7 mGy), 259.7 mGy (10.7-67.9 mGy) and 18.6 mSv (7.8-50.9 mSv), respectively. The median DLP, CTDIvol, effective dose, number of scans, tube current and exposure time during the targeting phase were higher than those during the other phases (p < 0.001). The scan range in the targeting phase was the same as that in the monitoring phase (p > 0.05) but smaller than those in the planning and survey phases (p < 0.001). The 3-year recurrence-free survival rate was 96.7%. CONCLUSIONS Low-dose CT protocols for guiding RFA may reduce radiation dose without compromising oncologic outcomes. Reducing the number of scans during the targeting phase contributes to dose reduction.
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Affiliation(s)
- Byung Kwan Park
- a Department of Radiology , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , Republic of Korea
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14
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Penzkofer T, Na HS, Isfort P, Wilkmann C, Osterhues S, Besting A, Hänisch C, Bisplinghoff S, Jansing J, von Werder S, Gooding J, de la Fuente M, Mahnken AH, Disselhorst-Klug C, Schmitz-Rode T, Kuhl C, Bruners P. Electromagnetically Navigated In Situ Fenestration of Aortic Stent Grafts: Pilot Animal Study of a Novel Fenestrated EVAR Approach. Cardiovasc Intervent Radiol 2017; 41:170-176. [DOI: 10.1007/s00270-017-1769-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 08/09/2017] [Indexed: 01/20/2023]
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Durand P, Moreau-Gaudry A, Silvent AS, Frandon J, Chipon E, Médici M, Bricault I. Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial. PLoS One 2017; 12:e0173751. [PMID: 28296957 PMCID: PMC5351986 DOI: 10.1371/journal.pone.0173751] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/22/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the accuracy and usability of an electromagnetic navigation system designed to assist Computed Tomography (CT) guided interventions. Materials and methods 120 patients requiring a percutaneous CT intervention (drainage, biopsy, tumor ablation, infiltration, sympathicolysis) were included in this prospective randomized trial. Nineteen radiologists participated. Conventional procedures (CT group) were compared with procedures assisted by a navigation system prototype using an electromagnetic localizer to track the position and orientation of a needle holder (NAV group). The navigation system displays the needle path in real-time on 2D reconstructed CT images extracted from the 3D CT volume. The regional ethics committee approved this study and all patients gave written informed consent. The main outcome was the distance between the planned trajectory and the achieved needle trajectory calculated from the initial needle placement. Results 120 patients were analyzable in intention-to-treat (NAV: 60; CT: 60). Accuracy improved when the navigation system was used: distance error (in millimeters: median[P25%; P75%]) with NAV = 4.1[2.7; 9.1], vs. with CT = 8.9[4.9; 15.1] (p<0.001). After the initial needle placement and first control CT, fewer subsequent CT acquisitions were necessary to reach the target using the navigation system: NAV = 2[2; 3]; CT = 3[2; 4] (p = 0.01). Conclusion The tested system was usable in a standard clinical setting and provided significant improvement in accuracy; furthermore, with the help of navigation, targets could be reached with fewer CT control acquisitions.
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Affiliation(s)
- Pierre Durand
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, University Grenoble Alpes, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, National Center for Scientific Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Anne-Sophie Silvent
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
- * E-mail:
| | - Julien Frandon
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
| | - Emilie Chipon
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Maud Médici
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
| | - Ivan Bricault
- Department of Imaging, Radiology and Medical Imaging, University Hospital, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, University Grenoble Alpes, Grenoble, France
- Laboratory of Techniques for biomedical engineering and complexity management – informatics, mathematics and applications, National Center for Scientific Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, National Institute of Health and Medical Research, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Department of Public Health, University Hospital, Grenoble, France
- Clinical Investigation Center - Innovative Technology 1406, Research Department, University Hospital, Grenoble, France
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16
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Isfort P, Penzkofer T, Wilkmann C, Na HS, Kotzlowski C, Ito N, Pfeffer JG, Bisplinghoff S, Osterhues S, Besting A, Gooding J, Schmitz-Rode T, Kuhl C, Mahnken AH, Bruners P. Feasibility of electromagnetically guided transjugular intrahepatic portosystemic shunt procedure. MINIM INVASIV THER 2016; 26:15-22. [PMID: 27686414 DOI: 10.1080/13645706.2016.1214155] [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: 10/21/2022]
Abstract
OBJECTIVES To develop an electromagnetic navigation technology for transjugular intrahepatic portosystemic shunt (TIPS) creation and translate it from phantom to an in-vivo large animal setting. MATERIAL AND METHODS A custom-designed device for TIPS creation consisting of a stylet within a 5 French catheter as well as a software prototype were developed that allow real-time tip tracking of both stylet and catheter using an electromagnetic tracking system. Feasibility of navigated TIPSS creation was tested in a phantom by two interventional radiologists (A/B) followed by in-vivo testing evaluation in eight domestic pigs. Procedure duration and number of attempts needed for puncture of the portal vein were recorded. RESULTS In the phantom setting, intervention time to gain access to the portal vein (PV) was 144 ± 67 s (A) and 122 ± 51 s (B), respectively. In the in-vivo trials, TIPS could be successfully completed in five out of eight animals. Mean time for the complete TIPS was 245 ± 205 minutes with a notable learning curve towards the last animal. CONCLUSIONS TIPS creation with the use of electromagnetic tracking technology proved to be feasible in-vitro as well as in-vivo. The system may be useful to facilitate challenging TIPSS procedures.
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Affiliation(s)
- Peter Isfort
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Tobias Penzkofer
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany.,b Surgical Planning Laboratory , Brigham and Women's Hospital , Boston , MA , USA.,c Diagnostic and Interventional Radiology , Charité Universitätsmedizin Berlin , Berlin , Germany
| | - Christoph Wilkmann
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Hong-Sik Na
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Christian Kotzlowski
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Nobutake Ito
- d Department of Radiology , Keio University , Tokyo , Japan.,e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Joachim Georg Pfeffer
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | | | | | | | - Jorge Gooding
- e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Thomas Schmitz-Rode
- e Applied Medical Engineering , RWTH Aachen University Hospital , Aachen , Germany
| | - Christiane Kuhl
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
| | - Andreas Horst Mahnken
- i Department of Diagnostic and Interventional Radiology , Philips University Hospital , Marburg , Germany
| | - Philipp Bruners
- a Diagnostic and Interventional Radiology , RWTH Aachen University Hospital , Aachen , Germany
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17
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Pishnamaz M, Wilkmann C, Na HS, Pfeffer J, Hänisch C, Janssen M, Bruners P, Kobbe P, Hildebrand F, Schmitz-Rode T, Pape HC. Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques. PLoS One 2016; 11:e0148199. [PMID: 26863310 PMCID: PMC4749384 DOI: 10.1371/journal.pone.0148199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022] Open
Abstract
Background Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures. Methods Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05. Results 160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001). Conclusion Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.
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MESH Headings
- Biomimetic Materials/chemistry
- Bone Screws
- Electromagnetic Radiation
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/methods
- Fractures, Bone/diagnostic imaging
- Fractures, Bone/pathology
- Fractures, Bone/surgery
- Humans
- Ilium/diagnostic imaging
- Ilium/pathology
- Ilium/surgery
- Imaging, Three-Dimensional/instrumentation
- Imaging, Three-Dimensional/methods
- Models, Anatomic
- Sacrum/diagnostic imaging
- Sacrum/pathology
- Sacrum/surgery
- Surgery, Computer-Assisted/instrumentation
- Surgery, Computer-Assisted/methods
- Time Factors
- Tomography, X-Ray Computed/instrumentation
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Miguel Pishnamaz
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
- * E-mail:
| | - Christoph Wilkmann
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
- Helmholtz Institute of RWTH Aachen University & Hospital, Institute of Applied Medical Engineering, Aachen, Germany
| | - Hong-Sik Na
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Jochen Pfeffer
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Christoph Hänisch
- Helmholtz Institute of RWTH Aachen University & Hospital, Chair of Medical Engineering, Aachen, Germany
| | - Max Janssen
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Philipp Bruners
- University of Aachen Medical Center, Department of Diagnostic and Interventional Radiology, Aachen, Germany
| | - Philipp Kobbe
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Frank Hildebrand
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
| | - Thomas Schmitz-Rode
- Helmholtz Institute of RWTH Aachen University & Hospital, Institute of Applied Medical Engineering, Aachen, Germany
| | - Hans-Christoph Pape
- University of Aachen Medical Center, Department of Orthopedic Trauma, Aachen, Germany
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Chehab MA, Brinjikji W, Copelan A, Venkatesan AM. Navigational Tools for Interventional Radiology and Interventional Oncology Applications. Semin Intervent Radiol 2015; 32:416-27. [PMID: 26622105 DOI: 10.1055/s-0035-1564705] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The interventional radiologist is increasingly called upon to successfully access challenging biopsy and ablation targets, which may be difficult based on poor visualization, small size, or the proximity of vulnerable regional anatomy. Complex therapeutic procedures, including tumor ablation and transarterial oncologic therapies, can be associated with procedural risk, significant procedure time, and measurable radiation time. Navigation tools, including electromagnetic, optical, laser, and robotic guidance systems, as well as image fusion platforms, have the potential to facilitate these complex interventions with the potential to improve lesion targeting, reduce procedure time, and radiation dose, and thus potentially improve patient outcomes. This review will provide an overview of currently available navigational tools and their application to interventional radiology and oncology. A summary of the pertinent literature on the use of these tools to improve safety and efficacy of interventional procedures compared with conventional techniques will be presented.
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Affiliation(s)
- Monzer A Chehab
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | | | - Alexander Copelan
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
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19
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Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, Wong S, Shih AJ, Webster RJ, Fischer GS, Nagrath S, Davis SE, White SB, Ahrar K. Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel. J Vasc Interv Radiol 2015; 27:8-19. [PMID: 26626860 DOI: 10.1016/j.jvir.2015.10.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 10/23/2015] [Accepted: 10/23/2015] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alda L Tam
- Departments of Interventional Radiology, Houston, Texas.
| | - Howard J Lim
- Division of Medical Oncology, University of British Columbia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | - Anobel Tamrazi
- Division of Vascular and Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael D Kuo
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Etay Ziv
- Departments of Interventional Radiology and Computational Biology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Stephen Wong
- Department of Systems Medicine & Bioengineering, Houston Methodist Research Institute, Houston, Texas
| | - Albert J Shih
- Departments of Mechanical and Biomechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, Tennessee
| | - Gregory S Fischer
- Automation and Interventional Medicine Robotics Lab, Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Sunitha Nagrath
- Chemical and Biomedical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Suzanne E Davis
- Division of Cancer Medicine, Research Planning and Development, University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sarah B White
- Department of Systems Medicine & Bioengineering, Houston Methodist Research Institute, Houston, Texas; Departments of Radiology, Neuroscience, Pathology & Laboratory Medicine, Weill Cornell Medical College of Cornell University, New York, New York; Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kamran Ahrar
- Departments of Interventional Radiology, Houston, Texas
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20
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Gruber-Rouh T, Schulz B, Eichler K, Naguib NNN, Vogl TJ, Zangos S. Radiation dose and quickness of needle CT-interventions using a laser navigation system (LNS) compared with conventional method. Eur J Radiol 2015. [PMID: 26210096 DOI: 10.1016/j.ejrad.2015.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to analyse the radiation dose and quickness of needle interventions using a Laser Navigation System (LNS-group) compared with conventional method (control-group). MATERIALS AND METHODS In this prospective, randomized, comparative study 58 patients (19 females, 39 males; mean age, 62.9 years) were punctured either with LNS (n=29) or with conventional method with a skin mark of the puncture site (n=29). In the LNS method the puncture site was marked with laser without additional CT. Thoracic and abdominal intervention was performed in 30 and 28 patients, respectively. Radiation dose and time of the procedures were analysed. Statistical significance was calculated according to the Mann-Whitney-U-test. RESULTS Mean target access path in the patients of the LNS group was 6.0 cm (range, 3.0-10.1cm) and in the control group 6.0 cm (range, 1.0-10.3 cm). Time duration of complete intervention in the LNS group was 20:25 min (range, 07:00-34:00 min) and in the control group 28:00 min (range, 13:00-51:00 min). The dose-length-product (DLP) of intervention scan of the LNS group was 42.3 mGy cm (range, 10-125 mGy cm), and of the control group 59.7 mGy cm (range, 25-176.42 mGy cm). CONCLUSION Using the LNS for CT-guided interventions results in faster intervention time with a lower dose.
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Affiliation(s)
- T Gruber-Rouh
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - B Schulz
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - K Eichler
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Nagy N N Naguib
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany; Department of Radiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - T J Vogl
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - S Zangos
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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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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Franz AM, Haidegger T, Birkfellner W, Cleary K, Peters TM, Maier-Hein L. Electromagnetic tracking in medicine--a review of technology, validation, and applications. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1702-1725. [PMID: 24816547 DOI: 10.1109/tmi.2014.2321777] [Citation(s) in RCA: 190] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without line-of-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.
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Wilkmann C, Ito N, Penzkofer T, Isfort P, Na HS, Hennes M, Disselhorst-Klug C, Mahnken AH, Kuhl CK, Bruners P. A miniature accelerometer-based guidance device for percutaneous computed tomography-guided punctures. Int J Comput Assist Radiol Surg 2014; 10:629-36. [PMID: 24972731 DOI: 10.1007/s11548-014-1096-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Percutaneous punctures are often performed under computed tomography (CT) guidance using a freehand method. Especially in challenging cases, initial accuracy of the needle placement is highly dependent on the radiologist's experience. Thus, a miniature lightweight guidance device was developed which is capable of assisting a radiologist during the needle placement process. METHODS The device utilizes an accelerometer to measure the needle's tilt by calculating a set of orientation angles. This set can be matched with the coordinate system of the CT imaging software during a simple alignment process. After that, the needle's orientation can be expressed in terms of projected angles in the axial and sagittal planes. The accuracy of the device was evaluated in a phantom study, and initial clinical trials were carried out performing facet joint punctures in a swine cadaver. RESULTS The sensor was embedded in a cube with dimensions of [Formula: see text] and a total weight of about 11 g which can be attached to the puncture needle at its rear end or handgrip. A graphical user interface (GUÌ) has been created offering visual real-time orientation guidance. Results of the phantom experiments showed differences between planned target and performed puncture angles of [Formula: see text] for in-plane and [Formula: see text] for out-of-plane punctures. CONCLUSION The results of the phantom and ex vivo study suggest that the device is useful to assist a radiologist in CT-guided percutaneous punctures and helps navigating the needle with high precision.
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Affiliation(s)
- Christoph Wilkmann
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 , Aachen, Germany,
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Maybody M, Stevenson C, Solomon SB. Overview of navigation systems in image-guided interventions. Tech Vasc Interv Radiol 2014; 16:136-43. [PMID: 23993075 DOI: 10.1053/j.tvir.2013.02.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
With the advent of new imaging technologies, physicians are urged to intervene on targets that are either undetectable previously or have challenging locations. The common practice of "expectant observation" is losing its appeal to many physicians as more and more of the previously "impossible to treat" lesions are within reach of operators. Navigation systems are a wide range of devices with different levels of complexity in design and function that are utilized to help operators to overcome challenges they confront in different clinical scenarios. With the help of these systems, operators can potentially improve clinical outcome of image-guided interventions. We present an overview of navigation in today's medicine and review some of the currently available systems.
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Affiliation(s)
- Majid Maybody
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
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Appelbaum L, Mahgerefteh SY, Sosna J, Goldberg SN. Image-Guided Fusion and Navigation: Applications in Tumor Ablation. Tech Vasc Interv Radiol 2013; 16:287-95. [DOI: 10.1053/j.tvir.2013.08.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Multimodality Fusion with MRI, CT, and Ultrasound Contrast for Ablation of Renal Cell Carcinoma. Case Rep Urol 2012; 2012:390912. [PMID: 23304625 PMCID: PMC3532915 DOI: 10.1155/2012/390912] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/14/2012] [Indexed: 11/30/2022] Open
Abstract
Fusion technology with electromagnetic (EM) tracking enables navigation with multimodality feedback that lets the operator use different modalities during different parts of the image-guided procedure. This may be particularly helpful in patients with renal insufficiency undergoing kidney tumor ablation, in whom there is a desire to minimize or avoid nephrotoxic iodinated contrast exposure. EM tracking software merges and fuses different imaging modalities such as MRI, CT, and ultrasound and can also display the position of needles in real time in relation to preprocedure imaging, which may better define tumor targets than available intraoperative imaging. EM tracking was successfully used to ablate a poorly visualized renal tumor, through the combined use of CT, gadolinium-enhanced MR, and contrast-enhanced US imaging to localize the tumor.
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Abi-Jaoudeh N, Kruecker J, Kadoury S, Kobeiter H, Venkatesan AM, Levy E, Wood BJ. Multimodality image fusion-guided procedures: technique, accuracy, and applications. Cardiovasc Intervent Radiol 2012; 35:986-98. [PMID: 22851166 PMCID: PMC3447988 DOI: 10.1007/s00270-012-0446-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 06/09/2012] [Indexed: 12/19/2022]
Abstract
Personalized therapies play an increasingly critical role in cancer care: Image guidance with multimodality image fusion facilitates the targeting of specific tissue for tissue characterization and plays a role in drug discovery and optimization of tailored therapies. Positron-emission tomography (PET), magnetic resonance imaging (MRI), and contrast-enhanced computed tomography (CT) may offer additional information not otherwise available to the operator during minimally invasive image-guided procedures, such as biopsy and ablation. With use of multimodality image fusion for image-guided interventions, navigation with advanced modalities does not require the physical presence of the PET, MRI, or CT imaging system. Several commercially available methods of image-fusion and device navigation are reviewed along with an explanation of common tracking hardware and software. An overview of current clinical applications for multimodality navigation is provided.
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Affiliation(s)
- Nadine Abi-Jaoudeh
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA.
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