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Fong KY, Tan ASM, Bin Sulaiman MS, Leong SH, Ng KW, Too CW. Phantom and Animal Study of a Robot-Assisted, CT-Guided Targeting System using Image-Only Navigation for Stereotactic Needle Insertion without Positional Sensors. J Vasc Interv Radiol 2022; 33:1416-1423.e4. [PMID: 35970505 DOI: 10.1016/j.jvir.2022.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/11/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To evaluate the feasibility and accuracy of a robotic system to integrate and map computed tomography (CT) and robotic coordinates, followed by automatic trajectory execution by a robotic arm. The system was hypothesized to achieve a targeting error of <5 mm without significant influence from variations in angulation or depth. MATERIALS AND METHODS An experimental study was conducted using a robotic system (Automated Needle Targeting device for CT [ANT-C]) for needle insertions into a phantom model on both moving patient table and moving gantry CT scanners. Eight spherical markers were registered as targets for 90 insertions at different trajectories. After a single ANT-C registration, the closed-loop software targeted multiple markers via the insertion of robotically aligned 18-gauge needles. Accuracy (distance from the needle tip to the target) was assessed by postinsertion CT scans. Similar procedures were repeated to guide 10 needle insertions into a porcine lung. A regression analysis was performed to test the effect of needle angulation and insertion depth on the accuracy of insertion. RESULTS In the phantom model, all needle insertions (median trajectory depth, 64.8 mm; range, 46.1-153 mm) were successfully performed in single attempts. The overall accuracy was 1.36 mm ± 0.53, which did not differ between the 2 types of CT scanners (1.39 mm ± 0.54 [moving patient table CT] vs 1.33 mm ± 0.52 [moving gantry CT]; P = .54) and was not significantly affected by the needle angulation and insertion depth. The accuracy for the porcine model was 9.09 mm ± 4.21. CONCLUSIONS Robot-assisted needle insertion using the ANT-C robotic device was feasible and accurate for targeting multiple markers in a phantom model.
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Affiliation(s)
- Khi Yung Fong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alexander Sheng Ming Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore
| | | | | | - Ka Wei Ng
- NDR Medical Technology Pvt Ltd, Singapore
| | - Chow Wei Too
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Singapore; Radiological Sciences Academic Clinical Program, SingHealth-Duke-NUS Academic Medical Centre, Singapore.
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Electromagnetic Navigation in Craniofacial Surgery Based on Automatic Registration of Dental Splints. J Craniofac Surg 2020; 31:393-396. [PMID: 31842079 DOI: 10.1097/scs.0000000000006038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Optical navigation method cannot be used in partial craniofacial surgery due to light blocking. At present, electromagnetic navigation method can be used instead. The occlusal splint obtained from the patient's dental mold is used in the traditional electromagnetic navigation registration. Then, marker points are selected manually for registration through imaging data during the operation, which leads to the deviation of selection. In this study, the self-developed registration software was used to perform automatic registration in the intraoperative registration. Experimental results showed that it has higher accuracy and faster speed, and is suitable for the actual operation process in clinical environment compared with the traditional manual registration.
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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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Madoff DC, Gaba RC, Weber CN, Clark TWI, Saad WE. Portal Venous Interventions: State of the Art. Radiology 2016; 278:333-53. [PMID: 26789601 DOI: 10.1148/radiol.2015141858] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In recent decades, there have been numerous advances in the management of liver cancer, cirrhosis, and diabetes mellitus. Although these diseases are wide ranging in their clinical manifestations, each can potentially be treated by exploiting the blood flow dynamics within the portal venous system, and in some cases, adding cellular therapies. To aid in the management of these disease states, minimally invasive transcatheter portal venous interventions have been developed to improve the safety of major hepatic resection, to reduce the untoward effects of sequelae from end-stage liver disease, and to minimize the requirement of exogenously administered insulin for patients with diabetes mellitus. This state of the art review therefore provides an overview of the most recent data and strategies for utilization of preoperative portal vein embolization, transjugular intrahepatic portosystemic shunt placement, balloon retrograde transvenous obliteration, and islet cell transplantation.
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Affiliation(s)
- David C Madoff
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Ron C Gaba
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Charles N Weber
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Timothy W I Clark
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
| | - Wael E Saad
- From the Department of Radiology, Division of Interventional Radiology, New York-Presbyterian Hospital/Weill Cornell Medical Center, 525 E 68th St, P-518, New York, NY 10065 (D.C.M.); Department of Radiology, Interventional Radiology Section, University of Illinois Hospital, Chicago, Ill (R.C.G.); Department of Radiology, University of Pennsylvania School of Medicine, Penn Presbyterian Medical Center, Philadelphia, Pa (C.N.W., T.W.I.C.); and Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, Ann Arbor, Mich (W.E.S.)
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Penzkofer T, Isfort P, Na HS, 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 CK, Bruners P. Technical concepts for vascular electromagnetic navigated interventions: Aortic in situ fenestration and transjugular intrahepatic porto-systemic shunts. ACTA ACUST UNITED AC 2014; 59:153-63. [DOI: 10.1515/bmt-2013-0045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 10/07/2013] [Indexed: 12/23/2022]
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Luo Z, Cai J, Wang S, Zhao Q, Peters TM, Gu L. Magnetic navigation for thoracic aortic stent-graft deployment using ultrasound image guidance. IEEE Trans Biomed Eng 2012. [PMID: 23193229 DOI: 10.1109/tbme.2012.2206388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We propose a system for thoracic aortic stent-graft deployment that employs a magnetic tracking system (MTS) and intraoperative ultrasound (US). A preoperative plan is first performed using a general public utilities-accelerated cardiac modeling method to determine the target position of the stent-graft. During the surgery, an MTS is employed to track sensors embedded in the catheter, cannula, and the US probe, while a fiducial landmark based registration is used to map the patient's coordinate to the image coordinate. The surgical target is tracked in real time via a calibrated intraoperative US image. Under the guidance of the MTS integrated with the real-time US images, the stent-graft can be deployed to the target position without the use of ionizing radiation. This navigation approach was validated using both phantom and animal studies. In the phantom study, we demonstrate a US calibration accuracy of 1.5 ± 0.47 mm, and a deployment error of 1.4 ± 0.16 mm. In the animal study, we performed experiments on five porcine subjects and recorded fiducial, target, and deployment errors of 2.5 ± 0.32, 4.2 ± 0.78, and 2.43 ± 0.69 mm, respectively. These results demonstrate that delivery and deployment of thoracic stent-graft under MTS-guided navigation using US imaging is feasible and appropriate for clinical application.
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Affiliation(s)
- Zhe Luo
- Image Guided Surgery and Therapy Laboratory, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.
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Bipolar radio frequency ablation of spinal neoplasms in late stage cancer disease: a report of three cases. Spine (Phila Pa 1976) 2012; 37:E64-8. [PMID: 21508889 DOI: 10.1097/brs.0b013e31821cc57e] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To avoid neuronal damage by using the bipolar radio frequency ablation of spinal tumors. SUMMARY OF BACKGROUND DATA Radio frequency ablation of tumorous masses is an established procedure and is increasingly used as pain therapy of unresectable spine tumors. Ablation of lesions adjacent to vulnerable structures remains a challenging task because flow of current is insufficiently controlled by monopolar probes. Using this technique, a prediction of the induced necrosis accurate to the millimeter is not feasible. METHODS Three patients with metastases of the spine were treated using the bipolar radio frequency ablation. RESULTS In all 3 cases collateral damage of neuronal structures could be avoided even though tumorous masses touched the cauda equina or were very close to vulnerable structures, respectively. The induction of necrosis was predictable to the millimeter. CONCLUSION Ablation of tumorous masses adjacent to neural structures by bipolar technique, is feasible and predictable. Spinal cord damage can be avoided by exact planning of the induced necrosis.
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Lei P, Moeslein F, Wood BJ, Shekhar R. Real-time tracking of liver motion and deformation using a flexible needle. Int J Comput Assist Radiol Surg 2010; 6:435-46. [PMID: 20700662 DOI: 10.1007/s11548-010-0523-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/14/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE A real-time 3D image guidance system is needed to facilitate treatment of liver masses using radiofrequency ablation, for example. This study investigates the feasibility and accuracy of using an electromagnetically tracked flexible needle inserted into the liver to track liver motion and deformation. METHODS This proof-of-principle study was conducted both ex vivo and in vivo with a CT scanner taking the place of an electromagnetic tracking system as the spatial tracker. Deformations of excised livers were artificially created by altering the shape of the stage on which the excised livers rested. Free breathing or controlled ventilation created deformations of live swine livers. The positions of the needle and test targets were determined through CT scans. The shape of the needle was reconstructed using data simulating multiple embedded electromagnetic sensors. Displacement of liver tissues in the vicinity of the needle was derived from the change in the reconstructed shape of the needle. RESULTS The needle shape was successfully reconstructed with tracking information of two on-needle points. Within 30 mm of the needle, the registration error of implanted test targets was 2.4 ± 1.0 mm ex vivo and 2.8 ± 1.5 mm in vivo. CONCLUSION A practical approach was developed to measure the motion and deformation of the liver in real time within a region of interest. The approach relies on redesigning the often-used seeker needle to include embedded electromagnetic tracking sensors. With the nonrigid motion and deformation information of the tracked needle, a single- or multimodality 3D image of the intraprocedural liver, now clinically obtained with some delay, can be updated continuously to monitor intraprocedural changes in hepatic anatomy. This capability may be useful in radiofrequency ablation and other percutaneous ablative procedures.
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Affiliation(s)
- Peng Lei
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Abi-Jaoudeh N, Glossop N, Dake M, Pritchard WF, Chiesa A, Dreher MR, Tang T, Karanian JW, Wood BJ. Electromagnetic navigation for thoracic aortic stent-graft deployment: a pilot study in swine. J Vasc Interv Radiol 2010; 21:888-95. [PMID: 20382032 DOI: 10.1016/j.jvir.2009.12.402] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 12/05/2009] [Accepted: 12/18/2009] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the feasibility of electromagnetic tracking as a method to augment conventional imaging guidance for the safe delivery, precise positioning, and accurate deployment of thoracic aortic endografts. MATERIALS AND METHODS Custom guide wires were fabricated, and the delivery catheters for thoracic aortic endoprostheses were retrofitted with integrated electromagnetic coil sensors to enable real-time endovascular tracking. Preprocedure thoracic computed tomographic (CT) angiograms were obtained after the placement of fiducial skin patches on the chest wall of three anesthetized swine, enabling automatic registration. The stent-graft deployment location target near the subclavian artery was selected on the preprocedure CT angiogram. Two steps were analyzed: advancing a tracked glidewire to the aortic arch and positioning the tracked stent-graft assembly by using electromagnetic guidance alone. Multiple CT scans were obtained to evaluate the accuracy of the electromagnetic tracking system by measuring the target registration error, which compared the actual position of the tracked devices to the displayed "virtual" electromagnetic-tracked position. Postdeployment CT angiography and necropsy helped confirm stent-graft position and subclavian artery patency. RESULTS A stent-graft was successfully delivered and deployed in each of the three animals by using real-time electromagnetic tracking alone. The mean fiducial registration error with autoregistration was 1.5 mm. Sixteen comparative scans were obtained to determine the target registration error, which was 4.3 mm +/- 0.97 (range, 3.0-6.0 mm) for the glidewire sensor coil. The mean target registration error for the stent-graft delivery catheter sensor coil was 2.6 mm +/- 0.7 (range, 1.9-3.8 mm). The mean deployment error for the stent-graft, defined as deployment deviation from the target, was 2.6 mm +/- 3.0. CONCLUSIONS Delivery and deployment of customized thoracic stent-grafts with use of electromagnetic tracking alone is feasible and accurate in swine. Combining endovascular electromagnetic tracking with conventional fluoroscopy may further improve accuracy and be a more realistic multimodality approach.
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Affiliation(s)
- Nadine Abi-Jaoudeh
- Department of Radiology and Imaging Sciences, National Institutes of Health, Rm 1C365 MSC 1182 10 Center Dr, 9000 Rockville Pike, Bethesda, MD 20890, USA.
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Regalado S, Erickson SJ, Zhu B, Ge J, Godavarty A. Automated coregistered imaging using a hand-held probe-based optical imager. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2010; 81:023702. [PMID: 20192497 DOI: 10.1063/1.3271019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Near-infrared optical imaging holds a promise as a noninvasive technology toward cancer diagnostics and other tissue imaging applications. In recent years, hand-held based imagers are of great interest toward the clinical translation of the technology. However hand-held imagers developed to date are typically designed to obtain surface images and not tomography information due to lack of coregistration facilities. Herein, a recently developed hand-held probe-based optical imager in our Optical Imaging Laboratory has been implemented with novel coregistration facilities toward real-time and tomographic imaging of tissue phantoms. Continuous-wave fluorescence-enhanced optical imaging studies were performed using an intensified charge coupled device camera based imaging system in order to demonstrate the feasibility of automated coregistered imaging of flat phantom surfaces, using a flexible probe that can also contour to curvatures. Three-dimensional fluorescence tomographic reconstructions were also demonstrated using coregistered frequency-domain measurements obtained using the hand-held based optical imager. It was also observed from preliminary studies on cubical phantoms that multiple coregistered scans differentiated deeper targets (approximately 3 cm) from artifacts that were not feasible from a single coregistered scan, demonstrating the possibility of improved target depth detectability in the future.
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Affiliation(s)
- Steven Regalado
- Department of Biomedical Engineering, Optical Imaging Laboratory, Florida International University, Miami, Florida 33174, USA
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Kalogeropoulou C, Kallidonis P, Liatsikos EN. Imaging in percutaneous nephrolithotomy. J Endourol 2009; 23:1571-7. [PMID: 19630501 DOI: 10.1089/end.2009.1521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Image guidance is a critical factor for the performance of urologic interventions. Percutaneous minimally invasive procedures have been developed and are being used with constantly increasing frequency. Procedures such as percutaneous nephrolithotomy (PCNL) are not performed without any image guidance. Recent developments in medical imaging, such as three-dimensional radiographic fluoroscopy, CT, and magnetic resonance (MR) fluoroscopy, four-dimensional ultrasonography, and image fusion techniques, propose a new generation of image-guidance tools that promise to improve patient care. These developments have been used or have the potential to be used in PCNL and other urologic interventional procedures. Moreover, advanced needles and needle guidance systems provide a new perspective for the nephrolithotomy suite of the future. The current review presents existing imaging technology in PCNL and interventional urology as well as advanced imaging techniques that are being or are expected to be evaluated in PCNL practice.
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Electromagnetic tracking for CT-guided spine interventions: phantom, ex-vivo and in-vivo results. Eur Radiol 2008; 19:990-4. [PMID: 19043720 DOI: 10.1007/s00330-008-1227-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Accepted: 10/20/2008] [Indexed: 01/25/2023]
Abstract
An electromagnetic-based tracking and navigation system was evaluated for interventional radiology. The electromagnetic tracking system (CAPPA IRAD EMT, CASinnovations, Erlangen, Germany) was used for real-time monitoring of punctures of the lumbar facet joints and intervertebral disks in a spine phantom, three pig cadavers and three anaesthesized pigs. Therefore, pre-interventional computed tomography (CT) datasets were transferred to the navigation system and puncture trajectories were planned. A coaxial needle was advanced along the trajectories while the position of the needle tip was monitored in real time. After puncture tracts were marked with pieces of wire another CT examination was performed and distances between wires and anatomical targets were measured. Performing punctures of the facet joints mean needle positioning errors were 0.4 +/- 0.8 mm in the spine phantom, 2.8 +/- 2.1 mm ex vivo and 3.0 +/- 2.0 mm in vivo with mean length of the puncture tract of 54.0 +/- 10.4 mm (phantom), 51.6 +/- 12.6 mm (ex vivo) and 50.9 +/- 17.6 mm (in vivo). At first attempt, intervertebral discs were successfully punctured in 15/15 in the phantom study, in 12/15 in the ex-vivo study and 14/15 in the in-vivo study, respectively. Immobilization of the patient and optimal positioning of the field generator are essential to achieve a high accuracy of needle placement in a clinical CT setting.
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