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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:jcm11144028. [PMID: 35887791 PMCID: PMC9322069 DOI: 10.3390/jcm11144028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [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;
- Correspondence:
| | - 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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Ma L, Liang H, Han B, Yang S, Zhang X, Liao H. Augmented reality navigation with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. Int J Comput Assist Radiol Surg 2022; 17:1543-1552. [PMID: 35704238 DOI: 10.1007/s11548-022-02671-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE We present a novel augmented reality (AR) surgical navigation method with ultrasound-assisted point cloud registration for percutaneous ablation of liver tumors. A preliminary study is carried out to verify its feasibility. METHODS Two three-dimensional (3D) point clouds of the liver surface are derived from the preoperative images and intraoperative tracked US images, respectively. To compensate for the soft tissue deformation, the point cloud registration between the preoperative images and the liver is performed using the non-rigid iterative closest point (ICP) algorithm. A 3D AR device based on integral videography technology is designed to accurately display naked-eye 3D images for surgical navigation. Based on the above registration, naked-eye 3D images of the liver surface, planning path, entry points, and tumor can be overlaid in situ through our 3D AR device. Finally, the AR-guided targeting accuracy is evaluated through entry point positioning. RESULTS Experiments on both the liver phantom and in vitro pork liver were conducted. Several entry points on the liver surface were used to evaluate the targeting accuracy. The preliminary validation on the liver phantom showed average entry-point errors (EPEs) of 2.34 ± 0.45 mm, 2.25 ± 0.72 mm, 2.71 ± 0.82 mm, and 2.50 ± 1.11 mm at distinct US point cloud coverage rates of 100%, 75%, 50%, and 25%, respectively. The average EPEs of the deformed pork liver were 4.49 ± 1.88 mm and 5.02 ± 2.03 mm at the coverage rates of 100% and 75%, and the average covered-entry-point errors (CEPEs) were 4.96 ± 2.05 mm and 2.97 ± 1.37 mm at 50% and 25%, respectively. CONCLUSION Experimental outcomes demonstrate that the proposed AR navigation method based on US-assisted point cloud registration has achieved an acceptable targeting accuracy on the liver surface even in the case of liver deformation.
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Affiliation(s)
- Longfei Ma
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hanying Liang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Boxuan Han
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Shizhong Yang
- Hepato-Pancreato-Biliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 102218, China
| | - Xinran Zhang
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China
| | - Hongen Liao
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, 100084, China.
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Reattachable fiducial skin marker for automatic multimodality registration. Int J Comput Assist Radiol Surg 2022; 17:2141-2150. [PMID: 35604488 PMCID: PMC9515062 DOI: 10.1007/s11548-022-02639-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/08/2022] [Indexed: 11/05/2022]
Abstract
Abstract
Purpose
Fusing image information has become increasingly important for optimal diagnosis and treatment of the patient. Despite intensive research towards markerless registration approaches, fiducial marker-based methods remain the default choice for a wide range of applications in clinical practice. However, as especially non-invasive markers cannot be positioned reproducibly in the same pose on the patient, pre-interventional imaging has to be performed immediately before the intervention for fiducial marker-based registrations.
Methods
We propose a new non-invasive, reattachable fiducial skin marker concept for multi-modal registration approaches including the use of electromagnetic or optical tracking technologies. We furthermore describe a robust, automatic fiducial marker localization algorithm for computed tomography (CT) and magnetic resonance imaging (MRI) images. Localization of the new fiducial marker has been assessed for different marker configurations using both CT and MRI. Furthermore, we applied the marker in an abdominal phantom study. For this, we attached the marker at three poses to the phantom, registered ten segmented targets of the phantom’s CT image to live ultrasound images and determined the target registration error (TRE) for each target and each marker pose.
Results
Reattachment of the marker was possible with a mean precision of 0.02 mm ± 0.01 mm. Our algorithm successfully localized the marker automatically in all ($$n=201$$
n
=
201
) evaluated CT/MRI images. Depending on the marker pose, the mean ($$n=10$$
n
=
10
) TRE of the abdominal phantom study ranged from 1.51 ± 0.75 mm to 4.65 ± 1.22 mm.
Conclusions
The non-invasive, reattachable skin marker concept allows reproducible positioning of the marker and automatic localization in different imaging modalities. The low TREs indicate the potential applicability of the marker concept for clinical interventions, such as the puncture of abdominal lesions, where current image-based registration approaches still lack robustness and existing marker-based methods are often impractical.
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Li J, Deng Z, Shen N, He Z, Feng L, Li Y, Yao J. A fully automatic surgical registration method for percutaneous abdominal puncture surgical navigation. Comput Biol Med 2021; 136:104663. [PMID: 34375903 DOI: 10.1016/j.compbiomed.2021.104663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 01/16/2023]
Abstract
Surgical registration that maps surgical space onto image space plays an important role in surgical navigation. Accurate surgical registration can help surgeons efficiently locate surgical instruments. The complicated marker-based surgical registration method is highly accurate, but it is time-consuming. Therefore, a marker-less surgical registration method with high-precision and high-efficiency is proposed without human intervention. Firstly, the surgical navigation system based on the multi-vision system is calibrated by using a specially-designed calibration board. When extracting the abdominal point cloud acquired by the structured light vision system, the constraint is constructed by using Computed Tomography (CT) image to filter out the points in irrelevant areas to improve the computational efficiency. The Coherent Point Drift (CPD) algorithm based on Gaussian Mixture Model (GMM) is applied in the registration of abdominal point cloud with lack of surface features. To enhance the efficiency of the CPD algorithm, firstly, the system calibration result is used in rough registration of the point cloud, and then the proper point cloud pretreatment method and its parameters are studied through experiments. Finally, the puncturing simulation experiments were carried out by using the abdominal phantom. The experimental results show that the proposed surgical registration method has high accuracy and efficiency, and has potential clinical application value.
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Affiliation(s)
- Jing Li
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Zongqian Deng
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Nanyan Shen
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China.
| | - Zhou He
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Lanyun Feng
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yingjie Li
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Jia Yao
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Li ADR, Liu Y, Plott J, Chen L, Montgomery JS, Shih A. Multi-Bevel Needle Design Enabling Accurate Insertion in Biopsy for Cancer Diagnosis. IEEE Trans Biomed Eng 2021; 68:1477-1486. [PMID: 33507862 PMCID: PMC8104469 DOI: 10.1109/tbme.2021.3054922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To obtain definitive cancer diagnosis for suspicious lesions, accurate needle deployment and adequate tissue sampling in needle biopsy are essential. However, the single-bevel needles in current biopsy devices often induce deflection during insertion, potentially causing lesion missampling/undersampling and cancer misdiagnosis. This study aims to reveal the biopsy needle design criteria enabling both low deflection and adequate tissue sampling. METHODS A novel model capable of predicting needle deflection and tissue deformation was first established to understand needle-tissue interaction with different needle tip geometries. Experiments of needle deflection and ex-vivo tissue biopsy were conducted for model validation. RESULTS The developed model showed a reasonably good prediction on the correlation of needle tip type vs. the resultant needle deflection and tissue sampling length. A new multi-bevel needle with the tissue separation point below the needle groove face has demonstrated to be an effective design with an 87% reduction in deflection magnitude and equivalently long tissue sampling length compared to the current single-bevel needle. CONCLUSION This study has revealed two critical design criteria for biopsy needles: 1) multiple bevel faces at the needle tip can generate forces to balance bending moments during insertion to enable a low needle deflection and 2) the tissue separation point should be below the needle groove face to ensure long tissue sampling length. SIGNIFICANCE The developed methodologies and findings in this study serve as proof-of-concept and can be utilized to investigate various biopsy procedures to improve cancer diagnostic accuracy as well as other procedures requiring accurate needle insertion.
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Feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in a swine liver model. Sci Rep 2021; 11:5218. [PMID: 33664412 PMCID: PMC7933138 DOI: 10.1038/s41598-021-84878-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/18/2021] [Indexed: 01/05/2023] Open
Abstract
Evaluate the feasibility, safety and accuracy of a CT-guided robotic assistance for percutaneous needle placement in the liver. Sixty-six fiducials were surgically inserted into the liver of ten swine and used as targets for needle insertions. All CT-scan acquisitions and robotically-assisted needle insertions were coordinated with breath motion using respiratory monitoring. Skin entry and target points were defined on planning CT-scan. Then, robotically-assisted insertions of 17G needles were performed either by experienced interventional radiologists or by a novice. Post-needle insertion CT-scans were acquired to assess accuracy (3D deviation, ie. distance from needle tip to predefined target) and safety. All needle insertions (43/43; median trajectory length = 83 mm (interquartile range [IQR] 72–105 mm) could be performed in one (n = 36) or two (n = 7) attempts (100% feasibility). Blinded evaluation showed an accuracy of 3.5 ± 1.3 mm. Accuracy did not differ between novice and experienced operators (3.7 ± 1.3 versus 3.4 ± 1.2 mm, P = 0.44). Neither trajectory angulation nor trajectory length significantly impacted accuracy. No complications were encountered. Needle insertion using the robotic device was shown feasible, safe and accurate in a swine liver model. Accuracy was influenced neither by the trajectory length nor by trajectory angulations nor by operator’s experience. A prospective human clinical trial is recruiting.
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Fong AJ, Stewart CL, Lafaro K, LaRocca CJ, Fong Y, Femino JD, Crawford B. Robotic assistance for quick and accurate image-guided needle placement. Updates Surg 2021; 73:1197-1201. [PMID: 33394359 DOI: 10.1007/s13304-020-00956-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Computed tomography (CT) image-guided procedures including biopsy, drug delivery, and ablation are gaining increasing application in medicine. Robotic technology holds the promise for allowing surgeons, and other proceduralists, access to such CT-guided procedures by potentially shortening training, improving accuracy, decreasing needle passes, and reducing radiation exposure. We evaluated surgeon learning and proficiency for image-guided needle placement with an FDA-cleared robotic arm. Five out of six surgeons had no prior CT-guided procedural experience, while one had prior experience with freehand CT-guided needle placement. All surgeons underwent a 60-min training with the MAXIO robot (Perfint Healthcare, Redmond, WA). The robot was used to place needles into three different pre-specified targets on a spine model. Performance time, procedural errors, and needle placement accuracy were recorded. All participants successfully placed needles into the targets using the robotic arm. The average time for needle placement was 3:44 ± 1:43 min. Time for needle placement decreased with subsequent attempts, with average third placement taking 2:29 ± 1:51 min less than the first attempt. The average vector distance from the target was 2.3 ± 1.2 mm. One error resulted in the need for reimaging by CT scan. No errant needle placement occurred. Surgeons (attending fellows and residents) without previous experience and minimal training could successfully place percutaneous needles under CT guidance quickly, accurately, and reproducibly using a robotic arm. This suggests that robotic technology may be used to facilitate surgeon adoption of CT image-guided needle-based procedures in the future.
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Affiliation(s)
- Abigail J Fong
- Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Camille L Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Kelly Lafaro
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Christopher J LaRocca
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA.
| | - Joseph D Femino
- Department of Surgery, City of Hope National Medical Center, 1500 E. Duarte Road, Duarte, CA, 91010, USA
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Feasibility of interstitial stepping-source electronic brachytherapy to locally inoperable tumors. J Contemp Brachytherapy 2020; 12:480-486. [PMID: 33299437 PMCID: PMC7701928 DOI: 10.5114/jcb.2020.100381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/16/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Radiotherapy is the mainstay in the treatment of locally inoperable tumors. Interstitial electronic needle-based kilovoltage brachytherapy (EBT) could be an economic alternative to high-dose-rate (HDR) brachytherapy or permanent seed implantation (PSI). In this work, we evaluated if locally inoperable tumors treated with PSI at our institution may be suitable for EBT. Material and methods A total of 10 post-interventional computed tomography (CT) scans of patients, who received PSI and simulated stepping-source EBT applied with Intrabeam system and needle applicator were used. EBT treatment planning software with 3-dimensional image and projection of applicator were applied for designing trajectories and establishing dwell positions. Dwell position doses were summarized, and doses covering 90% of the target volume (D90) achieved with stepping-source EBT were compared to those of PSI. Additionally, conformality of dose distributions and total irradiation time were assessed using conformation number (CN) or conformal index (COIN). Results In all patients, D90 of EBT exceeded the prescribed dose or D90 of PSI on average by 4.7% or 21.3% relative to the prescribed dose, respectively. Mean number of trajectories was 5.0 for EBT and 6.9 for PSI. Average CN/COIN for EBT was 0.69, with a mean irradiation time of 27.8 minutes for standardized dose of 13 Gy. Conclusions Stepping-source EBT allowed for a conformal treatment of inoperable interstitial tumors with similar D90. Fewer trajectories were required for EBT in majority of cases.
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Abstract
Robotic surgery has rapidly evolved. It is particularly attractive as an alternative minimally invasive approach in liver surgery because of improvements in visualization and articulated instruments. Limitations include increased operative times and lack of tactile feedback, but these have not been shown in studies. Considerations unique to robotic surgery, including safety protocols, must be put in place and be reviewed at the beginning of every procedure to ensure safety in the event of an emergent conversion. Despite the lack of early adoption by many hepatobiliary surgeons, robotic liver surgery continues to evolve and find its place within hepatobiliary surgery.
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Affiliation(s)
- Kelly J Lafaro
- Department of Surgery, Johns Hopkins University School of Medicine, Blalock Building, 600 N. Wolfe St, Baltimore, MD 21205, USA
| | - Camille Stewart
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA
| | - Abigail Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA; Department of Surgery, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010, USA.
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Multi-Operational Selective Computer-Assisted Targeting of hepatocellular carcinoma-Evaluation of a novel approach for navigated tumor ablation. PLoS One 2018; 13:e0197914. [PMID: 29791518 PMCID: PMC5965844 DOI: 10.1371/journal.pone.0197914] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 05/10/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To facilitate precise local ablation of hepatocellular carcinoma (HCC) in a setting of combined ablation and transarterial chemoembolization (TACE), we evaluated accuracy and efficiency of a novel technique for navigated positioning of ablation probes using intrahepatic tumor referencing and electromagnetic (EM) guidance, in a porcine model. Methods An angiographic wire with integrated EM reference sensor at its tip was inserted via a transarterial femoral access and positioned in the vicinity of artificial liver tumors. The resulting offset distance between the tumor center and the intrahepatic endovascular EM reference was calculated. Subsequently, EM tracked ablation probes were inserted percutaneously and navigated toward the tumor center, relying on continuous EM guidance via the intrahepatic reference. Targeting accuracy was assessed as the Euclidean distance between the tip of the ablation probe and the tumor center (Target Positioning Error, TPE). Procedural efficiency was assessed as time efforts for tumor referencing and tumor targeting. Results In 6 animals, 124 targeting measurements were performed with an offset distance < 30 mm (clinically most feasible position), resulting in a mean TPE of 2.9 ± 1.6 mm. No significant correlation between the TPE and different intrahepatic offset distances (range 21 to 61 mm, n = 365) was shown as long as the EM reference was placed within the liver. However, the mean TPE increased when placing the EM reference externally on the animal skin (p < 0.01). TPE was similar when targeting under continuous ventilation or in apnea (p = 0.50). Mean time for tumor referencing and navigated targeting was 6.5 ± 3.8 minutes and 14 ± 8 seconds, respectively. Conclusion The proposed technique allows precise and efficient navigated positioning of ablation probes into liver tumors in the animal model. We introduce a simple approach suitable for combined ablation and TACE of HCC in a single treatment session.
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Sastry AV, Swet JH, Murphy KJ, Baker EH, Vrochides D, Martinie JB, McKillop IH, Iannitti DA. A novel 3-dimensional electromagnetic guidance system increases intraoperative microwave antenna placement accuracy. HPB (Oxford) 2017; 19:1066-1073. [PMID: 28917643 DOI: 10.1016/j.hpb.2017.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Failure to locate lesions and accurately place microwave antennas can lead to incomplete tumor ablation. The Emprint™ SX Ablation Platform employs real-time 3D-electromagnetic spatial antenna tracking to generate intraoperative laparoscopic antenna guidance. We sought to determine whether Emprint™ SX affected time/accuracy of antenna-placement in a laparoscopic training model. METHODS Targets (7-10 mm) were set in agar within a laparoscopic training device. Novices (no surgical experience), intermediates (surgical residents), and experts (HPB-surgeons) were asked to locate and hit targets using a MWA antenna (10-ultrasound only, 10-Emprint™ SX). Time to locate target, number of attempts to hit the target, first-time hit rate, and time from initiating antenna advance to hitting the target were measured. RESULTS Participants located 100% of targets using ultrasound, with experts taking significantly less time than novices and intermediates. Using ultrasound only, successful hit-rates were 70% for novices and 90% for intermediates and experts. Using Emprint™ SX, successful hit rates for all 3-groups were 100%, with significantly increased first-time hit-rates and reduced time required to hit targets compared to ultrasound only. DISCUSSION Emprint™ SX significantly improved accuracy and speed of antenna-placement independent of experience, and was particularly beneficial for novice users.
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Affiliation(s)
- Amit V Sastry
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Jacob H Swet
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Keith J Murphy
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Erin H Baker
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Dionisios Vrochides
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - John B Martinie
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Iain H McKillop
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
| | - David A Iannitti
- Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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Beyer LP, Wiggermann P. Planning and guidance: New tools to enhance the human skills in interventional oncology. Diagn Interv Imaging 2017; 98:583-588. [PMID: 28818346 DOI: 10.1016/j.diii.2017.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/12/2017] [Indexed: 12/13/2022]
Abstract
Navigation systems have the potential to achieve a high accuracy for percutaneous ablation of tumors even for those in difficult locations. In the last years, successful research has been conducted to make navigation devices applicable to percutaneous tumor ablation with special planning software that now allows high accuracy even for deep-located small lesions close to critical structures. Because of the high number of available navigation systems, this review focuses on those with preexisting clinical studies.
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Affiliation(s)
- L P Beyer
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany.
| | - P Wiggermann
- Department of Radiology, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
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Dou H, Jiang S, Yang Z, Sun L, Ma X, Huo B. Design and validation of a CT-guided robotic system for lung cancer brachytherapy. Med Phys 2017; 44:4828-4837. [PMID: 28657112 DOI: 10.1002/mp.12435] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Currently, lung brachytherapy in clinical setting is a complex procedure. Operation accuracy depends on accurate positioning of the template; however, it is difficult to guarantee the positioning accuracy manually. Application of robotic-assisted systems can simplify the procedure and improve the manual positioning accuracy. Therefore, a novel CT-guided robotic system was developed to assist the lung cancer brachytherapy. METHODS A four degree-of-freedom (DOF) robot, controlled by a lung brachytherapy treatment planning system (TPS) software, was designed and manufactured to assist the template positioning. Target position of the template can be obtained from the treatment plan, thus the robot is driven to the target position automatically. The robotic system was validated in both the laboratory and the CT environment. In laboratory environment, a 3D laser tracker and an inertial measurement unit (IMU) were used to measure the mechanical accuracy in air, which includes positioning accuracy and position repeatability. Working reliability was also validated in this procedure by observing the response reliability and calculating the position repeatability. Imaging artifacts and accuracy of the robot registration were validated in the CT environment by using an artificial phantom with fiducial markers. CT images were obtained and used to test the image artifact and calculate the registration accuracy. Phantom experiments were conducted to test the accuracy of needle insertion by using a transparent hydrogel phantom with a high imitation artificial phantom. Also, the efficiency was validated in this procedure by comparing time costs in manual positioning with robotic positioning under the same experimental conditions. RESULTS The robotic system achieved the positioning accuracy of 0.28 ± 0.25 mm and the position repeatability of 0.09 ± 0.11 mm. Experimental results showed that the robot was CT-compatible and responded reliably to the control commands. The mean registration accuracy of the robotic system was 0.49 ± 0.29 mm. Phantom experiments indicated that the accuracy of needle insertion was 1.5 ± 1.7 mm at a depth ranging from 30 to 80 mm. The time used to adjust the template to the target position was 12 min on average by robotic system automatically. An average of 30 min was saved compared with the manual positioning procedure in phantom experiments. CONCLUSIONS This paper describes the design and experimental validation of a novel CT-guided robotic system for lung cancer brachytherapy. The robotic system was validated in a number of aspects which prove that it was capable of locating the template with clinically acceptable accuracy in the CT environment. All experimental results indicated that the system is reliable and ready to be applied to further studies on animals.
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Affiliation(s)
- Huaisu Dou
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Shan Jiang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China.,Centre for advanced Mechanisms and Robotics, Tianjin University, Tianjin, 300350, China
| | - Zhiyong Yang
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Luqing Sun
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Xiaodong Ma
- School of Mechanical Engineering, Tianjin University, Tianjin, 300350, China
| | - Bin Huo
- Department of Oncology, The second Hospital of Tianjin Medical University, Tianjin, 300211, China
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Xiao D, Li Y, Luo H, Zhang Y, Guo X, Zheng H, Hu Q, Jia F. In vivo comparison of two navigation systems for abdominal percutaneous needle intervention. Abdom Radiol (NY) 2017; 42:1993-2000. [PMID: 28217826 DOI: 10.1007/s00261-017-1083-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To compare the accuracy of a Kinect-Optical navigation system with an electromagnetic (EM) navigation system for percutaneous liver needle intervention. MATERIALS AND METHODS Five beagles with nine artificial tumors were used for validation. The Veran IG4 EM navigation system and a custom-made Kinect-Optical navigation system were used. Needle insertions into each tumor were conducted with these two guidance methods. The target positioning error (TPE) and the time cost of the puncture procedures were evaluated. RESULTS A total of 18 needle insertions were performed to evaluate the navigation accuracy of the two guidance approaches. The targeting error was 6.78 ± 3.22 mm and 8.72 ± 3.5 mm for the Kinect-Optical navigation system and the EM navigation system, respectively. There is no statistically significant difference in the TPE between the Kinect-Optical navigation system and the EM navigation system (p = 0.229). The processing time with the Kinect-Optical system (10 min) is similar to that of the Veran IG4 system (12 min). CONCLUSIONS The accuracy of the Kinect-Optical navigation system is comparable to that of the EM navigation system.
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Affiliation(s)
- Deqiang Xiao
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
| | - Yong Li
- Department of Interventional Radiology, Shenzhen People's Hospital, No. 1017, Dongmen North Rd., Luohu, Shenzhen, China
| | - Huoling Luo
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
| | - Yanfang Zhang
- Department of Interventional Radiology, Shenzhen People's Hospital, No. 1017, Dongmen North Rd., Luohu, Shenzhen, China.
| | - Xuejun Guo
- Department of Radiology, Peking University Shenzhen Hospital, No. 1120, Lianhua Rd, Futian, Shenzhen, China
| | - Huimin Zheng
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
| | - Qingmao Hu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China
| | - Fucang Jia
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China.
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, No. 1068, Xueyuan Avenue, Xili Nanshan, Shenzhen, China.
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Marinetto E, Uneri A, De Silva T, Reaungamornrat S, Zbijewski W, Sisniega A, Vogt S, Kleinszig G, Pascau J, Siewerdsen JH. Integration of free-hand 3D ultrasound and mobile C-arm cone-beam CT: Feasibility and characterization for real-time guidance of needle insertion. Comput Med Imaging Graph 2017; 58:13-22. [PMID: 28414927 DOI: 10.1016/j.compmedimag.2017.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/16/2016] [Accepted: 03/28/2017] [Indexed: 12/27/2022]
Abstract
This work presents development of an integrated ultrasound (US)-cone-beam CT (CBCT) system for image-guided needle interventions, combining a low-cost ultrasound system (Interson VC 7.5MHz, Pleasanton, CA) with a mobile C-arm for fluoroscopy and CBCT via use of a surgical tracker. Imaging performance of the ultrasound system was characterized in terms of depth-dependent contrast-to-noise ratio (CNR) and spatial resolution. US-CBCT system was evaluated in phantom studies simulating three needle-based procedures: drug delivery, tumor ablation, and lumbar puncture. Low-cost ultrasound provided flexibility but exhibited modest CNR and spatial resolution that is likely limited to fairly superficial applications within a ∼10cm depth of view. Needle tip localization demonstrated target registration error 2.1-3.0mm using fiducial-based registration.
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Affiliation(s)
- E Marinetto
- Departmento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Biomedical Engineering, Johns Hopkins University, MD, USA
| | - A Uneri
- Department of Computer Science, Johns Hopkins University, Baltimore, USA
| | - T De Silva
- Department of Biomedical Engineering, Johns Hopkins University, MD, USA
| | - S Reaungamornrat
- Department of Computer Science, Johns Hopkins University, Baltimore, USA
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, MD, USA
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, MD, USA
| | - S Vogt
- Siemens Healthcare XP Division, Erlangen, Germany
| | - G Kleinszig
- Siemens Healthcare XP Division, Erlangen, Germany
| | - J Pascau
- Departmento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, MD, USA; Department of Computer Science, Johns Hopkins University, Baltimore, USA.
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De Paolis LT, Ricciardi F. Augmented visualisation in the treatment of the liver tumours with radiofrequency ablation. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING-IMAGING AND VISUALIZATION 2017. [DOI: 10.1080/21681163.2017.1287598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Francesco Ricciardi
- Department of Engineering for Innovation, University of Salento, Lecce, Italy
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MITK-OpenIGTLink for combining open-source toolkits in real-time computer-assisted interventions. Int J Comput Assist Radiol Surg 2016; 12:351-361. [DOI: 10.1007/s11548-016-1488-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/08/2016] [Indexed: 11/26/2022]
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Time-Of-Flight Camera, Optical Tracker and Computed Tomography in Pairwise Data Registration. PLoS One 2016; 11:e0159493. [PMID: 27434396 PMCID: PMC4951045 DOI: 10.1371/journal.pone.0159493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 07/05/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose A growing number of medical applications, including minimal invasive surgery, depends on multi-modal or multi-sensors data processing. Fast and accurate 3D scene analysis, comprising data registration, seems to be crucial for the development of computer aided diagnosis and therapy. The advancement of surface tracking system based on optical trackers already plays an important role in surgical procedures planning. However, new modalities, like the time-of-flight (ToF) sensors, widely explored in non-medical fields are powerful and have the potential to become a part of computer aided surgery set-up. Connection of different acquisition systems promises to provide a valuable support for operating room procedures. Therefore, the detailed analysis of the accuracy of such multi-sensors positioning systems is needed. Methods We present the system combining pre-operative CT series with intra-operative ToF-sensor and optical tracker point clouds. The methodology contains: optical sensor set-up and the ToF-camera calibration procedures, data pre-processing algorithms, and registration technique. The data pre-processing yields a surface, in case of CT, and point clouds for ToF-sensor and marker-driven optical tracker representation of an object of interest. An applied registration technique is based on Iterative Closest Point algorithm. Results The experiments validate the registration of each pair of modalities/sensors involving phantoms of four various human organs in terms of Hausdorff distance and mean absolute distance metrics. The best surface alignment was obtained for CT and optical tracker combination, whereas the worst for experiments involving ToF-camera. Conclusion The obtained accuracies encourage to further develop the multi-sensors systems. The presented substantive discussion concerning the system limitations and possible improvements mainly related to the depth information produced by the ToF-sensor is useful for computer aided surgery developers.
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Xiao D, Luo H, Jia F, Zhang Y, Li Y, Guo X, Cai W, Fang C, Fan Y, Zheng H, Hu Q. A Kinect™camera based navigation system for percutaneous abdominal puncture. Phys Med Biol 2016; 61:5687-705. [DOI: 10.1088/0031-9155/61/15/5687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Simpfendörfer T, Hatiboglu G, Hadaschik BA, Wild E, Maier-Hein L, Rassweiler MC, Rassweiler J, Hohenfellner M, Teber D. [Navigation in urological surgery: Possibilities and limits of current techniques]. Urologe A 2016; 54:709-15. [PMID: 25572970 DOI: 10.1007/s00120-014-3709-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Surgical navigation describes the concept of real-time processing and presentation of preoperative and intraoperative data from different sources to intraoperatively provide surgeons with additional cognitive support. Imaging methods such as 3D ultrasound, magnetic resonance imaging (MRI) and computed tomography (CT) and data from optical, electromagnetic or mechanical tracking methods are used. The resulting information of the navigation system will be presented by the means of visual methods. Mostly virtual reality or augmented reality visualization is used. There are different guidance systems for various disciplines introduced. Mostly it operates on rigid structures (bone, brain). For soft tissue navigation motion compensation and deformation detection are necessary. Therefore, marker-based tracking methods are used in several urological application examples; however, the systems are often still under development and have not yet arrived in the clinical routine.
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Affiliation(s)
- T Simpfendörfer
- Urologische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland,
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Navigated Breast Tumor Excision Using Electromagnetically Tracked Ultrasound and Surgical Instruments. IEEE Trans Biomed Eng 2016; 63:600-6. [DOI: 10.1109/tbme.2015.2466591] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hata N, Song SE, Olubiyi O, Arimitsu Y, Fujimoto K, Kato T, Tuncali K, Tani S, Tokuda J. Body-mounted robotic instrument guide for image-guided cryotherapy of renal cancer. Med Phys 2016; 43:843-53. [PMID: 26843245 PMCID: PMC4723400 DOI: 10.1118/1.4939875] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/10/2015] [Accepted: 01/02/2016] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Image-guided cryotherapy of renal cancer is an emerging alternative to surgical nephrectomy, particularly for those who cannot sustain the physical burden of surgery. It is well known that the outcome of this therapy depends on the accurate placement of the cryotherapy probe. Therefore, a robotic instrument guide may help physicians aim the cryotherapy probe precisely to maximize the efficacy of the treatment and avoid damage to critical surrounding structures. The objective of this paper was to propose a robotic instrument guide for orienting cryotherapy probes in image-guided cryotherapy of renal cancers. The authors propose a body-mounted robotic guide that is expected to be less susceptible to guidance errors caused by the patient's whole body motion. METHODS Keeping the device's minimal footprint in mind, the authors developed and validated a body-mounted, robotic instrument guide that can maintain the geometrical relationship between the device and the patient's body, even in the presence of the patient's frequent body motions. The guide can orient the cryotherapy probe with the skin incision point as the remote-center-of-motion. The authors' validation studies included an evaluation of the mechanical accuracy and position repeatability of the robotic instrument guide. The authors also performed a mock MRI-guided cryotherapy procedure with a phantom to compare the advantage of robotically assisted probe replacements over a free-hand approach, by introducing organ motions to investigate their effects on the accurate placement of the cryotherapy probe. Measurements collected for performance analysis included accuracy and time taken for probe placements. Multivariate analysis was performed to assess if either or both organ motion and the robotic guide impacted these measurements. RESULTS The mechanical accuracy and position repeatability of the probe placement using the robotic instrument guide were 0.3 and 0.1 mm, respectively, at a depth of 80 mm. The phantom test indicated that the accuracy of probe placement was significantly better with the robotic instrument guide (4.1 mm) than without the guide (6.3 mm, p<0.001), even in the presence of body motion. When independent organ motion was artificially added, in addition to body motion, the advantage of accurate probe placement using the robotic instrument guide disappeared statistically [i.e., 6.0 mm with the robotic guide and 5.9 mm without the robotic guide (p = 0.906)]. When the robotic instrument guide was used, the total time required to complete the procedure was reduced from 19.6 to 12.7 min (p<0.001). Multivariable analysis indicated that the robotic instrument guide, not the organ motion, was the cause of statistical significance. The statistical power the authors obtained was 88% in accuracy assessment and 99% higher in duration measurement. CONCLUSIONS The body-mounted robotic instrument guide allows positioning of the probe during image-guided cryotherapy of renal cancer and was done in fewer attempts and in less time than the free-hand approach. The accuracy of the placement of the cryotherapy probe was better using the robotic instrument guide than without the guide when no organ motion was present. The accuracy between the robotic and free-hand approach becomes comparable when organ motion was present.
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Affiliation(s)
- Nobuhiko Hata
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Sang-Eun Song
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Olutayo Olubiyi
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | | | | | - Takahisa Kato
- Healthcare Optics Research Laboratory, Canon U.S.A., Cambridge, Massachusetts 02144
| | - Kemal Tuncali
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Soichiro Tani
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Junichi Tokuda
- National Center for Image Guided Therapy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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Helck A, Schumann C, Aumann J, Thierfelder K, Strobl FF, Braunagel M, Niethammer M, Clevert DA, Hoffmann RT, Reiser M, Sandner T, Trumm C. Automatic path proposal computation for CT-guided percutaneous liver biopsy. Int J Comput Assist Radiol Surg 2016; 11:2199-2205. [DOI: 10.1007/s11548-015-1349-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/30/2015] [Indexed: 10/22/2022]
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Zhuang X, Wang Q, Wang N, Hou X, Zhang J, Chi H. Effects of combining transarterial chemoembolization with percutaneous microwave coagulation therapy for hepatocellular carcinoma abutting the diaphragm. MINIM INVASIV THER 2015; 25:107-12. [PMID: 26560859 DOI: 10.3109/13645706.2015.1103751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study aims to explore the clinical effectiveness of a combination therapy of transarterial chemoembolization (TACE) and percutaneous microwave coagulation therapy (PMCT) in treating hepatocellular carcinoma (HCC) abutting the diaphragm. MATERIAL AND METHODS Six cases with HCC were treated with TACE followed by PMCT one month later with the aid of artificial pneumothorax. RESULTS CT/MRI revealed complete necrosis in the tumor lesions and the treated tumor margins (≥ 5 mm). Serum alpha-fetoprotein (AFP) levels markedly declined in patients who originally had higher serum AFP levels. Postoperative complications such as fever, mild hepatic dysfunction and pleural effusion were alleviated within a short period of time. All patients were closely monitored through follow-up; all patients survived, except for one patient who received a liver transplantation. CONCLUSIONS As lesions are either invisible or poorly visible in sonography, determining an effective treatment for HCC abutting the diaphragm remains a particular challenge. TACE and PMCT combined therapy with the aid of artificial pneumothorax proved to be an available treatment option.
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Affiliation(s)
- Xingjun Zhuang
- a Department of Oncology , 401th Hospital of PLA , Qingdao , China
| | - Qinxue Wang
- b Department of Infectious , Jiaozhou People's Hospital , Jiaozhou , China
| | - Ningning Wang
- a Department of Oncology , 401th Hospital of PLA , Qingdao , China
| | - Xiaowei Hou
- a Department of Oncology , 401th Hospital of PLA , Qingdao , China
| | - Jianshun Zhang
- b Department of Infectious , Jiaozhou People's Hospital , Jiaozhou , China
| | - Hongliang Chi
- b Department of Infectious , Jiaozhou People's Hospital , Jiaozhou , China
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Electromagnetic organ tracking allows for real-time compensation of tissue shift in image-guided laparoscopic rectal surgery: results of a phantom study. Surg Endosc 2015; 30:495-503. [DOI: 10.1007/s00464-015-4231-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/20/2015] [Indexed: 02/01/2023]
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Towards markerless navigation for percutaneous needle insertions. Int J Comput Assist Radiol Surg 2015; 11:107-17. [PMID: 26018847 DOI: 10.1007/s11548-015-1156-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 01/26/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Percutaneous needle insertions are increasingly used for diagnosis and treatment of abdominal lesions. The challenging part of computed tomography (CT)-guided punctures is the transfer of the insertion trajectory planned in the CT image to the patient. Conventionally, this often results in several needle repositionings and control CT scans. To address this issue, several navigation systems for percutaneous needle insertions have been presented; however, none of them has thus far become widely accepted in clinical routine. Their benefit for the patient could not exceed the additional higher costs and the increased complexity in terms of bulky tracking systems and specialized markers for registration and tracking. METHODS We present the first markerless and trackerless navigation concept for real-time patient localization and instrument guidance. It has specifically been designed to be integrated smoothly into the clinical workflow and does not require markers or an external tracking system. The main idea is the utilization of a range imaging device that allows for contactless and radiation-free acquisition of both range and color information used for patient localization and instrument guidance. RESULTS A first feasibility study in phantom and porcine models yielded a median targeting accuracy of 6.9 and 19.4 mm, respectively. CONCLUSIONS Although system performance remains to be improved for clinical use, expected advances in camera technology as well as consideration of respiratory motion and automation of the individual steps will make this approach an interesting alternative for guiding percutaneous needle insertions.
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Arnolli MM, Hanumara NC, Franken M, Brouwer DM, Broeders IAMJ. An overview of systems for CT- and MRI-guided percutaneous needle placement in the thorax and abdomen. Int J Med Robot 2014; 11:458-75. [DOI: 10.1002/rcs.1630] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nevan C. Hanumara
- Mechanical Engineering Department; Massachusetts Institute of Technology; MA USA
| | | | - Dannis M. Brouwer
- Laboratory of Mechanical Automation and Mechatronics, Faculty of Engineering Technology; University of Twente; The Netherlands
| | - Ivo A. M. J. Broeders
- Robotics and Mechatronics, MIRA Institute for Biomedical Technology and Technical Medicine; University of Twente; The Netherlands
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dos Santos TR, Seitel A, Kilgus T, Suwelack S, Wekerle AL, Kenngott H, Speidel S, Schlemmer HP, Meinzer HP, Heimann T, Maier-Hein L. Pose-independent surface matching for intra-operative soft-tissue marker-less registration. Med Image Anal 2014; 18:1101-14. [DOI: 10.1016/j.media.2014.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/10/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
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Adebar TK, Fletcher AE, Okamura AM. 3-D ultrasound-guided robotic needle steering in biological tissue. IEEE Trans Biomed Eng 2014; 61:2899-910. [PMID: 25014948 DOI: 10.1109/tbme.2014.2334309] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Robotic needle steering systems have the potential to greatly improve medical interventions, but they require new methods for medical image guidance. Three-dimensional (3-D) ultrasound is a widely available, low-cost imaging modality that may be used to provide real-time feedback to needle steering robots. Unfortunately, the poor visibility of steerable needles in standard grayscale ultrasound makes automatic segmentation of the needles impractical. A new imaging approach is proposed, in which high-frequency vibration of a steerable needle makes it visible in ultrasound Doppler images. Experiments demonstrate that segmentation from this Doppler data is accurate to within 1-2 mm. An image-guided control algorithm that incorporates the segmentation data as feedback is also described. In experimental tests in ex vivo bovine liver tissue, a robotic needle steering system implementing this control scheme was able to consistently steer a needle tip to a simulated target with an average error of 1.57 mm. Implementation of 3-D ultrasound-guided needle steering in biological tissue represents a significant step toward the clinical application of robotic needle steering.
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Interventional real-time ultrasound imaging with an integrated electromagnetic field generator. Int J Comput Assist Radiol Surg 2014; 9:759-68. [DOI: 10.1007/s11548-014-0990-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 03/06/2014] [Indexed: 11/26/2022]
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März K, Franz AM, Seitel A, Winterstein A, Bendl R, Zelzer S, Nolden M, Meinzer HP, Maier-Hein L. MITK-US: real-time ultrasound support within MITK. Int J Comput Assist Radiol Surg 2013; 9:411-20. [DOI: 10.1007/s11548-013-0962-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 11/05/2013] [Indexed: 11/28/2022]
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Smith RL, Wen J, Noel C, Mayse ML, Parikh PJ. A respiratory correlated image guided surgery method: quantitative accuracy results in swine and human cadaver environments. Int J Med Robot 2013; 10:44-54. [DOI: 10.1002/rcs.1508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 11/12/2022]
Affiliation(s)
| | - Jie Wen
- Department of Radiology; Washington University in St Louis; St Louis MO 63110 USA
| | | | | | - Parag J. Parikh
- Department of Radiation Oncology; Washington University School of Medicine; St. Louis MO 63110 USA
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Toporek G, Wallach D, Weber S, Bale R, Widmann G. Cone-beam Computed Tomography-guided Stereotactic Liver Punctures: A Phantom Study. Cardiovasc Intervent Radiol 2013; 36:1629-1637. [DOI: 10.1007/s00270-013-0635-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 03/10/2013] [Indexed: 12/23/2022]
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Müller M, Rassweiler MC, Klein J, Seitel A, Gondan M, Baumhauer M, Teber D, Rassweiler JJ, Meinzer HP, Maier-Hein L. Mobile augmented reality for computer-assisted percutaneous nephrolithotomy. Int J Comput Assist Radiol Surg 2013; 8:663-75. [DOI: 10.1007/s11548-013-0828-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
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CT-Guided Interventions Using a Free-Hand, Optical Tracking System: Initial Clinical Experience. Cardiovasc Intervent Radiol 2012; 36:1055-62. [DOI: 10.1007/s00270-012-0527-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/15/2012] [Indexed: 10/27/2022]
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A study of porcine liver motion during respiration for improving targeting in image-guided needle placements. Int J Comput Assist Radiol Surg 2012; 8:15-27. [DOI: 10.1007/s11548-012-0745-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 05/01/2012] [Indexed: 10/28/2022]
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Reaungamornrat S, Otake Y, Uneri A, Schafer S, Mirota DJ, Nithiananthan S, Stayman JW, Kleinszig G, Khanna AJ, Taylor RH, Siewerdsen JH. An on-board surgical tracking and video augmentation system for C-arm image guidance. Int J Comput Assist Radiol Surg 2012; 7:647-65. [PMID: 22539008 DOI: 10.1007/s11548-012-0682-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/20/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Conventional tracker configurations for surgical navigation carry a variety of limitations, including limited geometric accuracy, line-of-sight obstruction, and mismatch of the view angle with the surgeon's-eye view. This paper presents the development and characterization of a novel tracker configuration (referred to as "Tracker-on-C") intended to address such limitations by incorporating the tracker directly on the gantry of a mobile C-arm for fluoroscopy and cone-beam CT (CBCT). METHODS A video-based tracker (MicronTracker, Claron Technology Inc., Toronto, ON, Canada) was mounted on the gantry of a prototype mobile isocentric C-arm next to the flat-panel detector. To maintain registration within a dynamically moving reference frame (due to rotation of the C-arm), a reference marker consisting of 6 faces (referred to as a "hex-face marker") was developed to give visibility across the full range of C-arm rotation. Three primary functionalities were investigated: surgical tracking, generation of digitally reconstructed radiographs (DRRs) from the perspective of a tracked tool or the current C-arm angle, and augmentation of the tracker video scene with image, DRR, and planning data. Target registration error (TRE) was measured in comparison with the same tracker implemented in a conventional in-room configuration. Graphics processing unit (GPU)-accelerated DRRs were generated in real time as an assistant to C-arm positioning (i.e., positioning the C-arm such that target anatomy is in the field-of-view (FOV)), radiographic search (i.e., a virtual X-ray projection preview of target anatomy without X-ray exposure), and localization (i.e., visualizing the location of the surgical target or planning data). Video augmentation included superimposing tracker data, the X-ray FOV, DRRs, planning data, preoperative images, and/or intraoperative CBCT onto the video scene. Geometric accuracy was quantitatively evaluated in each case, and qualitative assessment of clinical feasibility was analyzed by an experienced and fellowship-trained orthopedic spine surgeon within a clinically realistic surgical setup of the Tracker-on-C. RESULTS The Tracker-on-C configuration demonstrated improved TRE (0.87 ± 0.25) mm in comparison with a conventional in-room tracker setup (1.92 ± 0.71) mm (p < 0.0001) attributed primarily to improved depth resolution of the stereoscopic camera placed closer to the surgical field. The hex-face reference marker maintained registration across the 180° C-arm orbit (TRE = 0.70 ± 0.32 mm). DRRs generated from the perspective of the C-arm X-ray detector demonstrated sub- mm accuracy (0.37 ± 0.20 mm) in correspondence with the real X-ray image. Planning data and DRRs overlaid on the video scene exhibited accuracy of (0.59 ± 0.38) pixels and (0.66 ± 0.36) pixels, respectively. Preclinical assessment suggested potential utility of the Tracker-on-C in a spectrum of interventions, including improved line of sight, an assistant to C-arm positioning, and faster target localization, while reducing X-ray exposure time. CONCLUSIONS The proposed tracker configuration demonstrated sub- mm TRE from the dynamic reference frame of a rotational C-arm through the use of the multi-face reference marker. Real-time DRRs and video augmentation from a natural perspective over the operating table assisted C-arm setup, simplified radiographic search and localization, and reduced fluoroscopy time. Incorporation of the proposed tracker configuration with C-arm CBCT guidance has the potential to simplify intraoperative registration, improve geometric accuracy, enhance visualization, and reduce radiation exposure.
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Affiliation(s)
- S Reaungamornrat
- Department of Biomedical Engineering, Johns Hopkins University, Traylor Building, Room #726, 720 Rutland Avenue, Baltimore, MD 21205-2109, USA.
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van Vledder MG, Assumpcao L, Munireddy S, Sehgal K, Boctor EM, Choti MA. Development of Hepatic Pseudotumors for Image-guided Interventional and Surgical Research in a Large Animal Model. J Vasc Interv Radiol 2011; 22:1452-6. [DOI: 10.1016/j.jvir.2011.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Revised: 05/07/2011] [Accepted: 05/10/2011] [Indexed: 11/28/2022] Open
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Oliveira-Santos T, Klaeser B, Weitzel T, Krause T, Nolte LP, Peterhans M, Weber S. A navigation system for percutaneous needle interventions based on PET/CT images: Design, workflow and error analysis of soft tissue and bone punctures. ACTA ACUST UNITED AC 2011; 16:203-19. [DOI: 10.3109/10929088.2011.597566] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seitel A, Engel M, Sommer CM, Radeleff BA, Essert-Villard C, Baegert C, Fangerau M, Fritzsche KH, Yung K, Meinzer HP, Maier-Hein L. Computer-assisted trajectory planning for percutaneous needle insertions. Med Phys 2011; 38:3246-59. [DOI: 10.1118/1.3590374] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Schullian P, Widmann G, Lang TB, Knoflach M, Bale R. Accuracy and diagnostic yield of CT-guided stereotactic liver biopsy of primary and secondary liver tumors. ACTA ACUST UNITED AC 2011; 16:181-7. [PMID: 21612328 DOI: 10.3109/10929088.2011.578367] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE CT-guided biopsy still plays a decisive role in the management of liver tumors, especially if the lesions are not visible or accessible by ultrasound. As CT-guided stereotaxy appears to be a very accurate targeting technique, the aim of this study was to evaluate the targeting accuracy, diagnostic yield, and complications of CT-guided stereotactic liver biopsy of primary and secondary liver tumors. METHODS AND MATERIALS Prior to stereotactic liver biopsy, patients under general anesthesia were immobilized using a vacuum cushion. Respiratory motion was controlled by temporary disconnections of the endotracheal tube. An optical-based navigation system was used for 3D trajectory planning and placement of a 15-G coaxial needle via a stereotactic aiming device. The histological samples were obtained using a 16-G Tru-Cut(™) biopsy needle system. For evaluation of targeting accuracy the control CT image with the needles in place was fused with the planning CT image. The lateral error at the tip and skin entry point and the angular error were calculated. In addition, the skin-to-liver-surface (SL) distance, the needle-to-liver-surface (NL) angle, and the presence of liver cirrhosis were evaluated. The diagnostic yield was evaluated by histological reports from the institutional pathologists. RESULTS The median lateral error was 2.5 mm (range: 0-6.5 mm) at the needle entry point and 3.2 mm (range: 0.01-9.4 mm) at the needle tip. The median angular error was 1.06° (range: 0-6.64°). Liver cirrhosis, NL angle and SL distance showed no significant impact on the targeting accuracy. Forty-five of the 46 liver biopsies (97.8%) were diagnostic according to the histological reports. No puncture-related complications such as bleeding or perforation of intestinal organs or lung tissue were recorded.
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Affiliation(s)
- Peter Schullian
- Department of Microinvasive Therapy, Department of Radiology, Medical University of Innsbruck, Austria
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Widmann G, Schullian P, Haidu M, Fasser M, Bale R. Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours. MINIM INVASIV THER 2011; 20:218-25. [DOI: 10.3109/13645706.2010.533923] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Passive Single Marker Tracking for Organ Motion and Deformation Detection in Open Liver Surgery. INFORMATION PROCESSING IN COMPUTER-ASSISTED INTERVENTIONS 2011. [DOI: 10.1007/978-3-642-21504-9_15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Chopra SS, Schmidt SC, Wiltberger G, Denecke T, Streitparth F, Seebauer C, Teichgräber U, Schumacher G, Eisele RM. Laparoscopic radiofrequency ablation of liver tumors: comparison of MR guidance versus conventional laparoscopic ultrasound for needle positioning in a phantom model. MINIM INVASIV THER 2010; 20:212-7. [PMID: 21082902 DOI: 10.3109/13645706.2010.534864] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Laparoscopic radiofrequency ablation (LapRFA) is an established procedure for liver tumors in patients who are unsuitable for resection. A novel technique of magnetic resonance (MR) guided needle positioning during LapRFA was developed and compared to conventional ultrasound (US) guidance in a phantom model. MR-guided procedures were conducted in a 1.0 tesla high field open MR using an MR compatible endoscope and camera. The ultrasound-guided procedure was performed with a clinically established laparoscopy setup and a 2D laparoscopic US probe. During both techniques an identical monopolar non-ferromagnetic RFA needle and a silicon-based phantom model were applied. Finally needle positioning was performed by two surgeons and one interventionalist. Time to needle placement and number of trials were recorded and statistically analyzed. MR-guided needle positioning under laparoscopic control was technically feasible. Average time to correct needle placement was 2' 6″ in the LapUS group and 1' 54″ in the MR group. The number of trials was 3.2 in the LapUS group and 2.6 in the MR group. Image quality was assessed by all participants. MR images showed a better tissue to tumor contrast and allowed an improved orientation due to multiplanar visualization. MR-guided laparoscopic RFA is a promising technique offering multiplanar needle positioning with high soft tissue contrast with immediate therapy control. In a phantom model it showed comparable results regarding needle positioning to the established technique of laparoscopic US guidance.
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Affiliation(s)
- Sascha S Chopra
- Department of General-, Visceral- and Transplantation Surgery; Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany.
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Peterhans M, vom Berg A, Dagon B, Inderbitzin D, Baur C, Candinas D, Weber S. A navigation system for open liver surgery: design, workflow and first clinical applications. Int J Med Robot 2010; 7:7-16. [PMID: 21341357 DOI: 10.1002/rcs.360] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND The surgical treatment of liver tumours relies on precise localization of the lesions and detailed knowledge of the patient-specific vascular and biliary anatomy. Detailed three-dimensional (3D) anatomical information facilitates complete tumour removal while preserving a sufficient amount of functional liver tissue. METHODS We present an easy to use, clinically applicable navigation system for efficient visualization and tool guidance during liver surgery. Accurate instrument guidance within 3D planning models was achieved with a fast registration procedure, assuming a locally rigid and temporarily static scenario. After deformations occurring during the procedure, efficient means for registration updates are provided. Special focus was given to workflow integration and the minimization of overhead time. The navigation system was validated with nine clinical cases. RESULTS Navigated surgical interventions were performed with a median time overhead of 16.5 min. The navigation technology had a median accuracy of 6.3 mm, improving anatomical orientation and the detection of structures at risk. CONCLUSIONS Successful application of the navigation technology to open liver surgery was achieved by minimizing the procedural complexity and optimizing integration within the existing surgical environment. The assumption of locally rigid patient registration was validated, and clinical evaluation shows clear benefits for the surgeon.
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Affiliation(s)
- M Peterhans
- ARTORG Center for Computer Aided Surgery and Institute for Surgical Technology and Biomechanics, University of Bern, Stauffacherstrasse 78, Bern, Switzerland.
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Müller SA, Maier-Hein L, Tekbas A, Seitel A, Ramsauer S, Radeleff B, Franz AM, Tetzlaff R, Mehrabi A, Wolf I, Kauczor HU, Meinzer HP, Schmied BM. Navigated liver biopsy using a novel soft tissue navigation system versus CT-guided liver biopsy in a porcine model: a prospective randomized trial. Acad Radiol 2010; 17:1282-7. [PMID: 20832025 DOI: 10.1016/j.acra.2010.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 05/17/2010] [Accepted: 05/19/2010] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this prospective, randomized animal study was to compare a new computer guided needle-based navigation system for liver biopsy with conventional computed tomography (CT)-guided liver biopsy. Computer-navigated interventions provide continuous needle tracking during motion and deformation from patient respiration and movement. MATERIALS AND METHODS Twenty artificial tumors of about 5 mm in diameter were injected into the livers of five pigs, each at a different site. Each tumor was targeted by conventional CT-guided and computer navigated intervention. Intervention was considered complete after successful tumor biopsy. Data on procedure time, number of CT scans performed, accuracy, and success rate were recorded. RESULTS All tumors (100%) were biopsied successfully. Mean procedural time was comparable between the two techniques (20 ± 9 minutes conventional versus 20 ± 8 minutes navigation). Mean number of CT scans were 1.2 ± 0.4 with navigation and 6.1 ± 3.8 with the conventional technique (P < .01). The dose-length product in the conventional group was significantly higher (212 ± 116 mGy × cm) than in the navigated group (78 ± 22 mGy × cm; P < .001). Mean number of capsule penetrations was 4 ± 1 with navigation versus 2 ± 1 with the conventional technique (P < .001). CONCLUSION Computer-navigated liver biopsy may provide a promising and innovative device for easy, rapid, and successful liver biopsies with low morbidity. Further technical improvements and clinical studies in humans are required.
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Widmann G, Schullian P, Haidu M, Wiedermann FJ, Bale R. Respiratory motion control for stereotactic and robotic liver interventions. Int J Med Robot 2010; 6:343-9. [DOI: 10.1002/rcs.343] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Sommer CM, Schwarzwaelder CB, Ramsauer S, Stampfl U, Stiller W, Nickel F, Omri W, Kenngott HG, Gehrig T, Meinzer HP, Kauczor HU, Radeleff BA. Intravenous 64-multi-detector row CT-cholangiography of porcine livers: a feasibility study with definition of the temporal window for optimal bile duct delineation. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2010; 17:666-72. [PMID: 20703845 DOI: 10.1007/s00534-010-0263-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE To assess the feasibility of intravenous 64-multi-detector row computed tomography (CT)-cholangiography of porcine livers with definition of the temporal window for optimal bile duct delineation. METHODS Six healthy Landrace pigs, each weighing 28.97 +/- 2.99 kg, underwent 64-multi-detector row CT-cholangiography. Each pig was infused with 50 ml of meglumine iotroxate continuously over a period of 20 min and, starting with the initiation of the infusion, 18 consecutive CT scans of the abdomen at 2-min intervals were acquired. All series were evaluated for bile duct visualization scores and maximum bile duct diameters as primary study goals and bile duct attenuation and liver enhancement as secondary study goals. RESULTS Of the 16 analyzed biliary tract segments, maximum bile duct visualization scores ranged between 4.00 +/- 0.00 and 2.83 +/- 1.47. Time to maximum bile duct visualization scores ranged between 10 and 34 min. Average bile duct visualization scores for the 10- to 34-min interval ranged between 3.99 +/- 0.05 and 2.78 +/- 0.10. Maximum bile duct diameters ranged between 6.47 +/- 1.05 and 2.65 +/- 2.23 mm. Time to maximum bile duct diameters ranged between 24 and 34 min. Average bile duct diameters for the 10- to 34-min interval ranged between 6.00 +/- 0.38 and 2.40 +/- 0.13 mm. CONCLUSIONS Intravenous 64-multi-detector row CT-cholangiography of non-diseased porcine liver is feasible, with the best bile duct delineation acquired between 10 and 34 min after initiation of the contrast agent infusion.
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Affiliation(s)
- Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
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