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Rouchy RC, Moreau-Gaudry A, Chipon E, Aubry S, Pazart L, Lapuyade B, Durand M, Hajjam M, Pottier S, Renard B, Logier R, Orry X, Cherifi A, Quehen E, Kervio G, Favelle O, Patat F, De Kerviler E, Hughes C, Medici M, Ghelfi J, Mounier A, Bricault I. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial. Trials 2017; 18:306. [PMID: 28683837 PMCID: PMC5501074 DOI: 10.1186/s13063-017-2049-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 06/14/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. METHODS/DESIGN This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. DISCUSSION This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01896219 . Registered on 5 July 2013.
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Affiliation(s)
- R C Rouchy
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France. .,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France. .,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.
| | - A Moreau-Gaudry
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - E Chipon
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - S Aubry
- Service de Radiologie Ostéo-Articulaire, Centre Hospitalier Universitaire (CHU) Besançon, F-25000, Besançon, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - L Pazart
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1431, F-25000, Besançon, France
| | - B Lapuyade
- Service d'Imagerie Diagnostique et Therapeutique, Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Durand
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1401, F-33000, Bordeaux, France.,Centre d'Investigation Clinique (CIC) 1401, University Bordeaux, F-33000, Bordeaux, France.,Centre Hospitalier Universitaire (CHU) Bordeaux, F-33000, Bordeaux, France
| | - M Hajjam
- Service de Radiologie, Hôpital Ambroise-Paré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92100, Boulogne-Billancourt, France
| | - S Pottier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1429, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), F-92380, Garches, France
| | - B Renard
- Service de Radiologie, Centre Hospitalier Universitaire (CHU) Lille, F-59000, Lille, France
| | - R Logier
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1403, Centre Hospitalier Universitaire (CHU) Lille, University Lille, F-59000, Lille, France
| | - X Orry
- Service de Radiologie, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - A Cherifi
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique - Centre de technologie innovante (CIC-IT) 1433, Centre Hospitalier Régional Universitaire (CHRU) de Nancy, F-54000, Nancy, France
| | - E Quehen
- Service Imagerie Abdominale et Générale, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - G Kervio
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1414, Centre Hospitalier Universitaire (CHU) Rennes, F-35000, Rennes, France
| | - O Favelle
- Département Imagerie Médicale, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - F Patat
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1415, Centre Hospitalier Universitaire (CHU) Tours, F-37000, Tours, France
| | - E De Kerviler
- Service de Radiologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75475, Paris, France
| | - C Hughes
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - M Medici
- Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - J Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - A Mounier
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, University Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Pole Recherche, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
| | - I Bricault
- Clinique Universitaire de Radiologie et Imagerie Médicale, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France.,Institut national de la santé et de la recherche médicale (Inserm) Centre d'Investigation Clinique (CIC) 1406, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), University Grenoble-Alpes, F-38000, Grenoble, France.,Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble (TIMC-IMAG), Centre national de la recherche scientifique (CNRS), F-38000, Grenoble, France.,Pole Sante Publique, Centre Hospitalier Universitaire (CHU) de Grenoble-Alpes, F-38000, Grenoble, France
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Andrès E, Talha S, Benyahia A, Keller O, Hajjam M, Moukadem A, Dieterlen A, Hajjam J, Ervé S, Hajjam A. [Experimentation of an e-platform to detect situations at risk of cardiac impairment (platform E-care) in an internal medicine unit]. Rev Med Interne 2016; 37:587-93. [PMID: 26852082 DOI: 10.1016/j.revmed.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/16/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Monitoring patients with heart failure by telemedicine systems is a potential means susceptible to optimize the management of these patients and avoid life-threatening emergencies. In this context, we experimented in internal medicine unit an e-platform E-care dedicated to automated, intelligent detection of situations at risk of heart failure. METHODS The E-care platform based on medical sensors (blood pressure, heart rate, O2, weight), communicating (Bluetooth), to go up, in real time, to an intelligent physiological information and an analysis of the ontology medical, leading ultimately to the generation of alerts. After a development phase (proof of concept), the E-care platform has been deployed and tested by health professionals and patients in an internal medicine unit with 20 beds, opened on emergencies to the Strasbourg University Hospitals. RESULTS One hundred and eighty patients were included and 1500 measurements were obtained. The patient profile included in this experiment was an elderly patient, with comorbidity in 90% of cases, with a loss of autonomy in 25%. Health professionals were using E-care platform every day to their great satisfaction. This experiment made it possible to validate the technology choices, to consolidate the system, and to test the robustness of the platform E-care. The collection continuously allowed us to have the critical number of patients for more detailed analysis of the relevance of alerts related to heart impairment. A preliminary analysis showed the relevance of the generated alerts. CONCLUSION Preliminary results following the deployment of E-care platform in hospitals appear to show the relevance of technological choices, tools and solutions developed and adopted. This telemedicine system allows automatic, non-intrusive, generate alerts related to the detection of situations at risk for heart failure. Ultimately, E-care was capable of preventing hospitalization. A home deployment is currently underway.
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Affiliation(s)
- E Andrès
- Service de médecine interne, diabète et maladies métaboliques, clinique médicale B, CHRU de Strasbourg, 1, porte de l'Hôpital, 67091 Strasbourg cedex, France; Centre de recherche pédagogique, faculté de médecine de Strasbourg, université de Strasbourg (UdS), 67091 Strasbourg, France.
| | - S Talha
- Service de physiologie et d'explorations fonctionnelles, faculté de médecine de Strasbourg, université de Strasbourg (UdS), CHRU, 67091 Strasbourg, France
| | - A Benyahia
- Service de physiologie et d'explorations fonctionnelles, faculté de médecine de Strasbourg, université de Strasbourg (UdS), CHRU, 67091 Strasbourg, France
| | - O Keller
- Service de médecine interne, diabète et maladies métaboliques, clinique médicale B, CHRU de Strasbourg, 1, porte de l'Hôpital, 67091 Strasbourg cedex, France; Centre de recherche pédagogique, faculté de médecine de Strasbourg, université de Strasbourg (UdS), 67091 Strasbourg, France
| | | | - A Moukadem
- Laboratoire MIPS, université Haute-Alsace de Mulhouse (UHA), 68100 Mulhouse, France
| | - A Dieterlen
- Laboratoire MIPS, université Haute-Alsace de Mulhouse (UHA), 68100 Mulhouse, France
| | - J Hajjam
- Centre d'expertise des TIC pour l'autonomie (CenTich) et mutualité française Anjou-Mayenne (MFAM), 49100 Angers, France
| | - S Ervé
- Centre d'expertise des TIC pour l'autonomie (CenTich) et mutualité française Anjou-Mayenne (MFAM), 49100 Angers, France
| | - A Hajjam
- Laboratoire IRTES-SeT, université de technologie de Belfort-Montbéliard (UTBM), 90010 Belfort-Montbéliard, France
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