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  • 1
    Keywords: OPTIMIZATION ; tumor ; Germany ; IN-VIVO ; VIVO ; CT ; imaging ; SUPPORT ; SYSTEM ; liver ; TUMORS ; ACCURACY ; computed tomography ; NUCLEAR-MEDICINE ; TIME ; TARGET ; NO ; TRIAL ; TRIALS ; ACQUISITION ; LESIONS ; EXPERIENCE ; RADIOFREQUENCY ABLATION ; REGISTRATION ; tomography ; COMPUTED-TOMOGRAPHY ; MOTION ; TRACKING ; IMAGE REGISTRATION ; nuclear medicine ; ORGAN MOTION ; radiology ; RE ; GUIDANCE ; ABLATION ; radiation therapy ; NUCLEAR ; USA ; SET ; IMPROVEMENT ; navigation ; MEDICINE ; CHALLENGES ; INSERTION ; HEPATIC-TUMORS ; INTERVENTIONS ; tumours ; NEEDLES ; computerised tomography ; needle insertion ; CLINICAL-EVALUATION ; motion compensation ; patient treatment
    Abstract: Computed tomography (CT)-guided percutaneous radiofrequency ablation (RFA) has become a commonly used procedure in the treatment of liver tumors. One of the main challenges related to the method is the exact placement of the instrument within the lesion. To address this issue, a system was developed for computer-assisted needle placement which uses a set of fiducial needles to compensate for organ motion in real time. The purpose of this study was to assess the accuracy of the system in vivo. Two medical experts with experience in CT-guided interventions and two nonexperts used the navigation system to perform 32 needle insertions into contrasted agar nodules injected into the livers of two ventilated swine. Skin-to-target path planning and real-time needle guidance were based on preinterventional 1 mm CT data slices. The lesions were hit in 97% of all trials with a mean user error of 2.4 +/- 2.1 mm, a mean target registration error (TRE) of 2.1 +/- 1.1 mm, and a mean overall targeting error of 3.7 +/- 2.3 mm. The nonexperts achieved significantly better results than the experts with an overall error of 2.8 +/- 1.4 mm (n=16) compared to 4.5 +/- 2.7 mm (n=16). The mean time for performing four needle insertions based on one preinterventional planning CT was 57 +/- 19 min with a mean setup time of 27 min, which includes the steps fiducial insertion (24 +/- 15 min), planning CT acquisition (1 +/- 0 min), and registration (2 +/- 1 min). The mean time for path planning and targeting was 5 +/- 4 and 2 +/- 1 min, respectively. Apart from the fiducial insertion step, experts and nonexperts performed comparably fast. It is concluded that the system allows for accurate needle placement into hepatic tumors based on one planning CT and could thus enable considerable improvement to the clinical treatment standard for RFA procedures and other CT-guided interventions in the liver. To support clinical application of the method, optimization of individual system modules to reduce intervention time is proposed
    Type of Publication: Journal article published
    PubMed ID: 19175098
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  • 2
    Keywords: tumor ; ACCURACY ; NUMBER ; COMPUTED-TOMOGRAPHY ; COMPLICATIONS ; GUIDANCE ; ABLATION ; phantom ; electromagnetic tracking ; image-guided therapy ; INTERVENTIONS ; motion compensation ; animal studies ; CT-guidance ; HEPATIC-LESIONS ; liver biopsy ; Liver simulator ; navigated biopsy
    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 x cm) than in the navigated group (78 +/- 22 mGy x 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
    Type of Publication: Journal article published
    PubMed ID: 20832025
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