A concept for electromagnetic navigated targeting of liver tumors using an angiographic approach

Abstract

The initial methodology of the proposed technique was confirmed to be feasible, introducing a novel concept for simple and precise navigated targeting of HCC.

Multi-Operational Selective Computer-Assisted Targeting of hepatocellular carcinoma—Evaluation of a novel approach for navigated tumor ablation

“…The reported effective end-to-end targeting errors range between 3–8 mm for in vitro and in vivo measurements [ 27 , 29 , 32 , 33 ]. We have previously reported target positioning errors below 3 mm when applying the herein proposed navigation approach in an ex vivo setting [ 20 ], and now showed similar targeting accuracies of 2.6 ± 1.6 mm for baseline measurements in vivo. This represents the best possible end-to-end accuracy when applying the proposed technique in an angiographic setting, and thus describes the inherent errors when using EM tracking in this environment.…”

“…Additionally, no EM tracked device for thermal ablation is currently available, although the advantage of using ablation probes tracked at their tip have been reported ex vivo and in vivo [ 29 , 43 , 44 ]. However, other EM tracked devices such as EM tracked trocars would be readily available for clinical use and have shown similar targeting accuracies in our ex vivo experiments [ 20 ]. Ultimately, this study did not include any aspects regarding local ablative treatment or outcomes beyond tumor targeting, and focused solely on the accuracy and efficiency of ablation probe positioning.…”

“…Separate skin incisions were used for probe insertion to create different angles and lengths of targeting trajectories. During navigated targeting, the C-arm was moved to a maximum distance from the working space to eliminate its influence on the EM field and thus on targeting accuracy [ 20 ]. On completion of probe positioning, two perpendicular images of the region of interest were acquired for evaluation of targeting accuracy.…”

“…In a series of ex vivo experiments, we have previously described stability of EM tracking regarding environmental interferences in the angiography suite, feasibility of the applied image evaluation approach as well as ex vivo targeting accuracy of the proposed technique [ 20 ]. In the present work, we aimed to confirm that the MOSCAT for HCC approach allows precise and efficient targeting of intrahepatic tumors in an in vivo setting.…”

Real-Time Wireless Tumor Tracking in Navigated Liver Resections: An Ex Vivo Feasibility Study

“…Studies on lesion tracking using electromagnetic (EM) trackers have shown promising results. [17][18][19][20] Most of these EM trackers are wired, which requires intraoperative implantation and subsequent intraoperative imaging to locate the tracker relative to the lesion after which the system can be calibrated. These intraoperative steps consume intraoperative time and hamper surgical workflow.…”