Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial

Durand, Pierre; Moreau–Gaudry, Alexandre; Silvent, Anne-Sophie; Frandon, Julien; Chipon, E.; Medici, Maud; Bricault, Ivan

doi:10.1371/journal.pone.0173751

Cited by 46 publications

(42 citation statements)

References 19 publications

(26 reference statements)

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“…1.6 ± 1.3 mm. A randomized study on computer assisted electromagnetic navigation shows a median initial targeting accuracy of 4.1 mm for 60 needle placements . In this study too, further needle corrections where performed manually after the initial navigated needle placement.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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Background & Aims:Ablation plays an important role in the treatment of hepatocellular carcinoma. Because image-guided navigation technology has recently entered the clinical setting, we aimed to analyse its safety, therapeutic and procedural efficiency. Methods: Retrospective analysis of patients treated with stereotactic image-guided microwave ablation (SMWA) between January 2015 and December 2017. Interventions were performed using computertomography-guidance with needle trajectory, ablation planning and automatic single-marker patient registration. Needle placement and ablation coverage was controlled by image fusion under general anaesthesia with jet-ventilation. Results: In total 174 ablations were performed in 88 patients during 119 interventions. Mean age was 66 (46-84) years, 74 (84.1%) were men and 74% were Child Pugh Class A. Median tumour size was 16 (4-45) mm, 62.2% were BCLC A. Median lateral and longitudinal error of needle placement were 3.2 (0.2-14.1) and 1.6 (0-15.8) mm.Median one tumour (1-4) was ablated per session. One patient developed a Dindo IIIb (0.8%) complication, six minor complications. After re-ablation of 12 lesions, an efficacy rate of 96.3% was achieved. Local tumour progression was 6.3% (11/174).Close proximity to major vessels was significantly correlated with local tumour progression (P < .05). Median overall follow-up was 17.5 months after intervention and 24 months after initial diagnosis. BCLC stage, child class and previous treatment were significantly correlated with overall survival (P < .05). Conclusion:Stereotactic image-guided microwave ablation is a safe and efficient treatment for HCC offering a curative treatment approach in general and in particular for lesions not detectable on conventional imaging or untreatable because of difficult anatomic locations. K E Y W O R D Shepatocellular carcinoma, microwave ablation, navigation, stereotactic

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Section: Discussionmentioning

confidence: 99%

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Lachenmayer

Tinguely

Maurer

et al. 2019

Liver International

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“…A phantom study [3] reported a median distance accuracy of 3.7 mm in out-ofplane trajectories using this navigation system. In addition, a prospective randomized clinical trial [10] demonstrated that the needle insertion accuracy was significantly improved with this navigation system, when compared to insertion with conventional CT guidance (median distance accuracy, 4.1 mm vs. 8.9 mm) in various clinical conditions including out-of-plane trajectory. Some robotic positioning systems have been commercialized, including iSYS (Kitzbuhel) [8,[11][12][13] and MAXIO (Perfint Healthcare) [14][15][16][17].…”

Section: Discussionmentioning

confidence: 96%

“…Other than our robot, several devices and robots to assist out-of-plane needle insertion have been evaluated. An electromagnetically guided system (IMACTIS) displays the needle path in real time on two-dimensional CT images reconstructed from preprocedural CT data [3,10]. A phantom study [3] reported a median distance accuracy of 3.7 mm in out-ofplane trajectories using this navigation system.…”

Section: Discussionmentioning

confidence: 99%

Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals

et al. 2019

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Objectives To evaluate the accuracy of robotic CT-guided out-of-plane needle insertion in phantom and animal experiments. Methods A robotic system (Zerobot), developed at our institution, was used for needle insertion. In the phantom experiment, 12 robotic needle insertions into a phantom at various angles in the XY and YZ planes were performed, and the same insertions were manually performed freehand, as well as guided by a smartphone application (SmartPuncture). Angle errors were compared between the robotic and smartphone-guided manual insertions using Student's t test. In the animal experiment, 6 robotic out-ofplane needle insertions toward targets of 1.0 mm in diameter placed in the kidneys and hip muscles of swine were performed, each with and without adjustment of needle orientation based on reconstructed CT images during insertion. Distance accuracy was calculated as the distance between the needle tip and the target center. Results In the phantom experiment, the mean angle errors of the robotic, freehand manual, and smartphone-guided manual insertions were 0.4°, 7.0°, and 3.7°in the XY plane and 0.6°, 6.3°, and 0.6°in the YZ plane, respectively. Robotic insertions in the XY plane were significantly (p < 0.001) more accurate than smartphone-guided insertions. In the animal experiment, the overall mean distance accuracy of robotic insertions with and without adjustment of needle orientation was 2.5 mm and 5.0 mm, respectively. Conclusion Robotic CT-guided out-of-plane needle insertions were more accurate than smartphone-guided manual insertions in the phantom and were also accurate in the in vivo procedure, particularly with adjustment during insertion. Key Points • Out-of-plane needle insertions performed using our robot were more accurate than smartphone-guided manual insertions in the phantom experiment and were also accurate in the in vivo procedure. • In the phantom experiment, the mean angle errors of the robotic and smartphone-guided manual out-of-plane needle insertions were 0.4°and 3.7°in the XY plane (p < 0.001) and 0.6°and 0.6°in the YZ plane (p = 0.65), respectively.

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“…For instance, Xu et al [14] developed a smartphone augmented-reality application to provide visual guidance to the surgeon during the phase of angle selection of manual pre-insertion. With the Imactis TM commercial CTnavigation system, Durand et al [15] enhanced CT-guided interventions with a visual feedback of the trajectory of the needle before the insertion, thanks to electro-magnetic tracking. Another visual-guidance device for needle preinsertion assistance was proposed by Grasso et al [16].…”

Section: Related Workmentioning

confidence: 99%

Design of haptic guides for pre-positioning assistance of a comanipulated needle

Gurnel

Marchal

Launay

et al. 2019

2019 IEEE International Conference on Systems, Man and Cybernetics (SMC)

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In minimally-invasive procedures like biopsy, the physician has to insert a needle into the tissues of a patient to reach a target. Currently, this task is mostly performed manually and under visual guidance. However, manual needle insertion can result in a large final positioning error of the tip that might lead to misdiagnosis and inadequate treatment. A way to solve this limitation is to use shared control; a gestureassistance paradigm that combines the cognitive skills of the operator with the precision, stamina and repeatability of a robotic or haptic device. In this paper, we propose to assist the physician with a haptic device that holds the needle and generates mechanical guides during the phase of manual needle pre-positioning. In the latter, the physician has to place the tip of the needle on a planned entry point, with a pre-defined angle of incidence. From this pre-operative information and also from intra-operative measurements, we propose to generate haptic cues, known as virtual fixtures, to guide the physician towards the desired position and orientation of the needle. It takes the form of five haptic guides, each one implementing virtual fixtures. We conducted a user study where those guides were compared to the unassisted reference gesture. The most constraining guide, in terms of assisted degrees of freedom, was highlighted as the one that provides the best results in terms of performance and user experience.

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Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial

Cited by 46 publications

References 19 publications

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

Robotic CT-guided out-of-plane needle insertion: comparison of angle accuracy with manual insertion in phantom and measurement of distance accuracy in animals

Design of haptic guides for pre-positioning assistance of a comanipulated needle

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