Electromagnetic navigation platform for endovascular surgery: how to develop sensorized catheters and guidewires

Condino, Sara; Ferrari, Vincenzo; Freschi, Cinzia; Alberti, Aldo; Berchiolli, Raffaella; Mosca, Franco; Ferrari, Mauro

doi:10.1002/rcs.1417

Cited by 48 publications

(34 citation statements)

References 20 publications

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“…However, the need for a cable connection to the sensor is still a problem for these types of interventions, because it usually blocks the catheter and does not allow the use of guidewires. Recently, new methods to include EM sensors into guidewires have been presented but were only tested in phantoms so far [24].…”

Section: A Range Of Applicationmentioning

confidence: 99%

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Franz

Haidegger

Birkfellner

et al. 2014

IEEE Trans. Med. Imaging

384

273

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Abstract-Object tracking is a key enabling technology in the context of computer-assisted medical interventions. Allowing the continuous localization of medical instruments and patient anatomy, it is a prerequisite for providing instrument guidance to subsurface anatomical structures. The only widely used technique that enables real-time tracking of small objects without lineof-sight restrictions is electromagnetic (EM) tracking. While EM tracking has been the subject of many research efforts, clinical applications have been slow to emerge. The aim of this review paper is therefore to provide insight into the future potential and limitations of EM tracking for medical use. We describe the basic working principles of EM tracking systems, list the main sources of error, and summarize the published studies on tracking accuracy, precision and robustness along with the corresponding validation protocols proposed. State-of-the-art approaches to error compensation are also reviewed in depth. Finally, an overview of the clinical applications addressed with EM tracking is given. Throughout the paper, we report not only on scientific progress, but also provide a review on commercial systems. Given the continuous debate on the applicability of EM tracking in medicine, this paper provides a timely overview of the state-of-the-art in the field.

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Section: A Range Of Applicationmentioning

confidence: 99%

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Franz

Haidegger

Birkfellner

et al. 2014

IEEE Trans. Med. Imaging

384

273

View full text Add to dashboard Cite

show abstract

“…Lastly, minute EM sensor coils should be integrated into the distal portion of the catheter to accurately track the position of the tip in real time and to reconstruct the curvature of the distal part of the tip [11].…”

Section: Methodsmentioning

confidence: 99%

“…In this work, the sensorization and calibration strategies described in [11] were employed and two minute 5 DOFs EM sensor coils (0.3 Â 13 mm) (Aurora, Northern Digital, Waterloo, Canada) were integrated into the distal portion of the catheter. Moreover, as a precautionary measure, an additional 5-DOFs sensor was integrated into the catheter tip to refine the calibration [30].…”

Section: Sensorizationmentioning

confidence: 99%

“…Concerning the second issue, our research group and others [10][11][12][13] have demonstrated that a three-dimensional (3 D) computer-aided guidance system, based on the electromagnetic (EM) tracking of the surgical tools, can be a reliable solution to guide the endovascular instruments to the target site. These systems can use intraoperative data, such as 3 D ultrasound or 3 D rotational angiography, as a source to extract the 3 D model of the patient anatomy or important information for guidance of the endovascular instruments, such as vessel lumen centerline [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

Piazza

Condino

Alberti

et al. 2017

Computer Assisted Surgery

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Purpose: The in situ fenestration of a standard endograft is currently limited by difficulties in targeting the fenestration site under fluoroscopic control and by the lack of a safe method to perforate the graft. Evidence in the literature suggests the use of a 3 D electromagnetic navigator to accurately guide the endovascular instruments to the target and a laser to selectively perforate the graft. The aim of this work is to provide design guidelines to develop a sensorized catheter to guide the laser tool to the fenestration site and conduct preliminary testing of the feasibility of the proposed solution. Matherials and methods: Different catheter designs were delineated starting from engineering considerations, then prototypes were preliminarily tested to collect surgeon opinions and to steer the design process toward the preferred solution reported by the user. Finally, mechanical simulations were performed with CathCAD, a design software system for the development of composite tubing for endovascular catheters. Results: Based on surgeon feedback, a 9-French steerable catheter with a stabilization system was designed. CathCAD simulations allowed us to define the construction parameters (e.g., materials and geometric constrains) for the fabrication of composite tubes with mechanical properties (flexural, axial, and torsional rigidities) compatible with target values in the literature for guiding catheters. Conclusion:The presented results preliminarily demonstrate the clinical reasonability and feasibility of the designed tool in terms of mechanical properties. Further mechanical tests and extensive in vitro clinical trials are required prior to animal testing.

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“…In rigid phantom studies, electromagnetic navigation systems reached accuracies of up to 1 mm [19]. However, in contrast to the phantom study, registration errors because of patient motion and organ shift due to respiratory motion are key points in the clinical setting.…”

mentioning

confidence: 99%

Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A Phantom Study

Putzer

Arco

Schamberger

et al. 2016

Fortschr Röntgenstr

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Purpose: We compared the targeting accuracy and reliability of two different electromagnetic navigation systems for manually guided punctures in a phantom. Materials and Methods: CT data sets of a gelatin filled plexiglass phantom were acquired with 1,?3, and 5?mm slice thickness. After paired-point registration of the phantom, a total of 480 navigated?stereotactic needle insertions were performed manually using electromagnetic guidance with two different navigation systems (Medtronic Stealth Station: AxiEM; Philips: PercuNav). A control CT was obtained to measure the target positioning error between the planned and actual needle trajectory. Results: Using the Philips PercuNav, the accomplished Euclidean distances were 4.42???1.33?mm, 4.26???1.32?mm, and 4.46???1.56?mm at a slice thickness of 1, 3, and 5?mm, respectively. The mean lateral positional errors were 3.84???1.59?mm, 3.84???1.43?mm, and 3.81???1.71?mm, respectively. Using the Medtronic Stealth Station AxiEM, the Euclidean distances were 3.86???2.28?mm, 3.74???2.1?mm, and 4.81???2.07?mm at a slice thickness of 1, 3, and 5?mm, respectively. The mean lateral positional errors were 3.29???1.52?mm, 3.16???1.52?mm, and 3.93???1.68?mm, respectively. Conclusion: Both electromagnetic navigation devices showed excellent results regarding puncture accuracy in a phantom model. The Medtronic Stealth Station AxiEM provided more accurate results in comparison to the Philips PercuNav for CT with 3?mm slice thickness. One potential benefit of electromagnetic navigation devices is the absence of visual contact between the instrument and the sensor system. Due to possible interference with metal objects, incorrect position sensing may occur. In contrast to the phantom study, patient movement including respiration has to be compensated for in the clinical setting. Key points: ??Commercially available electromagnetic navigation systems have the potential to improve the therapeutic range for CT?guided percutaneous procedures by comparing the needle placement accuracy on the basis of planning CT data sets with different slice thickness. Citation Format: ??Putzer D, Arco D, Schamberger B et?al. Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A?Phantom Study. Fortschr R?ntgenstr 2016; 188: 470???478

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Electromagnetic navigation platform for endovascular surgery: how to develop sensorized catheters and guidewires

Abstract: The strategy proposed to sensorize endovascular instruments paves the way for the development of surgical strategies with reduced radiation dose and contrast medium injection. Further in vitro, animal and clinical experiments are necessary for complete surgical validation.

Cited by 48 publications

References 20 publications

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Electromagnetic Tracking in Medicine—A Review of Technology, Validation, and Applications

Design of a sensorized guiding catheter for in situ laser fenestration of endovascular stent

Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A Phantom Study

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