Navigation-Based Needle Puncture of a Cadaver Using a Hybrid Tracking Navigational System

Khan, M. Fawad; Doğan, Selami; Maataoui, Adel; Wesarg, Stefan; Gurung, Jessen; Ackermann, Hanns; Schiemann, Mirko; Wimmer‐Greinecker, Gerhard; Vogl, Thomas J.

doi:10.1097/01.rli.0000236910.75905.cc

Cited by 47 publications

(34 citation statements)

References 41 publications

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“…2,4 To address this issue, several navigation systems have been introduced which can guide the physician towards a preselected target (e.g. [5][6][7][8][9][10][11][12][13] ). The overall insertion error of these systems typically comprises (cf.…”

Section: Purposementioning

confidence: 99%

Human vs. robot operator error in a needle-based navigation system for percutaneous liver interventions

et al. 2009

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Computed tomography (CT) guided percutaneous punctures of the liver for cancer diagnosis and therapy (e.g. tumor biopsy, radiofrequency ablation) are well-established procedures in clinical routine. One of the main challenges related to these interventions is the accurate placement of the needle within the lesion. Several navigation concepts have been introduced to compensate for organ shift and deformation in real-time, yet, the operator error remains an important factor influencing the overall accuracy of the developed systems. The aim of this study was to investigate whether the operator error and, thus, the overall insertion error of an existing navigation system could be further reduced by replacing the user with the medical robot Robopsy. For this purpose, we performed navigated needle insertions in a static abdominal phantom as well as in a respiratory liver motion simulator and compared the human operator error with the targeting error performed by the robot. According to the results, the Robopsy driven needle insertion system is able to more accurately align the needle and insert it along its axis compared to a human operator. Integration of the robot into the current navigation system could thus improve targeting accuracy in clinical use.

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Section: Purposementioning

confidence: 99%

Human vs. robot operator error in a needle-based navigation system for percutaneous liver interventions

et al. 2009

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“…Zhang et al [2] reported a success rate of 87.5% (n = 16) in a silicon liver mounted onto a motion simulator and a mean targeting error of 8.3 ± 3.7 mm (n = 32) in swine. Other groups obtained mean errors of 8.4 ± 1.8 mm (n = 42) in human cadavers [3] and 6.4 ± 1.8 (n = 22) in ventilated swine [1].…”

Section: Discussionmentioning

confidence: 99%

“…Zhang et al [2] implanted tumor models containing radio-opaque CT contrast medium into a silicon liver model mounted on a motion simulator and also conducted experiments in swine with agar injections as nodular targets. Kahn et al [3] evaluated their navigation system in human cadavers, with three different targets: a predefined position within the ascending aorta, a calcified plaque in an artery, and the tip of a port catheter. Fichtinger et al [1] conducted experiments in ventilated swine cadavers and used stainless-steel staples as targets.…”

Section: Introductionmentioning

confidence: 99%

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In-Vivo Targeting of Liver Lesions with a Navigation System Based on Fiducial Needles

et al.

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Abstract. We assessed the targeting precision of a previously reported needle-based soft tissue navigation system in-vivo. Eight 2 ml agar nodules were implanted into the livers of two swine as tumor models. One medical expert with experience in punctures and one non-expert used the navigation system to target each nodule twice. The targeting error, which includes the system error and the user error, was defined as the distance between the applicator tip and the center of gravity of the lesions in computed tomography (CT) control scans and was 5.3 ± 2.2 mm (n = 16) for the expert, 3.2 ± 1.3 mm (n = 16) for the non-expert, and 4.2 ± 2.1 mm (n = 32) averaged over both subjects. A robust targeting precision of the order of magnitude of 4 mm could improve the treatment standard for CT-guided minimally invasive interventions in the liver dramatically.

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“…In the area of needle guidance applications, many navigation systems have been developed to solve specific clinical problems, such as liver puncture [7,8] and vertebroplasty procedures [9], as well as for general biopsy procedures [10,11]. While some groups [9][10][11] rely on well established rigid approaches for registering the patient to the image and are therefore limited to targeting static anatomical regions, other groups have investigated nonrigid methods to gate breathing [7] or to model deformation [8] in order to target organs that can deform considerably during the procedure. A recent review by Cleary and Peters [12] shows that even though non-rigid methods are making progress for interventions in the thorax and abdomen, most current work is still based on the rigid approach.…”

Section: Introductionmentioning

confidence: 99%

A navigation system for percutaneous needle interventions based on PET/CT images: Design, workflow and error analysis of soft tissue and bone punctures

Oliveira-Santos

Klaeser

Weitzel

et al. 2011

Computer Aided Surgery

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Percutaneous needle intervention based on PET/CT images is effective, but exposes the patient to unnecessary radiation due to the increased number of CT scans required. Computer assisted intervention can reduce the number of scans, but requires handling, matching and visualization of two different datasets. While one dataset is used for target definition according to metabolism, the other is used for instrument guidance according to anatomical structures. No navigation systems capable of handling such data and performing PET/CT image-based procedures while following clinically approved protocols for oncologic percutaneous interventions are available. The need for such systems is emphasized in scenarios where the target can be located in different types of tissue such as bone and soft tissue. These two tissues require different clinical protocols for puncturing and may therefore give rise to different problems during the navigated intervention.Studies comparing the performance of navigated needle interventions targeting lesions located in these two types of tissue are not often found in the literature. Hence, this paper presents an optical navigation system for percutaneous needle interventions based on PET/CT images. The system provides viewers for guiding the physician to the target with real-time visualization of PET/CT datasets, and is able to handle targets located in both bone and soft tissue. The navigation system and the required clinical workflow were designed taking into consideration clinical protocols and requirements, and the system is thus operable by a single person, even during transition to the sterile phase. Both the system and the workflow were evaluated in an initial set of experiments simulating 41 lesions (23 located in bone tissue and 18 in soft tissue) in swine cadavers. We also measured and decomposed the overall system error into distinct error sources, which allowed for the identification of particularities involved in the process as well as highlighting the differences between bone and soft tissue punctures.An overall average error of 4.23 mm and 3.07 mm for bone and soft tissue punctures, respectively, demonstrated the feasibility of using this system for such interventions. The proposed system workflow was shown to be effective in separating the preparation from the sterile phase, as well as in keeping the system manageable by a single operator. Among the distinct sources of error, the user error based on the system accuracy (defined as the distance from the planned target to the actual needle tip) appeared to be the most significant. Bone punctures showed higher user error, whereas soft tissue punctures showed higher tissue deformation error.

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Navigation-Based Needle Puncture of a Cadaver Using a Hybrid Tracking Navigational System

Abstract: Needle puncture in a soft tissue environment using the navigational system Medarpa can be reliably performed and matches the accuracy achieved by a computed tomography-guided puncture technique.

Cited by 47 publications

References 41 publications

Human vs. robot operator error in a needle-based navigation system for percutaneous liver interventions

Human vs. robot operator error in a needle-based navigation system for percutaneous liver interventions

In-Vivo Targeting of Liver Lesions with a Navigation System Based on Fiducial Needles

A navigation system for percutaneous needle interventions based on PET/CT images: Design, workflow and error analysis of soft tissue and bone punctures

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