Electromagnetic field-based navigation for percutaneous punctures on C-arm CT: experimental evaluation and clinical application

• Published in: European radiology 2008-12, Vol.18 (12), p.2855-2864
• Main Authors: Meyer, Bernhard C., Peter, Olaf, Nagel, Markus, Hoheisel, Martin, Frericks, Bernd B., Wolf, Karl-Jürgen, Wacker, Frank K.
• Format: Article
• Language: English
• Subjects: Diagnostic Radiology; Electromagnetic Fields; Electromagnetic Phenomena; Electronics - instrumentation; Equipment Design; Equipment Failure Analysis; Humans; Imaging; Internal Medicine; Interventional; Interventional Radiology; Medicine; Medicine & Public Health; Neuroradiology; Phantoms, Imaging; Punctures - instrumentation; Punctures - methods; Radiography, Interventional - instrumentation; Radiography, Interventional - methods; Radiology; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-008-1063-1

The aim of this study was to prospectively evaluate the needle visualization and placement error and use of an electromagnetic field-based tracking navigation device for puncture procedures based on C-arm CT (CACT) images. A commercially available navigation device was mounted on an angiographic X-ray system setup for CACT. After the target was defined, needle placement was performed under real-time visualization of the virtual needle in CACT images. The final, real needle position was assessed by CACT. Punctures were performed in phantoms ( n  = 76) and in twelve patients (eight biopsies, three drainages, one injection). Procedure times, system error, user error and total error were assessed. In phantoms, mean total error was 2.3 ± 0.9 mm, user error was 1.4 ± 0.8 mm and system error was 1.7 ± 0.8 mm. In the patient study, the targeted puncture was successful in all twelve cases. The mean total error was 5.4 mm ± 1.9 mm (maximum 8.1 mm), user error was 3.7 ± 1.7 mm, system error was 3.2 ± 1.4 mm and mean skin-to-target time was less than 1 min. The navigation device relying on CACT was accurate in terms of needle visualization and useful for needle placement under both experimental and clinical conditions. For more complex procedures, electromagnetic field-based tracking guidance might be of help in facilitating the puncture and reducing both the puncture risk and procedure time.