David A. Valenti^*, Louis-Martin Boucher, Giovanni Artho, Christopher von Jako, Tatiana Cabrera

Show more
Department of Medical Imaging, McGill University, Montreal, Canada.
ActiViews, Inc., Wakefield, USA.
Show less

Abstract: Purpose: To evaluate a new miniature optical navigation system for CT-guided liver interventions. Material and Methods: A two-center, prospective study was performed with four interventional radiologists. A total of 20 patients had CT-guided liver biopsy or ablation interventions utilizing the CT-Guide? navigation system (ActiViews Inc., Wakefield, MA) between July 2011 and December 2011. The navigation system consists of a self-adhesive patientsticker printed with coincident colored and radio-opaque reference markers, a miniature disposable video camera that clips on and off an interventional instrument, and software loaded on a computer to display the navigation information. The primary end point was the frequency of a satisfactory instrument position for the intended intervention. Results: The cohort consisted of 13 males and 7 females with an average age of 63.1 years (range of 38 to 80). Most of the patients, 70%, underwent CT-guided liver biopsy while the remainder had CT-guided ablation therapy. The average lesion size was 3.1 cm (range of 1.1 - 6.9 cm). All of the interventions, regardless of lesion size, met the primary end point of satisfactory instrument positioning. There were no device-related or unexpected adverse events recorded. Only one patient had a mild adverse event and it resolved without intervention. Conclusions: This study demonstrated the safety and effectiveness of the CT-Guide? navigation system for CT-guided liver interventions, for both biopsies and ablations. The targeting success rate for a satisfactory intervention was 100% with the system.

Keywords: Computerized Navigation; CT-Guided Biopsy; CT-Guided Ablations

Cite this paper: Valenti, D. , Boucher, L. , Artho, G. , Jako, C. and Cabrera, T. (2013) Minioptical Navigation System for CT-Guided Percutaneous Liver Procedures. Advances in Computed Tomography, 2, 77-82. doi: 10.4236/act.2013.23014.

References

[1]   M. Lüning, B. Schmeisser, H. Wolff, W. Schopke, E. Hoppe and R. Meyer, “Analysis of the Results of 96 CT-Guided Fine Needle Biopsies of Liver Masses,” Fortschr Rontgenstr, Vol. 141, No. 9, 1984, pp. 267-275. doi:10.1055/s-2008-1053132

[2]   J. Bruix and M. Sherman, “Management of Hepatocellular Carcinoma,” Hepatology, Vol. 42, No. 5, 2005, pp. 1208-1036. doi:10.1002/hep.20933

[3]   K. R. Reddy and E. R. Schiff, “Gastrointestinal Emergencies,” Williams & Wilkins, Baltimore, 1996-1997.

[4]   S. A. Curley, P. Marra, K. Beaty, L. M. Ellis, J. N. Vauthey, E. K. Abdalla, C. Scaife, C. Raut, R. Wolff, H. Choi, E. Loyer, P. Vallone, F. Fiore, F. Scordino, V. De Rosa, R. Orlando, S. Pignata, B. Daniele and F. Izzo, “Early and Late Complications after Radiofrequency Ablation of Malignant Liver Tumors in 608 Patients,” Annals of Surgery, Vol. 239, No. 4, 2004, pp. 450-458. doi:10.1097/01.sla.0000118373.31781.f2

[5]   T. de Baere,O. Risse, V. Kuoch, C. Dromain, C. Sengel, T. Smayra, M. Gamal El Din, C. Letoublon, D. Elias, “Adverse Events during Radiofrequency Treatment of 582 Hepatic Tumors,” American Journal of Roentgenology, Vol. 181, No. 3, 2003, pp. 695-700. doi:10.2214/ajr.181.3.1810695

[6]   J. Kettenbach, W. Kostler, E. Rucklinger, B. Gustorff, M. Hüpfl, F. Wolf, K. Peer, M. Weigner, J. Lammer, W. Müller and S. N. Goldberg, “Percutaneous Saline-Enhanced Radiofrequency Ablation of Unresectable Hepatic Tumors: Initial Experience in 26 Patients,” American Journal of Roentgenology, Vol. 180, No. 6, 2003, pp. 1537-1545. doi:10.2214/ajr.180.6.1801537

[7]   K. Katada, R. Kato, H. Anno, Y. Ogura, S. Koga, Y. Ida, M. Sato and K. Nonomura, “Guidance with Real-Time CT Fluoroscopy: Early Clinical Experience,” Radiology, Vol. 200, No. 3, 1996, pp. 851-856.

[8]   E. K. Paulson, D. H. Sheafor, D. S. Enterline, H. P. McAdams and T. T. Yoshizumi, “CT Fluoroscopy-Guided Interventional Procedures: Techniques and Radiation Dose to Radiologists,” Radiology, Vol. 220, No. 1, 2001, pp. 161-167.

[9]   G. Jako, “Lasers Cut a Swath in Surgical and Medical Applications,” IEEE Spectrum, Vol. 22, 1985, pp. 82-87. doi:10.1109/MSPEC.1985.6370594

[10]   R. Buchalla, S. Hopf-Jensen, O. Rubarth and W. Borm, “Frameless Navigated Biopsy with the BrainLAB® VarioGuide System: A Technical Note,” Journal of Neurological Surgery. Part A, Central European Neurosurgery, 2012, in Press.

[11]   R. A. von Jako, J. A. Carrino, K. S. Yonemura, G. A. Noda, W. Zhue, D. Blaskiewicz, M. Rajue, D. E. Groszmann and G. Weber, “Electromagnetic Navigation for Percutaneous Guide-Wire Insertion: Accuracy and Efficiency Compared to Conventional Fluoroscopic Guidance,” Neuroimage, Vol. 47, Suppl. 2, 2009, pp. 127-132. doi:10.1016/j.neuroimage.2009.05.002

[12]   C. von Jako, Y. Zuk, O. Zur and P. Gilboa, “A Novel Accurate Minioptical Tracking System for Percutaneous Needle Placement,” IEEE Transactions on Biomedical Engineering, Vol. 60, No. 8, 2013, pp. 2222-2225. doi:10.1109/TBME.2013.2251883

[13]   B. J. Wood, H. Zhang, A. Durrani, N. Glossop, S. Ranjan, D. Lindisch, E. Levy, F. Banovac, J. Borgert, S. Krueger, J. Kruecker, A. Viswanathan and K. Cleary, “Navigation with Electromagnetic Tracking for Interventional Radiology Procedures: A Feasibility Study,” Journal of Vascular and Interventional Radiology, Vol. 16, No. 4, 2005, pp. 493-505. doi:10.1097/01.RVI.0000148827.62296.B4

[14]   J. Krucker, S. Xu, N. Glossop, A. Viswanathan, J. Borgert, H. Schulz and B. J. Wood, “Electromagnetic Tracking for Thermal Ablation and Biopsy Guidance: Clinical Evaluation of Spatial Accuracy,” Journal of Vascular and Interventional Radiology, Vol. 18, No. 9, 2007, pp. 1141-1150. doi:10.1016/j.jvir.2007.06.014

[15]   L. Appelbaum, J. Sosna, Y. Nissenbaum, A. Benshtein, and S. N. Goldberg, “Electromagnetic Navigation System for CT-Guided Biopsy of Small Lesions,” American Journal of Roentgenology, Vol. 196, No. 5, 2011, pp. 1194-1200. doi:10.2214/AJR.10.5151

[16]   J. Hummel, M. Figl, C. Kollmann, H. Bergmannb and W. Birkfellner, “Evaluation of a Miniature Electromagnetic Position Tracker,” Medical Physics, Vol. 29, No. 10, 2002, pp. 2205-2212. doi:10.1118/1.1508377