, Volume 61, Issue 1, pp 55–61 | Cite as

Evaluation of a novel, patient-mounted system for CT-guided needle navigation—an ex vivo study

  • Anna Mokry
  • Florian Willmitzer
  • Rafael HostettlerEmail author
  • Henning Richter
  • Patrick Kircher
  • Sibylle Kneissl
  • Stephan Wetzel
Spinal Neuroradiology



To describe the features of a novel patient-mounted system for CT-guided needle navigation, the Puncture Cube System (PCS), and to evaluate the accuracy and efficiency of the PCS by (a) applying numerical simulations and (b) by conducting punctures using the system in comparison to punctures using the free-hand method (FHM).


The PCS consists of a self-adhesive cube that is attached to the patient, with multiple through-holes in the upper and lower template plate and dedicated software that, using a computer vision algorithm, recognizes the cube in a planning scan. The target in the image dataset is connected by a line, here “virtual needle,” which passes through the cube. For any chosen path of the virtual needle, the entry points for the needle into the cube are displayed by the software for the upper and lower template on-the-fly.

The possible exactness of the system was investigated by using numerical simulations. Next, 72 punctures were performed by 6 interventionists using a phantom to compare for accuracy, time requirement, and number of CT scans for punctures with the system to the FHM ex vivo (phantom study).


The theoretical precision to arrive at targets increased with the distance of the target but remained low. The mean error for targets up to 20 cm below the lower plate was computed to be well below 0.5 mm, and the worst-case error stayed below 1.3 mm.

Compared to a conventional free-hand procedure, the use of the navigation system resulted in a statistically significantly improved accuracy (3.4 mm ± 2.3 mm versus FHM 4.9 mm ± 3.2 mm) and overall lower intervention time (168 s ± 28.5 s versus FHM 200 s ± 44.8 s). Furthermore, the number of CT scans was reduced to 2.3 versus FHM 2.8).


The PCS is a promising technique to improve accuracy and reduce intervention time in CT-guided needle navigations compared to the FHM.


Computer tomography Navigation Needle guidance 


Compliance with ethical standards


No funding was received for this study.

Conflict of interest

RH and SW are shareholders of Medical Templates AG.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinical Unit of Diagnostic ImagingVetmeduni ViennaViennaAustria
  2. 2.Clinic for Diagnostic Imaging, Department of Clinical Diagnostics and Services, Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
  3. 3.Robotics and Embedded SystemsTechnical University MunichMunichGermany
  4. 4.Medical Templates AGEggSwitzerland
  5. 5.Department of NeuroradiologyHirslanden Clinic ZurichZurichSwitzerland

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