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CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies—A Phantom Study

  • Vania TacherEmail author
  • Maxime Blain
  • Edouard Hérin
  • Manuel Vitellius
  • Mélanie Chiaradia
  • Nadia Oubaya
  • Haytham Derbel
  • Hicham Kobeiter
Laboratory Investigation Imaging
  • 28 Downloads
Part of the following topical collections:
  1. Imaging

Abstract

Purpose

We set out to compare three types of three-dimensional CBCT-based imaging guidance modalities in a phantom study: image fusion with fluoroscopy (IF), electromagnetic navigation (EMN) and the association of both technologies (CEMNIF).

Materials and Methods

Four targets with a median diameter of 11 mm [first quartile (Q1): 10; third quartile (Q3): 12] with acute angle access (z-axis < 45°) and four targets of 10 mm [8–15] with large angle access (z-axis > 45°) were defined on an abdominal phantom (CIRS, Meditest, Tabuteau, France). Acute angle access targets were punctured using IF, EMN or CEMNIF and large angle access targets with EMN by four operators with various experiences. Efficacy (target reached), accuracy (distance between needle tip and target center), procedure time, radiation exposure and reproducibility were explored and compared.

Results

All targets were reached (100% efficacy) by all operators. For targets with acute angle access, procedure times (EMN: 265 s [236–360], IF: 292 s [260–345], CEMNIF: 320 s [240–333]) and accuracy (EMN: 3 mm [2–5], IF: 2 mm [1–3], CEMNIF: 3 mm [2–4]) were similar. Radiation exposure (EMN: 0; IF: 708 mGy.cm2 [599–1128]; CEMNIF: 51 mGy.cm2 [15–150]; p < 0.001) was significantly higher with IF than with CEMNIF and EMN. For targets with large angle access, procedure times (EMN: 345 s [259–457], CEMNIF: 425 s [340–473]; p = 0.01) and radiation exposure (EMN: 0, CEMIF: 159 mGy.cm2 [39–316]; p < 0.001) were significantly lower with EMN but with lower accuracy (EMN: 4 mm [4–6] and CEMNIF: 4 mm [3, 4]; p = 0.01). The operator’s experience did not impact the tested parameters regardless of the technique.

Conclusion

In this phantom study, EMN was not limited to acute angle targets. Efficacy and accuracy of puncture for acute angle access targets with EMN, IF or CEMNIF were similar. CEMNIF is more accurate for large angle access targets at the cost of a slightly higher procedure time and radiation exposure.

Keywords

3D image guidance CBCT Percutaneous intervention Electromagnetic navigation Phantom study Radiation exposure Accuracy 

Notes

Acknowledgements

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study was not supported by any funding.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Assistance Publique – Hôpitaux de Paris (AP-HP), Service d’Imagerie Médicale, CHU Henri MondorCréteilFrance
  2. 2.Université Paris-Est Créteil (UPEC)CréteilFrance
  3. 3.Unité INSERM U955 #18, IMRBCréteilFrance
  4. 4.Service de santé publiqueAPHP Hôpital Henri MondorCréteilFrance
  5. 5.UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit)Paris-Est UniversityCréteilFrance

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