Robot arm based flat panel CT-guided electromagnetic tracked spine interventions: phantom and animal model experiments
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To evaluate accuracy and procedure times of electromagnetic tracking (EMT) in a robotic arm mounted flat panel setting using phantom and animal cadaveric models.
Methods and materials:
A robotic arm mounted flat panel (RMFP) was used in combination with EMT to perform anthropomorphic phantom (n = 90) and ex vivo pig based punctures (n = 120) of lumbar facet joints (FJ, n = 120) and intervertebral discs (IVD, n = 90). Procedure accuracies and times were assessed and evaluated.
FJ punctures were carried out with a spatial accuracy of 0.8 ± 0.9 mm (phantom) and 0.6 ± 0.8 mm (ex vivo) respectively. While IVD punctures showed puncture deviations of 0.6 ± 1.2 mm (phantom) and 0.5 ± 0.6 mm (ex vivo), direct and angulated phantom based punctures had accuracies of 0.8 ± 0.9 mm and 1.0 ± 1.3 mm. Planning took longer for ex vivo IVD punctures compared to phantom model interventions (39.3 ± 17.3 s vs. 20.8 ± 5.0 s, p = 0.001) and for angulated vs. direct phantom FJ punctures (19.7 ± 5.1 s vs. 28.6 ± 7.8 s, p < 0.001). Puncture times were longer for ex vivo procedures when compared to phantom model procedures in both FJ (37.9 ± 9.0 s vs. 23.6 ± 7.2 s, p = 0.001) and IVD punctures (43.9 ± 16.1 s vs. 31.1 ± 6.4 s, p = 0.026).
The combination of RMFP with EMT provides an accurate method of navigation for spinal interventions such as facet joint punctures and intervertebral disc punctures.
KeywordsFlat detector CT Electromagnetic navigation Spinal interventions Robotics Interventional radiology
This work has been funded in part by the German Ministry for Education and Research (BMBF) in the framework of the OrthoMIT project under grant no. 01EQ0402. Equipment and material for this study were provided by CAS innovations, Siemens Healthcare, Erlangen, Germany. The authors collaborate in research with Medtronic.
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