As a low-cost needle navigation system, AngleNav may be used to improve the accuracy, speed, and ease of CT-guided needle punctures. The AngleNav hardware includes a wireless device with a microelectromechanical (MEMS) tracker that can be attached to any standard needle. The physician defines the target, desired needle path and skin entry point on a CT slice image. The accuracy of AngleNav was first tested in a 3D-printed calibration platform in a benchtop setting. An abdominal phantom study was then performed in a CT scanner to validate the accuracy of the device’s angular measurement. Finally, an in vivo swine study was performed to guide the needle towards liver targets (n = 8). CT scans of the targets were used to quantify the angular errors and needle tip-to-targeting distance errors between the planned needle path and the final needle position. The MEMS tracker showed a mean angular error of 0.01° with a standard deviation (SD) of 0.62° in the benchtop setting. The abdominal phantom test showed a mean angular error of 0.87° with an SD of 1.19° and a mean tip-to-target distance error of 4.89 mm with an SD of 1.57 mm. The animal experiment resulted in a mean angular error of 6.6° with an SD of 1.9° and a mean tip-to-target distance error of 8.7 mm with an SD of 3.1 mm. These results demonstrated the feasibility of AngleNav for CT-guided interventional workflow. The angular and distance errors were reduced by 64.4 and 54.8% respectively if using AngleNav instead of freehand insertion, with a limited number of operators. AngleNav assisted the physicians to deliver accurate needle insertion during CT-guided intervention. The device could potentially reduce the learning curve for physicians to perform CT-guided needle targeting.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Abolhassani, N., R. V. Patel, and F. Ayazi. Minimization of needle deflection in robot-assisted percutaneous therapy. Int. J. Med. Robot. 3(2):140–148, 2007.
Amin, Z., J. J. Donald, A. Masters, R. Kant, A. C. Steger, S. G. Bown, and W. R. Lees. Hepatic metastases: interstitial laser photocoagulation with real-time US monitoring and dynamic CT evaluation of treatment. Radiology 187(2):339–347, 1993.
Bartling S., Kachelrieß, M., Kuntz, J., Gupta, R., Walsh, C. Wang, I. S. CT-guided interventions: current practice and future directions. In: Intraoperative imaging and image-guided therapy, edited by F. A. Jolesz. Newyork: Springer, 2014.
Brown, K. T., G. I. Getrajdman, and J. F. Botet. Clinical trial of the Bard CT guide system. J. Vasc. Interv. Radiol. 6(3):405–410, 1995.
CAScination. CAS-ONE Liver, 2017. http://www.cascination.com/products/cas-one-liver/. Accessed 16 October 2017.
Chellathurai, A., S. Kanhirat, K. Chokkappan, T. S. Swaminathan, and N. Kulasekaran. Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus. Indian J. Radiol. Imaging 19(3):206–207, 2009.
Cobb, J., J. Henckel, P. Gomes, and S. Harris. Hands-on robotic unicompartmental knee replacement. Bone Joint 88:188–197, 2006.
Daly, B., and P. A. Templeton. Real-time CT fluoroscopy: evolution of an interventional tool. Radiology 211(2):309–315, 1999.
Dou, H., S. Jiang, Z. Yang, L. Sun, X. Ma, and B. Huo. Design and validation of a CT-guided robotic system for lung cancer brachytherapy. Med. Phys. 44(9):4828–4837, 2017.
Fichtinger, G., J. P. Fiene, C. W. Kennedy, G. Kronreif, I. Iordachita, D. Y. Song, E. C. Burdette, and P. Kazanzides. Robotic assistance for ultrasound-guided prostate brachytherapy. Med. Image Anal. 12(5):535–545, 2008.
Frederick, P. R., T. H. Brown, M. H. Miller, A. L. Bahr, and K. H. Taylor. A light-guidance system to be used for CT-guided biopsy. Radiology 154(2):535–536, 1985.
Froelich, J. J., B. Saar, M. Hoppe, N. Ishaque, E. M. Walthers, and J. Regn. Real-time Ct-fluoroscopy for guidance of percutaneous drainage procedures. J. Vasc. Interv. Radiol. 9(5):735–740, 1998.
Gangi, A., B. Kastler, J. M. Arhan, A. Klinkert, J. M. Grampp, and J. L. Dietemann. A compact laser beam guidance system for interventional CT. J. Comput. Assist. Tomogr. 18(2):326–328, 1994.
Glossop, N. D. Advantages of optical compared with electromagnetic tracking. JBJS 91(Supplement_1):23–28, 2009.
GmbH ASTS. Quick and uncomplicated CT-guided interventions on the highest level with 3D-LNS, 2017. http://www.amedo-gmbh.com/index.php/en/. Accessed 16 October 2017.
Grasso, R. F., E. Faiella, G. Luppi, E. Schena, F. Giurazza, R. Del Vescovo, F. D’Agostino, R. L. Cazzato, and B. B. Zobel. Percutaneous lung biopsy: comparison between an augmented reality CT navigation system and standard CT-guided technique. Int. J. Comput. Assist. Radiol. Surg. 8(5):837–848, 2013.
Gupta, A., M. E. Allaf, L. R. Kavoussi, T. W. Jarrett, D. Y. Chan, L.-M. Su, and S. B. Solomon. Computerized tomography guided percutaneous renal cryoablation with the patient under conscious sedation: initial clinical experience. J. Urol. 175(2):447–453, 2006.
Haaga, J. R., and R. J. Alfidi. Precise biopsy localization by computer tomography. Radiology 118(3):603–607, 1976.
Haaga, J. R., R. J. Alfidi, T. R. Havrilla, A. M. Cooperman, F. E. Seidelmann, and N. E. Reich. CT detection and aspiration of abdominal abscesses. AJR 128(3):465–474, 1977.
Hassfeld, S., and J. Mühling. Comparative examination of the accuracy of a mechanical and an optical system in CT and MRT based instrument navigation. Int. J. Oral Maxillofac. Surg. 29(6):400–407, 2000.
Howard, M. H., and R. C. Nelson. An electronic device for needle placement during sonographically guided percutaneous intervention. Radiology 218(3):905–911, 2001.
Hruby, W., and H. Muschik. Belt device for simplified CT-guided puncture and biopsy: a technical note. Cardiovasc. Intervent. Radiol. 10(5):301–302, 1987.
Jacobi, V., A. Thalhammer, and J. Kirchner. Value of a laser guidance system for CT interventions: a phantom study. Eur. Radiol. 9(1):137–140, 1999.
Jakopec, M., F. Baena, and S. J. Harris. The hands-on orthopaedic robot “Acrobot”: early clinical trials of total knee replacement surgery. IEEE Trans. Robot. 19(5):902–911, 2003.
Kettenbach, J., L. Kara, G. Toporek, M. Fuerst, and G. Kronreif. A robotic needle-positioning and guidance system for CT-guided puncture: ex vivo results. Minim. Invasive Ther. Allied Technol. 23(5):271–278, 2014.
Kim, E., T. J. Ward, R. S. Patel, A. M. Fischman, S. Nowakowski, and R. A. Lookstein. CT-guided liver biopsy with electromagnetic tracking: results from a single-center prospective randomized controlled trial. AJR 203(6):W715–W723, 2014.
Kloeppel, R., T. Weisse, F. Deckert, W. Wilke, and S. Pecher. CT-guided intervention using a patient laser marker system. Eur. Radiol. 10(6):1010–1014, 2000.
Krombach, G. A., and A. Mahnken. US-guided nephrostomy with the aid of a magnetic field-based navigation device in the porcine pelvicaliceal system. J. Vasc. Interv. Radiol. 12(5):623–628, 2001.
Leschka, S. C., D. Babic, S. El Shikh, C. Wossmann, M. Schumacher, and C. A. Taschner. C-arm cone beam computed tomography needle path overlay for image-guided procedures of the spine and pelvis. Neuroradiology 54(3):215–223, 2012.
Ltd PHP. MAXIO is a USFDA 510(k) approved device, 2017. http://www.perfinthealthcare.com/MaxioOverview.asp. Accessed 16 October 2017.
Martinez, R. M., W. Ptacek, W. Schweitzer, G. Kronreif, M. Fürst, M. J. Thali, and L. C. Ebert. CT-guided, minimally invasive, postmortem needle biopsy using the B-rob II needle-positioning robot. J. Forens. Sci. 59(2):517–521, 2014.
Mbalisike, E. C., T. J. Vogl, S. Zangos, K. Eichler, P. Balakrishnan, and J. Paul. Image-guided microwave thermoablation of hepatic tumours using novel robotic guidance: an early experience. Eur. Radiol. 25(2):454–462, 2015.
Miaux, Y., A. Guermazi, D. Gossot, P. Bourrier, D. Angoulvant, A. Khairoune, C. Turki, and E. Bouche. Laser guidance system for CT-guided procedures. Radiology 194(1):282–284, 1995.
Moser, C., J. Becker, M. Deli, M. Busch, M. Boehme, and D. H. W. Groenemeyer. A novel laser navigation system reduces radiation exposure and improves accuracy and workflow of CT-guided spinal interventions: a prospective, randomized, controlled, clinical trial in comparison to conventional freehand puncture. Eur. J. Radiol. 82(4):627–632, 2013.
NeoRad. SimpliCT, 2017. http://neorad.no/products_1/simplict_for_ct_and_pet_ct/. Accessed 16 October 2017.
N.V.K.P.EPIQ PercuNav, 2017. https://www.philips.co.in/healthcare/product/HCNOCTN150/epiq-percunav-premium-fusion-and-navigation. Accessed 16 October 2017.
Onik, G., E. R. Cosman, T. H. Wells, Jr, H. I. Goldberg, A. A. Moss, P. Costello, R. A. Kane, W. I. Hoddick, and B. Demas. CT-guided aspirations for the body: comparison of hand guidance with stereotaxis. Radiology 166(2):389–394, 1988.
Onik, G., P. Costello, E. Cosman, T. Wells, Jr, H. Goldberg, A. Moss, R. Kane, M. E. Clouse, W. Hoddick, S. Moore, et al. CT body stereotaxis: an aid for CT-guided biopsies. AJR 146(1):163–168, 1986.
Ozdoba, C., K. Voigt, and F. Nusslin. New device for CT-targeted percutaneous punctures. Radiology 180(2):576–578, 1991.
Palestrant, A. M. Comprehensive approach to CT-guided procedures with a hand-held guidance device. Radiology 174(1):270–272, 1990.
Penzkofer, T., P. Bruners, P. Isfort, F. Schoth, R. W. Gunther, T. Schmitz-Rode, and A. H. Mahnken. Free-hand CT-based electromagnetically guided interventions: accuracy, efficiency and dose usage. Minim. Invasive. Ther. Allied Technol. 20(4):226–233, 2011.
Pereles, F. S., M. Baker, R. Baldwin, E. Krupinski, and E. C. Unger. Accuracy of CT biopsy: laser guidance versus conventional freehand techniques. Acad. Radiol. 5(11):766–770, 1998.
Reyes, G. D. A guidance device for CT-guided procedures. Radiology 176(3):863–864, 1990.
Ryan, E. R., C. T. Sofocleous, H. Schöder, J. A. Carrasquillo, S. Nehmeh, S. M. Larson, R. Thornton, R. H. Siegelbaum, J. P. Erinjeri, and S. B. Solomon. Split-dose technique for FDG PET/CT–guided percutaneous ablation: a method to facilitate lesion targeting and to provide immediate assessment of treatment effectiveness. Radiology 268(1):288–295, 2013.
Schulz, B., K. Eichler, P. Siebenhandl, T. Gruber-Rouh, C. Czerny, T. J. Vogl, and S. Zangos. Accuracy and speed of robotic assisted needle interventions using a modern cone beam computed tomography intervention suite: a phantom study. Eur. Radiol. 23(1):198–204, 2013.
Silverman, S. G., K. Tuncali, D. F. Adams, R. D. Nawfel, K. H. Zou, and P. F. Judy. CT fluoroscopy-guided abdominal interventions: techniques, results, and radiation exposure. Radiology 212(3):673–681, 1999.
Tselikas, L., J. Joskin, F. Roquet, G. Farouil, S. Dreuil, A. Hakimé, C. Teriitehau, A. Auperin, T. de Baere, and F. Deschamps. Percutaneous bone biopsies: comparison between flat-panel cone-beam CT and CT-scan guidance. Cardiovasc. Intervent. Radiol. 38(1):167–176, 2015.
Wile, G. E., J. R. Leyendecker, K. A. Krehbiel, R. B. Dyer, and R. J. Zagoria. CT and MR imaging after imaging-guided thermal ablation of renal neoplasms. Radiographics 27(2):325–339, 2007.
Wolf, F. J., D. J. Grand, J. T. Machan, T. A. DiPetrillo, W. W. Mayo-Smith, and D. E. Dupuy. Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients. Radiology 247(3):871–879, 2008.
Wunschik, F., M. Georgi, and O. Pastyr. Stereotactic biopsy using computed tomography. J. Comput. Assist. Tomogr. 8(1):32–37, 1984.
NIH does not endorse or recommend any commercial products, processes, or services. The content of this manuscript does not necessarily reflect the views or policies of the Department of Health and Human Services, nor do mention of trade names, commercial products, or organizations imply endorsement by the USA Government. This work was supported by the Center for Interventional Oncology in the Intramural Research Program of the National Institutes of Health (NIH), grants 1ZIDBC011242 and 1ZIDCL040015.
Conflict of Interest
NIH and authors may own intellectual property in the field.
Associate Editor Agata A. Exner oversaw the review of this article.
About this article
Cite this article
Li, R., Xu, S., Pritchard, W.F. et al. AngleNav: MEMS Tracker to Facilitate CT-Guided Puncture. Ann Biomed Eng 46, 452–463 (2018). https://doi.org/10.1007/s10439-017-1968-4
- CT-guided biopsy or ablation
- MEMS sensor
- Angular tracking