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Cone-beam Computed Tomography-guided Stereotactic Liver Punctures: A Phantom Study

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Abstract

Purpose

Images from computed tomography (CT), combined with navigation systems, improve the outcomes of local thermal therapies that are dependent on accurate probe placement. Although the usage of CT is desired, its availability for time-consuming radiological interventions is limited. Alternatively, three-dimensional images from C-arm cone-beam CT (CBCT) can be used. The goal of this study was to evaluate the accuracy of navigated CBCT-guided needle punctures, controlled with CT scans.

Methods

Five series of five navigated punctures were performed on a nonrigid phantom using a liver specific navigation system and CBCT volumetric dataset for planning and navigation. To mimic targets, five titanium screws were fixed to the phantom. Target positioning accuracy (TPECBCT) was computed from control CT scans and divided into lateral and longitudinal components. Additionally, CBCT-CT guidance accuracy was deducted by performing CBCT-to-CT image coregistration and measuring TPECBCT-CT from fused datasets. Image coregistration was evaluated using fiducial registration error (FRECBCT-CT) and target registration error (TRECBCT-CT).

Results

Positioning accuracies in lateral directions pertaining to CBCT (TPECBCT = 2.1 ± 1.0 mm) were found to be better to those achieved from previous study using CT (TPECT = 2.3 ± 1.3 mm). Image coregistration error was 0.3 ± 0.1 mm, resulting in an average TRE of 2.1 ± 0.7 mm (N = 5 targets) and average Euclidean TPECBCT-CT of 3.1 ± 1.3 mm.

Conclusions

Stereotactic needle punctures might be planned and performed on volumetric CBCT images and controlled with multidetector CT with positioning accuracy higher or similar to those performed using CT scanners.

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Acknowledgments

Parts of the work presented in this manuscript are founded by the Eurostars-Eureka Programme under the project iVisc (E!6201). The authors thank CAScination AG, Bern, Switzerland, for providing hardware support, Dr. Matthias Peterhans and Sylvain Anderegg for valuable support during the development of the approach, and finally Kate A. Gavaghan and Tom Williamson for proofreading the paper.

Conflict of interest

Grzegorz Toporek, Dr. Daphné Wallach, Prof. Dr. Stefan Weber, and Dr. Gerlig Widmann declare no conflict of interest. Prof. Reto Bale is a coinventor of the stereotactic ATLAS aiming device (Medical Intelligence GmbH, Schwabmünchen, Germany) and a coshareholder in its financial returns.

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Authors and Affiliations

  1. ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland

    Grzegorz Toporek, Daphné Wallach & Stefan Weber

  2. Section of Microinvasive Therapy, Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Reto Bale & Gerlig Widmann

Authors
  1. Grzegorz Toporek
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  2. Daphné Wallach
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  3. Stefan Weber
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  4. Reto Bale
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  5. Gerlig Widmann
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Correspondence to Daphné Wallach.

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Toporek, G., Wallach, D., Weber, S. et al. Cone-beam Computed Tomography-guided Stereotactic Liver Punctures: A Phantom Study. Cardiovasc Intervent Radiol 36, 1629–1637 (2013). https://doi.org/10.1007/s00270-013-0635-x

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  • DOI: https://doi.org/10.1007/s00270-013-0635-x

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