Marius Schwalbe1, Tom Williamson1, Iwan Paolucci1, Torsten Fuss2, Iris Baumgartner2, Daniel Candinas3, Stefan Weber1, Pascale Tinguely3. 1. a ARTORG Center for Biomedical Engineering Research , University of Bern , Bern , Switzerland. 2. b Division of Clinical and Interventional Angiology , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland. 3. c Department of Visceral Surgery and Medicine , Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland.
Abstract
BACKGROUND: The benefits of using navigation technology for percutaneous local ablation of selected hepatocellular carcinoma (HCC) have been shown. Due to additional efforts in the procedural workflow, barriers to introducing navigation systems on a broad clinical level remain high. In this work, initial steps toward a novel concept for simple and precise targeting of HCC are evaluated. MATERIAL AND METHODS: The proposed technique is based on an angiographic approach using an intrahepatic electromagnetic (EM) reference, for consecutive percutaneous navigated positioning of ablation probes. We evaluated the environmental influence of the angiography suite on EM tracking accuracy, the measurement of a 3 D offset from two 2 D fluoroscopy images, and the accuracy and efficiency of the proposed approach in a porcine liver model. RESULTS: The C-arm had a major influence on EM tracking accuracy, with an error up to 3.8 mm. The methodology applied for measurement of a 3 D offset from 2 D fluoroscopy images was confirmed to be feasible with a mean error of 0.76 mm. In the porcine liver model experiment, the overall target positioning error (TPE) was 2.0 mm and time for navigated targeting was 17.9 seconds, when using a tracked ablation probe. CONCLUSIONS: The initial methodology of the proposed technique was confirmed to be feasible, introducing a novel concept for simple and precise navigated targeting of HCC.
BACKGROUND: The benefits of using navigation technology for percutaneous local ablation of selected hepatocellular carcinoma (HCC) have been shown. Due to additional efforts in the procedural workflow, barriers to introducing navigation systems on a broad clinical level remain high. In this work, initial steps toward a novel concept for simple and precise targeting of HCC are evaluated. MATERIAL AND METHODS: The proposed technique is based on an angiographic approach using an intrahepatic electromagnetic (EM) reference, for consecutive percutaneous navigated positioning of ablation probes. We evaluated the environmental influence of the angiography suite on EM tracking accuracy, the measurement of a 3 D offset from two 2 D fluoroscopy images, and the accuracy and efficiency of the proposed approach in a porcine liver model. RESULTS: The C-arm had a major influence on EM tracking accuracy, with an error up to 3.8 mm. The methodology applied for measurement of a 3 D offset from 2 D fluoroscopy images was confirmed to be feasible with a mean error of 0.76 mm. In the porcine liver model experiment, the overall target positioning error (TPE) was 2.0 mm and time for navigated targeting was 17.9 seconds, when using a tracked ablation probe. CONCLUSIONS: The initial methodology of the proposed technique was confirmed to be feasible, introducing a novel concept for simple and precise navigated targeting of HCC.
Authors: Pascale Tinguely; Marius Schwalbe; Torsten Fuss; Dominik P Guensch; Andreas Kohler; Iris Baumgartner; Stefan Weber; Daniel Candinas Journal: PLoS One Date: 2018-05-23 Impact factor: 3.240