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.

中文翻译：

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基于CBCT的经皮穿刺图像引导：电磁导航与3D图像融合与荧光检查对两种技术的结合-幻影研究。

目的我们开始在幻像研究中比较三种基于三维CBCT的成像指导模式：荧光透视图像融合（IF），电磁导航（EMN）和两种技术的结合（CEMNIF）。材料与方法四个靶标，中位直径为11毫米[第一四分位数（Q1）：10；平均四分之一；在腹部体模上定义了具有锐角通道（z轴<45°）的第三四分位（Q3）：12]和具有大角度通道（z轴> 45°）的10 mm [8-15]的四个目标（z轴> 45°） CIRS，Meditest，法国Tabuteau）。由具有不同经验的四名操作员使用IF，EMN或CEMNIF穿刺了急性角度进入目标，并使用EMN穿刺了大角度进入目标。功效（达到目标），准确性（针尖与目标中心之间的距离），手术时间，探索和比较了辐射暴露和再现性。结果所有操作者均达到了所有目标（100％疗效）。对于具有锐角进入的目标，其操作时间（EMN：265 s [236-360]，IF：292 s [260-345]，CEMNIF：320 s [240-333]）和精度（EMN：3 mm [2- 5]，IF：2毫米[1-3]，CEMNIF：3毫米[2-4]）相似。IF的辐射暴露（EMN：0； IF：708 mGy.cm2 [599-1128]； CEMNIF：51 mGy.cm2 [15-150]； p <0.001）显着高于CEMNIF和EMN。对于具有大角度进入的目标，其处理时间（EMN：345 s [259-457]，CEMNIF：425 s [340-473]； p = 0.01）和辐射暴露（EMN：0，CEMIF：159 mGy.cm2 [39] -316]； p <0.001）在使用EMN时显着降低，但准确性较低（EMN：4 mm [4-6]和CEMNIF：4 mm [3，4]； p = 0.01）。运营商' 不论采用哪种技术，其经验均不会影响测试参数。结论在该幻像研究中，EMN不仅限于锐角目标。使用EMN，IF或CEMNIF进行锐角进入目标的穿刺效果和准确性相似。对于大角度进入目标，CEMNIF更为精确，但其过程时间和放射线照射时间略长。