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CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies—A Phantom Study

  • Laboratory Investigation
  • Imaging
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

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.

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References

  1. Little MP, Wakeford R, Tawn EJ, Bouffler SD, Berrington de Gonzalez A. Risks associated with low doses and low dose rates of ionizing radiation: why linearity may be (almost) the best we can do. Radiology. 2009;251:6–12.

    Article  Google Scholar 

  2. Fenster A, Bax J, Neshat H, Cool D, Kakani N, Romagnoli C. 3D ultrasound imaging in image-guided intervention. In: Conference proceedings: annual international conference of the IEEE engineering in medicine and biology society IEEE engineering in medicine and biology society conference. 2014, vol. 2014, p. 6151–6154

  3. Khankan AA, Al-Muaikeel M. Image-guided percutaneous transthoracic biopsy in lung cancer: emphasis on CT-guided technique. J Infect Public Health. 2012;5(Suppl 1):S22–30.

    Article  Google Scholar 

  4. Gupta S, Nguyen HL, Morello FA Jr, Ahrar K, Wallace MJ, Madoff DC, et al. Various approaches for CT-guided percutaneous biopsy of deep pelvic lesions: anatomic and technical considerations. Radiographics: Rev Publ Radiol Soc N Am, Inc. 2004;24:175–89.

    Article  Google Scholar 

  5. Stern EJ, Webb WR, Gamsu G. CT gantry tilt: utility in transthoracic fine-needle aspiration biopsy. Work in progress. Radiology. 1993;187:873–4.

    Article  CAS  Google Scholar 

  6. Tacher V, Radaelli A, Lin M, Geschwind JF. How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274:320–34.

    Article  Google Scholar 

  7. Abi-Jaoudeh N, Kruecker J, Kadoury S, Kobeiter H, Venkatesan AM, Levy E, et al. Multimodality image fusion-guided procedures: technique, accuracy, and applications. Cardiovasc Intervent Radiol. 2012;35:986–98.

    Article  Google Scholar 

  8. Abi-Jaoudeh N, Fisher T, Jacobus J, Skopec M, Radaelli A, Van Der Bom IM, et al. Prospective randomized trial for image-guided biopsy using cone-beam CT navigation compared with conventional CT. J Vasc Interv Radiol JVIR. 2016;27:1342–9.

    Article  Google Scholar 

  9. Tacher V, Desgranges P, You K, Ridouani F, Marzelle J, Kobeiter H. Feasibility of three-dimensional MR angiography image fusion guidance for endovascular abdominal aortic aneurysm repair. J Vasc Interv Radiol JVIR. 2016;27:188–93.

    Article  Google Scholar 

  10. Tacher V, Petit A, Derbel H, Novelli L, Vitellius M, Ridouani F, et al. Three-dimensional image fusion guidance for transjugular intrahepatic portosystemic shunt placement. Cardiovasc Intervent Radiol. 2017;40:1732–9.

    Article  Google Scholar 

  11. Deschamps F, Solomon SB, Thornton RH, Rao P, Hakime A, Kuoch V, et al. Computed analysis of three-dimensional cone-beam computed tomography angiography for determination of tumor-feeding vessels during chemoembolization of liver tumor: a pilot study. Cardiovasc Intervent Radiol. 2010;33:1235–42.

    Article  Google Scholar 

  12. Lucatelli P, Argiro R, Bascetta S, Saba L, Catalano C, Bezzi M, et al. Single injection dual phase CBCT technique ameliorates results of trans-arterial chemoembolization for hepatocellular cancer. Transl Gastroenterol Hepatol. 2017;2:83.

    Article  Google Scholar 

  13. Lucatelli P, Argiro R, Ginanni Corradini S, Saba L, Cirelli C, Fanelli F, et al. Comparison of image quality and diagnostic performance of cone-beam CT during drug-eluting embolic transarterial chemoembolization and multidetector CT in the detection of hepatocellular carcinoma. J Vasc Interv Radiol JVIR. 2017;28:978–86.

    Article  Google Scholar 

  14. Lucatelli P, Corona M, Argiro R, Anzidei M, Vallati G, Fanelli F, et al. Impact of 3D rotational angiography on liver embolization procedures: review of technique and applications. Cardiovasc Intervent Radiol. 2015;38:523–35.

    Article  Google Scholar 

  15. Leger T, Tacher V, Majewski M, Touma J, Desgranges P, Kobeiter H. Image fusion guidance for in situ laser fenestration of aortic stent graft for endovascular repair of complex aortic aneurysm: feasibility, efficacy and overall functional success. Cardiovasc Intervent Radiol. 2019;42:1371–79.

    Article  Google Scholar 

  16. Touma J, Kobeiter H, Majewski M, Tacher V, Desgranges P. Triple in situ antegrade laser fenestration of aortic stent-graft extension using fusion imaging for urgent treatment of symptomatic abdominal aneurysm with type 1 endoleak. Cardiovasc Intervent Radiol. 2018;41:513–7.

    Article  Google Scholar 

  17. Abi-Jaoudeh N, Kobeiter H, Xu S, Wood BJ. Image fusion during vascular and nonvascular image-guided procedures. Tech Vasc Interv Radiol. 2013;16:168–76.

    Article  Google Scholar 

  18. Rouchy RC, Moreau-Gaudry A, Chipon E, Aubry S, Pazart L, Lapuyade B, et al. Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial. Trials. 2017;18:306.

    Article  CAS  Google Scholar 

  19. Durand P, Moreau-Gaudry A, Silvent AS, Frandon J, Chipon E, Medici M, et al. Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: a prospective randomized clinical trial. PLoS ONE. 2017;12:e0173751.

    Article  Google Scholar 

  20. Tacher V, Lin M, Desgranges P, Deux JF, Grunhagen T, Becquemin JP, et al. Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol JVIR. 2013;24:1698–706.

    Article  Google Scholar 

  21. Schernthaner RE, Chapiro J, Sahu S, Withagen P, Duran R, Sohn JH, et al. Feasibility of a modified cone-beam CT rotation trajectory to improve liver periphery visualization during transarterial chemoembolization. Radiology. 2015;277:833–41.

    Article  Google Scholar 

  22. Racadio JM, Nachabe R, Homan R, Schierling R, Racadio JM, Babic D. Augmented reality on a C-arm system: a preclinical assessment for percutaneous needle localization. Radiology. 2016;281:249–55.

    Article  Google Scholar 

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Acknowledgements

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Assistance Publique – Hôpitaux de Paris (AP-HP), Service d’Imagerie Médicale, CHU Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France

    Vania Tacher, Maxime Blain, Edouard Hérin, Manuel Vitellius, Mélanie Chiaradia, Haytham Derbel & Hicham Kobeiter

  2. Université Paris-Est Créteil (UPEC), 94010, Créteil, France

    Vania Tacher, Edouard Hérin, Haytham Derbel & Hicham Kobeiter

  3. Unité INSERM U955 #18, IMRB, Créteil, France

    Vania Tacher & Haytham Derbel

  4. Service de santé publique, APHP Hôpital Henri Mondor, Créteil, France

    Nadia Oubaya

  5. UPEC, DHU A-TVB, IMRB-EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Paris-Est University, 94000, Créteil, France

    Nadia Oubaya

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  1. Vania Tacher
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  2. Maxime Blain
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  8. Hicham Kobeiter
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Correspondence to Vania Tacher.

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Tacher, V., Blain, M., Hérin, E. et al. CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies—A Phantom Study. Cardiovasc Intervent Radiol 43, 495–504 (2020). https://doi.org/10.1007/s00270-019-02356-w

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  • DOI: https://doi.org/10.1007/s00270-019-02356-w

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