Electromagnetic navigation versus fluoroscopy in aortic endovascular procedures: a phantom study

  • Kjetil Tystad LundEmail author
  • Geir Arne Tangen
  • Frode Manstad-Hulaas
Original Article



To explore the possible benefits of electromagnetic (EM) navigation versus conventional fluoroscopy during abdominal aortic endovascular procedures.


The study was performed on a phantom representing the abdominal aorta. Intraoperative cone beam computed tomography (CBCT) of the phantom was acquired and merged with a preoperative multidetector CT (MDCT). The CBCT was performed with a reference plate fixed to the phantom that, after merging the CBCT with the MDCT, facilitated registration of the MDCT volume with the EM space. An EM field generator was stationed near the phantom. Navigation software was used to display EM-tracked instruments within the 3D image volume. Fluoroscopy was performed using a C-arm system. Five operators performed a series of renal artery cannulations using modified instruments, alternatingly using fluoroscopy or EM navigation as the sole guidance method. Cannulation durations and associated radiation dosages were noted along with the number of cannulations complicated by loss of guidewire insertion.


A total of 120 cannulations were performed. The median cannulation durations were 41.5 and 34.5 s for the fluoroscopy- and EM-guided cannulations, respectively. No significant difference in cannulation duration was found between the two modalities (p = 0.736). Only EM navigation showed a significant reduction in cannulation duration in the latter half of its cannulation series compared with the first half (p = 0.004). The median dose area product for fluoroscopy was 0.0836 \(\hbox {Gy cm}^{2}\). EM-guided cannulations required a one-time CBCT dosage of 3.0278 \(\hbox {Gy cm}^{2}\). Three EM-guided and zero fluoroscopy-guided cannulations experienced loss of guidewire insertion.


Our findings indicate that EM navigation is not inferior to fluoroscopy in terms of the ability to guide endovascular interventions. Its utilization may be of particular interest in complex interventions where adequate visualization or minimal use of contrast agents is critical. In vivo studies featuring an optimized implementation of EM navigation should be conducted.


Fluoroscopy Electromagnetic navigation 3D tracking Endovascular procedures Abdominal aorta 



This study was funded by The Faculty of Medicine, NTNU; Department of Radiology, St. Olavs Hospital; and the Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy. The study was conducted at the Operating Room of the Future (FOR), St. Olavs Hospital, Trondheim, Norway. The authors thank Reidar Brekken, Dept. Medical Technology, SINTEF, Trondheim, Norway, for his assistance with the data analysis.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Human participants or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

Supplementary material 1 (mp4 5771 KB)


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Copyright information

© CARS 2016

Authors and Affiliations

  1. 1.Faculty of Medicine, Institute of Circulation and Medical ImagingNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.National Competence Centre for Ultrasound and Image-Guided TherapyTrondheimNorway
  3. 3.Operating Room of the FutureSt. Olavs HospitalTrondheimNorway
  4. 4.Department of RadiologySt. Olavs HospitalTrondheimNorway
  5. 5.Department of Medical TechnologySINTEFTrondheimNorway

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