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Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Treatment of vascular malformations requires the placement of a needle within vessels which may be as small as 1 mm, with the current state of the art relying exclusively on two-dimensional fluoroscopy images for guidance. We hypothesize that the combination of stereotactic image guidance with existing targeting methods will result in faster and more reproducible needle placements, as well as reduced radiationexposure, when compared to standard methods based on fluoroscopy alone.

Methods

The proposed navigation approach was evaluated in a phantom experiment designed to allow direct comparison with the conventional method. An anatomical phantom of the left forearm was constructed, including an independent control mechanism to indicate the attainment of the target position. Three interventionalists (one inexperienced, two of them frequently practice the conventional fluoroscopic technique) performed 45 targeting attempts utilizing the combined and 45 targeting attempts utilizing the standard approaches.

Results

In all 45 attempts, the users were able to reach the target when utilizing the combined approach. In two cases, targeting was stopped after 15 min without reaching the target when utilizing only the C-arm. The inexperienced user was faster when utilizing the combined approach and applied significantly less radiation than when utilizing the conventional approach. Conversely, both experienced users were faster when using the conventional approach, in one case significantly so, with no significant difference in radiation dose when compared to the combined approach.

Conclusions

This work presents an initial evaluation of a combined navigation fluoroscopy targeting technique in a phantom study. The results suggest that, especially for inexperienced interventionalists, navigation may help to reduce the time and the radiation dose. Future work will focus on the improvement and clinical evaluation of the proposed method.

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Acknowledgments

The work presented in this manuscript was partially funded by the Ruth & Arthur Scherbarth Stiftung. The authors would like to acknowledge Huanxiang Lu, Matteo Fusaglia, Denise Baumann, Matthias Peterhans, and Juan Ansó for advice, and CAScination AG for providing the IGS system used in the experiments.

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Authors and Affiliations

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

    Marius Schwalbe, Tom Williamson & Stefan Weber

  2. Division of Clinical and Interventional Angiology, Inselspital, Bern University Hospital, Bern, Switzerland

    Axel Haine, Marc Schindewolf, Iris Baumgartner & Torsten Fuss

  3. Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, Bern, Switzerland

    Hendrik von Tengg-Kobligk

Authors
  1. Marius Schwalbe
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  2. Axel Haine
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  3. Marc Schindewolf
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  4. Hendrik von Tengg-Kobligk
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  5. Tom Williamson
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  6. Stefan Weber
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  7. Iris Baumgartner
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  8. Torsten Fuss
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Corresponding author

Correspondence to Marius Schwalbe.

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The authors declare that they have no conflict of interest.

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

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Schwalbe, M., Haine, A., Schindewolf, M. et al. Feasibility of stereotactic MRI-based image guidance for the treatment of vascular malformations: a phantom study. Int J CARS 11, 2207–2215 (2016). https://doi.org/10.1007/s11548-016-1417-0

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  • DOI: https://doi.org/10.1007/s11548-016-1417-0

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