Comput. Aided Surg. - A navigation system for percutaneous needle interventions based on PET/CT images: design, workflow and error analysis of soft tissue and bone punctures.


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Percutaneous needle intervention based on PET/CT images is effective, but exposes the patient to unnecessary radiation due to the increased number of CT scans required. Computer assisted intervention can reduce the number of scans, but requires handling, matching and visualization of two different datasets. While one dataset is used for target definition according to metabolism, the other is used for instrument guidance according to anatomical structures. No navigation systems capable of handling such data and performing PET/CT image-based procedures while following clinically approved protocols for oncologic percutaneous interventions are available. The need for such systems is emphasized in scenarios where the target can be located in different types of tissue such as bone and soft tissue. These two tissues require different clinical protocols for puncturing and may therefore give rise to different problems during the navigated intervention. Studies comparing the performance of navigated needle interventions targeting lesions located in these two types of tissue are not often found in the literature. Hence, this paper presents an optical navigation system for percutaneous needle interventions based on PET/CT images. The system provides viewers for guiding the physician to the target with real-time visualization of PET/CT datasets, and is able to handle targets located in both bone and soft tissue. The navigation system and the required clinical workflow were designed taking into consideration clinical protocols and requirements, and the system is thus operable by a single person, even during transition to the sterile phase. Both the system and the workflow were evaluated in an initial set of experiments simulating 41 lesions (23 located in bone tissue and 18 in soft tissue) in swine cadavers. We also measured and decomposed the overall system error into distinct error sources, which allowed for the identification of particularities involved in the process as well as highlighting the differences between bone and soft tissue punctures. An overall average error of 4.23mm and 3.07mm for bone and soft tissue punctures, respectively, demonstrated the feasibility of using this system for such interventions. The proposed system workflow was shown to be effective in separating the preparation from the sterile phase, as well as in keeping the system manageable by a single operator. Among the distinct sources of error, the user error based on the system accuracy (defined as the distance from the planned target to the actual needle tip) appeared to be the most significant. Bone punctures showed higher user error, whereas soft tissue punctures showed higher tissue deformation error.

Resumo Limpo

percutan needl intervent base petct imag effect expos patient unnecessari radiat due increas number ct scan requir comput assist intervent can reduc number scan requir handl match visual two differ dataset one dataset use target definit accord metabol use instrument guidanc accord anatom structur navig system capabl handl data perform petct imagebas procedur follow clinic approv protocol oncolog percutan intervent avail need system emphas scenario target can locat differ type tissu bone soft tissu two tissu requir differ clinic protocol punctur may therefor give rise differ problem navig intervent studi compar perform navig needl intervent target lesion locat two type tissu often found literatur henc paper present optic navig system percutan needl intervent base petct imag system provid viewer guid physician target realtim visual petct dataset abl handl target locat bone soft tissu navig system requir clinic workflow design take consider clinic protocol requir system thus oper singl person even transit steril phase system workflow evalu initi set experi simul lesion locat bone tissu soft tissu swine cadav also measur decompos overal system error distinct error sourc allow identif particular involv process well highlight differ bone soft tissu punctur overal averag error mm mm bone soft tissu punctur respect demonstr feasibl use system intervent propos system workflow shown effect separ prepar steril phase well keep system manag singl oper among distinct sourc error user error base system accuraci defin distanc plan target actual needl tip appear signific bone punctur show higher user error wherea soft tissu punctur show higher tissu deform error

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