Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A Phantom Study

Abstract

Purpose: We compared the targeting accuracy and reliability of two different electromagnetic navigation systems for manually guided punctures in a phantom.

Materials and Methods: CT data sets of a gelatin filled plexiglass phantom were acquired with 1, 3, and 5 mm slice thickness. After paired-point registration of the phantom, a total of 480 navigated stereotactic needle insertions were performed manually using electromagnetic guidance with two different navigation systems (Medtronic Stealth Station: AxiEM; Philips: PercuNav). A control CT was obtained to measure the target positioning error between the planned and actual needle trajectory.

Results: Using the Philips PercuNav, the accomplished Euclidean distances were 4.42 ± 1.33 mm, 4.26 ± 1.32 mm, and 4.46 ± 1.56 mm at a slice thickness of 1, 3, and 5 mm, respectively. The mean lateral positional errors were 3.84 ± 1.59 mm, 3.84 ± 1.43 mm, and 3.81 ± 1.71 mm, respectively. Using the Medtronic Stealth Station AxiEM, the Euclidean distances were 3.86 ± 2.28 mm, 3.74 ± 2.1 mm, and 4.81 ± 2.07 mm at a slice thickness of 1, 3, and 5 mm, respectively. The mean lateral positional errors were 3.29 ± 1.52 mm, 3.16 ± 1.52 mm, and 3.93 ± 1.68 mm, respectively.

Conclusion: Both electromagnetic navigation devices showed excellent results regarding puncture accuracy in a phantom model. The Medtronic Stealth Station AxiEM provided more accurate results in comparison to the Philips PercuNav for CT with 3 mm slice thickness. One potential benefit of electromagnetic navigation devices is the absence of visual contact between the instrument and the sensor system. Due to possible interference with metal objects, incorrect position sensing may occur. In contrast to the phantom study, patient movement including respiration has to be compensated for in the clinical setting.

Key points:

• Commercially available electromagnetic navigation systems have the potential to improve the therapeutic range for CT guided percutaneous procedures by comparing the needle placement accuracy on the basis of planning CT data sets with different slice thickness.

Citation Format:

• Putzer D, Arco D, Schamberger B et al. Comparison of Two Electromagnetic Navigation Systems For CT-Guided Punctures: A Phantom Study. Fortschr Röntgenstr 2016; 188: 470 – 478

Zusammenfassung

Ziel: Die Studie dient dem Vergleich der Zielgenauigkeit und Zuverlässigkeit von 2 elektromagnetischen Navigationssystemen für manuell gesteuerte Punktionen an einem Phantom.

Material und Methoden: CT-Datensätze eines mit Gelatine gefüllten Plexiglas-Phantoms wurden mit 1, 3 und 5 mm Schichtdicke erfasst. Nach Punkt-Paar-Registrierung des Phantoms wurden insgesamt 480 stereotaktisch navigierte, manuelle Nadelinsertionen mit 2 verschiedenen Navigationssystemen durchgeführt (Medtronic Stealth Sta-tion: AXIEM; Philips: PercuNav). Ein Kontroll-CT diente zur Messung der Abweichungen zwischen der geplanten und tatsächlichen Nadelposition.

Ergebnisse: Unter Verwendung von Philips PercuNav waren die euklidischen Abstände 4,42 ± 1,33 mm, 4,26 ± 1,32 mm und 4,46 ± 1,56 mm bei einer Schichtdicke von 1, 3 und 5 mm. Die mittleren seitlichen Positionsfehler waren 3,84 ± 1,59 mm, 3,84 ± 1,43 mm und 3,81 ± 1,71 mm. Unter Verwendung der Medtronic Stealth-Station AXIEM waren die euklidischen Abstände 3,86 ± 2,28 mm, 3,74 mm und ± 2,1 4,81 ± 2,07 mm bei einer Schichtdicke von 1, 3 und 5 mm. Die mittleren seitlichen Positionsfehler waren 3,29 ± 1,52 mm, 3,16 ± 1,52 mm und 3,93 ± 1,68 mm.  

Schlussfolgerung: Beide elektromagnetischen Navigationsgeräte lieferten ausgezeichnete Ergebnisse in Bezug auf die Genauigkeit. Die Medtronic Stealth-Station AXIEM ermöglichte genauere Ergebnisse im Vergleich zur Philips PercuNav, bei Durchführung der CT mit 3 mm Schichtdicke. Die Tatsache, dass elektromagnetische Navigationssysteme keinen direkten Sichtkontakt zwischen Nadel und Feldgenerator erfordern, ist ein potentieller Vorteil. Im Hinblick auf einen möglichen Einfluss von metallischen Objekten auf die Genauigkeit der Navigation sind weitere Studien zur Beurteilung notwendig. Im klinischen Alltag müssen im Rahmen der Navigation Bewegungsartefakte und Atemartefakte bedacht werden.

Kernaussagen:

• Kommerziell verfügbare, elektromagnetische Navigationssysteme haben das Potential, den therapeutischen Einsatzbereich von CT gezielten Punktionen zu erweitern, wenn man die Genauigkeit der Nadelplatzierung mit den Planungsdatensätzen in unterschiedlichen Schichtdicken vergleicht.

Key words

electromagnetic navigation system - CT guided punctures - needle guidance system - biopsy - CT - interventional procedures

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