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Patient-specific needle guidance templates drilled intraprocedurally for image guided intervention: feasibility study in swine

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Abstract

Purpose

Thermal ablation of large tumors may benefit from simultaneous placement of multiple needles, but accurate placement becomes challenging as the number of needles increases. The aim of this work was to evaluate use of personalized needle guidance grid templates based on intraprocedural CT and fabricated at the point of care to implement ablation treatment plans with multiple needles in vivo.

Methods

A plastic frame was designed to hold two parallel plastic guide plates in a rigid relationship, fixed over the abdomen by a mounting arm. Steel ball targets (1.5 mm) were implanted under ultrasound in the livers of two domestic swine under general anesthesia. Following breath-hold CT of the subject and frame, the targets and frame were identified using customized 3D Slicer-based planning software. Multiple needle trajectories targeting the balls were planned, including complex off-plane trajectories. A machining program for drilling the hole pattern corresponding to the planned needle trajectories was generated. The pattern was drilled in the two plates with a numerical-controlled milling machine in the suite. The plates were attached to the frame and needles passed through the paired holes to the calculated depth. Placement accuracy was defined as needle tip-to-target distance on post-placement CT.

Results

The planning process and manufacturing required approximately 6 and 15 min, respectively. Needles were rapidly inserted (n = 11) to the target points without complications or traversing nontarget anatomy. The mean needle tip-to-target distance error was 3.4 ± 2.2, range 0–7 mm.

Conclusion

Rapid and accurate needle placement was feasible using a subject-specific, custom-drilled, needle guidance grid template fabricated intraprocedurally. Targeting accuracy and performance were similar to more complex and expensive tracking systems which may enable accurate intraprocedural implementation of treatment plans in the liver or other organs. This may be of value in complex ablation cases or in areas where more advanced guidance systems are not available.

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Acknowledgements

We thank Andras Lasso and Gabor Fichtinger of the Department of Computer Science, Queens University, for their assistance with the planning software used in this study.

Funding

This work was supported by the Center for Interventional Oncology in the Intramural Research Program of the National Institutes of Health (NIH) by intramural NIH Grants NIH Z01 1ZID BC011242 and CL040015.

Author information

Authors and Affiliations

  1. Queen’s University, Kingston, ON, Canada

    Neil Glossop

  2. ArciTrax Inc., Toronto, ON, Canada

    Neil Glossop

  3. Medical University of Innsbruck, Innsbruck, Austria

    Reto Bale

  4. Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA

    Sheng Xu, William F. Pritchard, John W. Karanian & Bradford J. Wood

  5. National Institute of Biomedical Imaging and Bioengineering, Bethesda, MD, 20892, USA

    Bradford J. Wood

  6. National Cancer Institute Center for Cancer Research, National Institutes of Health, Bethesda, MD, 20892, USA

    Bradford J. Wood

Authors
  1. Neil Glossop
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  2. Reto Bale
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Corresponding author

Correspondence to Neil Glossop.

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Conflict of interest

Neil Glossop is an employee of ArciTrax Inc. and has intellectual property in related fields. Reto Bale is a paid consultant for Medtronic, Siemens, and Interventional Systems. Sheng Xu reports no competing interests. William Pritchard reports no competing interests. John Karanian reports no competing interests. Bradford Wood is the Principal Investigator on a Cooperative Research & Development Agreement (CRADA) between NIH and Philips and Philips Research. Philips pays royalties to NIH for a licensing agreement with NIH, who then pays royalties to BW for licensed patents from Philips. NIH may share intellectual property with ArciTrax. Bradford Wood is the Principal Investigator on CRADAs between NIH and NVIDIA, XACT Robotics, Celsion, Siemens, and BTG/Biocompatibles (now Boston Scientific). NIH has a Material Transfer Agreements with Angiodynamics.

Ethical approval

All applicable international, national, and/or institutional guidelines for the care and use of animals were followed. This study was carried out in strict accordance with the recommendations in the Guide for the Care and Use of Laboratory Animals of the National Institutes of Health. The study protocol was approved by the Animal Care and Use Committee of the NIH Clinical Center.

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Glossop, N., Bale, R., Xu, S. et al. Patient-specific needle guidance templates drilled intraprocedurally for image guided intervention: feasibility study in swine. Int J CARS 18, 537–544 (2023). https://doi.org/10.1007/s11548-022-02747-4

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  • DOI: https://doi.org/10.1007/s11548-022-02747-4

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