Intraoperative and interventional MRI: Recommendations for a safe environment

Kettenbach, Joachim; Kacher, Daniel F.; Kanan, Angela R.; Rostenberg, Bill; Fairhurst, Janice; Stadler, Alfred; Kienreich, K; Jólesz, Ferenc A.

doi:10.1080/13645700600640774

Cited by 34 publications

(23 citation statements)

References 38 publications

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“…MR has many advantages such as multiplanar imaging without registration efforts (very useful for subdiaphragmal lesions) and registration errors, may get advantage of hepatospecific contrast agents and has the highest liver-tumour contrast compared to CT and US and has no ionizing radiation (13). MR, however is expensive and requires compatible equipment, access may be limited and needs experience, and may be currently only useful for lesions not accessible by other methods (14)(15). Paired-point registration calculates the geometrical transformation that best aligns corresponding points in image and patient space, respectively (12,16).…”

Section: Discussionmentioning

confidence: 98%

Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours

Widmann

Schullian

Haidu

et al. 2011

Minimally Invasive Therapy & Allied Technologies

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The targeting accuracy during CT-guided stereotactic radiofrequency ablation (SRFA) of liver tumours was evaluated in a clinical study. Patients under general anaesthesia were immobilized using a vacuum cushion and respiratory motion control was based on temporary disconnections of the endotracheal tube. An optical-based navigation system was used for 3D trajectory planning and needle placement via a stereotactic aiming device. A control CT with the needles in place was fused with the planning CT for accuracy evaluation. Sub-analysis was performed for "location" (liver segments II-VIII), "approach" (intercostal or transabdominal), "properties" (clear parenchymal, subcapsular, subphrenic, fat, and subphrenic plus fat), and "path length". In 20 patients with 35 liver lesions, a total of 145 needles were placed with mean (±SD) lateral errors of 3.6 ± 2.5 mm at the needle tip, angular errors of 1.3° ± 1.2°, and longitudinal errors at the needle tip of -7.4 ± 6.2 mm. No puncture-related complications were noted. No significant differences of angular errors between segments, approach and properties were recorded. Long paths correlated with smaller angular errors. CT-guided stereotaxy can be considered safe and provided precise multiple needle placement for SRFA of liver lesions at arbitrary trajectories in various segments and locations.

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Section: Discussionmentioning

confidence: 98%

Targeting accuracy of CT-guided stereotaxy for radiofrequency ablation of liver tumours

Widmann

Schullian

Haidu

et al. 2011

Minimally Invasive Therapy & Allied Technologies

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“…Although, the preparation time for MRI might be potentially longer than in fluoroscopy (as it includes the correct placement of the radiofrequency coil), recent studies have shown how acceptable times can be achieved [23]. In this regard, appropriate training of intervention team plays an essential role [24]. When using the iPad as a visualisation device, times were slightly longer in the case of RTiPadBT configuration [4.25 (0.45) min for treatment phase] but shorter in the case of GEiPadBT.…”

Section: Discussionmentioning

confidence: 99%

Comparative ergonomic workflow and user experience analysis of MRI versus fluoroscopy-guided vascular interventions: an iliac angioplasty exemplar case study

et al. 2015

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Purpose A methodological framework is introduced to assess and compare a conventional fluoroscopy protocol for peripheral angioplasty with a new magnetic resonant imaging (MRI)-guided protocol. Different scenarios were considered during interventions on a perfused arterial phantom with regard to time-based and cognitive task analysis, user experience and ergonomics. Methods Three clinicians with different expertise performed a total of 43 simulated common iliac angioplasties (9 fluoroscopic, 34 MRI-guided) in two blocks of sessions. Six different configurations for MRI guidance were tested in the first block. Four of them were evaluated in the sec- ond block and compared to the fluoroscopy protocol. Relevant stages' durations were collected, and interventions were audio-visually recorded from different perspectives. A cued retrospective protocol analysis (CRPA) was undertaken, including personal interviews. In addition, ergonomic constraints in the MRI suite were evaluated. Results Significant differences were found when comparing the performance between MRI configurations versus fluoroscopy. Two configurations [with times of 8.56 (0.64) and 9.48 (1.13) min] led to reduce procedure time for MRI guidance, comparable to fluoroscopy [8.49 (0.75) min]. The CRPA pointed out the main influential factors for clinical procedure performance. The ergonomic analysis quantified musculoskeletal risks for interventional radiologists when utilising MRI. Several alternatives were suggested to prevent potential low-back injuries. Conclusions This work presents a step towards the implementation of efficient operational protocols for MRI-guided procedures based on an integral and multidisciplinary framework, applicable to the assessment of current vascular protocols. The use of first-user perspective raises the possibility of establishing new forms of clinical training and education.

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“…A narrow burr hole and the noise lead to low surgical comfort. Furthermore, many safety issues must be taken into account regarding heating and "missile" effects (7,9,14,23,24). To reduce heating risk for DBS electrodes, a very low head-specific absorption rate level (Ͻ0.1 W/kg) is recommended by the manufacturer, thus resulting in poor image quality.…”

Section: General Experiencesmentioning

confidence: 99%