Rapid freehand MR‐guided percutaneous needle interventions: An image‐based approach to improve workflow and feasibility

Rothgang, Eva; Gilson, Wesley D.; Wacker, Frank; Hornegger, Joachim; Lorenz, Christine H.; Weiss, Clifford R.

doi:10.1002/jmri.23894

Cited by 33 publications

(52 citation statements)

References 35 publications

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“…In addition, some equipment manufacturers offer special interfaces that allow the user to interactively control imaging for visualizing and adjusting the needle [80].…”

Section: Navigationmentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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ABSTR AC TBackground MRI is attractive for the guiding and monitoring of interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure physiologic parameters like flow and cardiac function.Method The current status of interventional MRI for the clinical routine was analyzed.Results The effort needed for the development of MR-safe monitoring systems and instruments initially resulted in the application of interventional MRI only for procedures that could not be performed by other means. Accordingly, biopsy of lesions in the breast, which are not detectable by other modalities, has been performed under MRI guidance for decades. Currently, biopsies of the prostate under MRI guidance are established in a similar fashion. At many sites blind biopsy has already been replaced by MR-guided biopsy or at least by the fusion of MR images with ultrasound. Cardiovascular This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.interventions are performed at several centers for ablation as a treatment for atrial fibrillation. Conclusion IntroductionMRI has an intrinsically high soft-tissue contrast and can be used to measure physiological parameters, such as blood flow (flow rate and flow volume), diffusion, temperature, and movement. Since its introduction into the clinical routine in the 1980 s, it has also been used for guiding and monitoring interventions. However, in contrast to CT and ultrasound, the use of MRI for guiding interventions requires significant technical effort. Due to the disruptive effect of the strong main magnetic field and the alternating electromagnetic fields, the monitoring of patients during an intervention by measuring ECG signals, oxygen saturation, or blood pressure requires special equipment. These monitoring systems must not interfere with the MRI scan and must be MR-safe (according to DIN EN 62 570:2010 -05). The list of requirements regarding monitoring equipment provides an indication of the development effort, with suitable monitoring equipment representing only one of the components necessary for MR-guided interventions.In addition to MRI safety, all catheters and instruments must be adapted to this modality. To ensure MRI safety, metal must be largely avoided since, depending on the length and orientation to the main magnetic field, it can heat up and consequently even result in burns. Achieving rigidity and torsion stability of catheters or guide wires without the use of metal for reinforcement represents a technical challenge. In the case of needles, breaking resistance is one of the more difficult properties to achieve for MR-safe designs. Moreover, instruments must be able to be effectively visualized without adjacent structures being superimposed by artifacts. The tip must be able to be identified and definitively differentiated from the shaft since MRI as a cross-sectional imaging method typically uses individual slices even for guiding interventions and does not use projections as in fluoroscopy...

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“…In addition, some equipment manufacturers offer special interfaces that allow the user to interactively control imaging for visualizing and adjusting the needle [80].…”

Section: Navigationmentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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“…Regardless of the system design, MR imaging in real time in "open" magnets during puncture has several advantages: the free selection of slice orientation in MRI can be interactively used with the help of a water-filled syringe or a finger to find the body access point without a light localizer and/or marker; continuous imaging of the needle, puncture path, and target allows safe puncture; oblique puncture trajectories can be better maintained in the freehand technique; efficient puncture is possible [2,4,13,26]. Ideally the interactive adjustment of slice planes does not have to be performed manually but rather fully automatic adjustment to the orientation of the instruments is performed [27]. To facilitate needle tracking, interactive user interfaces for MR-guided interventions have been introduced [4,27,28] some of which can also process coordinates from external navigation systems to adjust the slice orientation to the trajectory of the instrument.…”

Section: Instruments and Operating Concepts For Oncologymentioning

confidence: 99%

“…Ideally the interactive adjustment of slice planes does not have to be performed manually but rather fully automatic adjustment to the orientation of the instruments is performed [27]. To facilitate needle tracking, interactive user interfaces for MR-guided interventions have been introduced [4,27,28] some of which can also process coordinates from external navigation systems to adjust the slice orientation to the trajectory of the instrument. Moreover, efforts are being made to integrate instrument navigation, ablation planning software, and temperature monitoring into the MRI scanner to achieve an integrated approach to tumor treatment.…”

Section: Instruments and Operating Concepts For Oncologymentioning

confidence: 99%

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

Barkhausen

Kahn

Krombach

et al. 2017

Fortschr Röntgenstr

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Background MRI is attractive for guiding and monitoring interventional procedures due to its high intrinsic soft tissue contrast and the possibility to measure flow and cardiac function. Methods Technical solutions have been developed for all procedural steps including imaging guidance, MR-safe catheters and instruments and patient monitoring. This has led to widening of the clinical applications. Interventional MRI is becoming increasingly important for the treatment of patients suffering from malignant diseases. The detectability of masses and consequently their accessibility for biopsy is higher, compared to other modalities, due to the high intrinsic soft tissue contrast of MRI. Temperature-dependent sequences allow for minimally invasive and tissue-sparing ablation (A-0 ablation). Conclusion Interventional MRI has become established in the clinical routine for a variety of indications, including biopsies and tumor ablation. Since the economic requirement of covering costs by reimbursement is met and interventional MRI decreases the mortality and morbidity of interventional procedures, broader application of interventional MRI can be expected in the clinical routine in the future. Key points Citation Format

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“…Despite the number of advantages, MRI is not widely accepted as an interventional imaging modality with the majority of procedures being performed predominately at academic health centers (2). Interventional MRI (iMRI) and iMRI workflow is greatly influenced by the limited patient access and the requirement to ensure MRI safety throughout a procedure (3).…”

Section: Introductionmentioning

confidence: 99%

“…This is particularly important for endovascular procedures, where blood flow and respiratory motion are present during device manipulation. Interactions with the MRI system, in terms of device localization and change of acquisition parameters, are challenging (4) in comparison to conventional X-Ray guided procedures and represent a major hurdle for an efficient workflow (2, 5). …”

Section: Introductionmentioning

confidence: 99%

Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction

Rube

Holbrook

Cox

et al. 2014

Magnetic Resonance Imaging

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Purpose Device tracking is crucial for interventional MRI (iMRI) because conventional device materials do not contribute to the MR signal, may cause susceptibility artifacts and are generally invisible if moved out of the scan plane. A robust method for wireless tracking and dynamic guidance of interventional devices equipped with wirelessly connected resonant circuits (wRC) is presented. Methods The proposed method uses weak spatially-selective excitation pulses with very low flip angle (0.3°), a Hadamard multiplexed tracking scheme and employs phase-field dithering to obtain the 3D position of a wRC. RF induced heating experiments (ASTM protocol) and balloon angioplasties of the iliac artery were conducted in a perfused vascular phantom and three Thiel soft-embalmed human cadavers. Results Device tip tracking was interleaved with various user-selectable fast pulse sequences receiving a geometry update from the tracking kernel in less than 30 ms. Integrating phase-field dithering significantly improved our tracking robustness for catheters with small diameters (4–6 French). The volume root mean square distance error was 2.81 mm (standard deviation: 1.31 mm). No significant RF induced heating (<0.6°C) was detected during heating experiments. Conclusion This tip tracking approach provides flexible, fast and robust feedback loop, intuitive iMRI scanner interaction, does not constrain the physician and delivers very low specific absorption rates. Devices with wRC can be exchanged during a procedure without modifications to the iMRI setup or the pulse sequence. A drawback of our current implementation is that position information is available for a single tracking coil only. This was satisfactory for balloon angioplasties of the iliac artery but further studies are required for complex navigation and catheter shapes before animal trials and clinical application.

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Rapid freehand MR‐guided percutaneous needle interventions: An image‐based approach to improve workflow and feasibility

Abstract: The developed methods allow for accurate needle placement along complex trajectories and are anticipated to reduce table time for MR-guided percutaneous needle interventions.

Cited by 33 publications

References 35 publications

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 1: General Application

White Paper: Interventional MRI: Current Status and Potential for Development Considering Economic Perspectives, Part 2: Liver and Other Applications in Oncology

Wireless MR tracking of interventional devices using phase-field dithering and projection reconstruction

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