Clinical evaluation of a robotic system for precise CT-guided percutaneous procedures.

Levy, Shiran; Goldberg, S. Nahum; Roth, Ido; Shochat, Moran; Sosna, Jacob; Leichter, Isaac; Flacke, Sebastian

Purpose: To assess accuracy and compare protocols for CT-guided needle insertion for clinical biopsies using a hands-free robotic system, balancing system accuracy with duration of procedure and radiation dose. Methods: Thirty-two percutaneous abdominal and pelvic biopsies were performed and analyzed at two centers (Center 1 n = 11; Center 2 n = 21) as part of an ongoing prospective, multi-center study. CT datasets were obtained for planning and controlled placement of 17 g needles using a patient-mounted, CT-guided robotic system. Planning included target selection, skin entry point, and predetermined checkpoints. Additional CT imaging was performed at checkpoints to confirm needle location and permit stepwise correction of the trajectory. Center 1 used a more conservative approach with multiple checkpoints, whereas Center 2 used fewer checkpoints. Scanning and needle advancement were performed under respiratory gating. Accuracy, radiation dose, and steering duration were compared. Results: Overall accuracy was 1.6 ± 1.5 mm (1.9 ± 1.2 mm Center 1; 1.5 ± 1.6 mm Center 2; p = 0.55). Mean distance to target was 86.2 ± 27.1 mm (p = 0.18 between centers). Center 1 used 4.6 ± 0.8 checkpoints, whereas Center 2 used 1.8 ± 0.6 checkpoints (p < 0.001). Effective radiation doses were lower for Center 1 than for Center 2 (22.2 ± 12.6 mSv vs. 11.7 ± 4.3 mSv; p = 0.002). Likewise, steering duration (from planning to target) was significantly reduced in relation to the number of checkpoints from 43.8 ± 15.9 min for Center 1 to 30.5 ± 10.2 min for Center 2 (p = 0.008). Conclusions: Accurate needle targeting with < 2 mm error can be achieved in patients when using a CT-guided robotic system. Judicious selection of the number of checkpoints may substantially reduce procedure time and radiation dose without sacrificing accuracy.

COMPUTED tomography; ROBOTICS; RADIATION doses; FLUOROSCOPY

Abdominal Radiology, 2021, Vol 46, Issue 10, p5007

2366-004X

Academic Journal

10.1007/s00261-021-03175-9