Needle-Based Interventions With the Image-Guided Surgery Toolkit (IGSTK): From Phantoms to Clinical Trials

TLDR

The authors present three IGSTK‑based image‑guided navigation systems for needle‑based interventional radiology, designed to automate planning and guide multiple electrode insertions while minimizing tissue damage. These systems target vertebroplasty, RF ablation of large lung tumors, and lung biopsy, and were evaluated using a custom phantom with clinicians and an animal model. The systems replace fluoroscopy or CT fluoroscopy, reducing radiation exposure for patients and clinicians, enable challenging oblique trajectories, and are currently being used in a Georgetown University clinical trial with three cases.

Abstract

We present three image-guided navigation systems developed for needle-based interventional radiology procedures, using the open source image-guided surgery toolkit (IGSTK). The clinical procedures we address are vertebroplasty, RF ablation of large lung tumors, and lung biopsy. In vertebroplasty, our system replaces the use of fluoroscopy, reducing radiation exposure to patient and physician. We evaluate this system using a custom phantom and compare the results obtained by a medical student, an interventional radiology fellow, and an attending physician. In RF ablation of large lung tumors, our system provides an automated interventional plan that minimizes damage to healthy tissue and avoids critical structures, in addition to accurate guidance of multiple electrode insertions. We evaluate the system's performance using an animal model. Finally, in the lung biopsy procedure, our system replaces the use of computed tomographic (CT) fluoroscopy, reducing radiation exposure to patient and physician, while at the same time enabling oblique trajectories which are considered challenging under CT fluoroscopy. This system is currently being used in an ongoing clinical trial at Georgetown University Hospital and was used in three cases.