title: CT data-based navigation for post-mortem biopsy--a feasibility study.
abstract: BACKGROUND
  Recent advances in medical imaging have brought post-mortem minimally invasive computed tomography (CT) guided percutaneous biopsy to public attention.
  
  
  OBJECTIVE
  The goal of the following study was to facilitate and automate post-mortem biopsy, to suppress radiation exposure to the investigator, as may occur when tissue sampling under computer tomographic guidance, and to minimize the number of needle insertion attempts for each target for a single puncture.
  
  
  METHODS
  Clinically approved and post-mortem tested ACN-III biopsy core needles (14 gauge x 160 mm) with an automatic pistol device (Bard Magnum, Medical Device Technologies, Denmark) were used for probe sampling. The needles were navigated in gelatine/peas phantom, ex vivo porcine model and subsequently in two human bodies using a navigation system (MEM centre/ISTB Medical Application Framework, Marvin, Bern, Switzerland) with guidance frame and a CT (Emotion 6, Siemens, Germany).
  
  
  RESULTS
  Biopsy of all peas could be performed within a single attempt. The average distance between the inserted needle tip and the pea centre was 1.4mm (n=10; SD 0.065 mm; range 0-2.3 mm). The targets in the porcine liver were also accurately punctured. The average of the distance between the needle tip and the target was 0.5 mm (range 0-1 mm). Biopsies of brain, heart, lung, liver, pancreas, spleen, and kidney were performed on human corpses. For each target the biopsy needle was only inserted once. The examination of one body with sampling of tissue probes at the above-mentioned locations took approximately 45 min.
  
  
  CONCLUSIONS
  Post-mortem navigated biopsy can reliably provide tissue samples from different body locations. Since the continuous update of positional data of the body and the biopsy needle is performed using optical tracking, no control CT images verifying the positional data are necessary and no radiation exposure to the investigator need be taken into account. Furthermore, the number of needle insertions for each target can be minimized to a single one with the ex vivo proven adequate accuracy and, in contrast to conventional CT guided biopsy, the insertion angle may be oblique. Navigation for minimally invasive tissue sampling is a useful addition to post-mortem CT guided biopsy.
authors.affiliation: Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland. emin.aghayev@memcenter.unibe.ch
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.forename: Lars C
authors.initials: LC
authors.lastname: Ebert
authors.forename: Andreas
authors.initials: A
authors.lastname: Christe
authors.forename: Christian
authors.initials: C
authors.lastname: Jackowski
authors.forename: Tobias
authors.initials: T
authors.lastname: Rudolph
authors.forename: Jens
authors.initials: J
authors.lastname: Kowal
authors.forename: Peter
authors.initials: P
authors.lastname: Vock
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thali
mesh_terms: D000818:Animals; D001331:Automation; D044963:Biopsy, Fine-Needle / Q000379:methods*; D001921:Brain / Q000473:pathology; D005240:Feasibility Studies; D049429:Forensic Pathology / Q000379:methods*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008168:Lung / Q000473:pathology; D010179:Pancreas / Q000473:pathology; D019047:Phantoms, Imaging; D015641:Radiography, Interventional; D013154:Spleen / Q000473:pathology; D013552:Swine; D014057:Tomography, X-Ray Computed