title: Electromagnetic navigation system for CT-guided biopsy of small lesions.
abstract: OBJECTIVE
  The purpose of this study was to evaluate an electromagnetic navigation system for CT-guided biopsy of small lesions.
  
  
  METHODS
  Standardized CT anthropomorphic phantoms were biopsied by two attending radiologists. CT scans of the phantom and surface electromagnetic fiducial markers were imported into the memory of the 3D electromagnetic navigation system. Each radiologist assessed the accuracy of biopsy using electromagnetic navigation alone by targeting sets of nine lesions (size range, 8-14 mm; skin to target distance, 5.7-12.8 cm) under eight different conditions of detector field strength and orientation (n = 117). As a control, each radiologist also biopsied two sets of five targets using conventional CT-guided technique. Biopsy accuracy, number of needle passes, procedure time, and radiation dose were compared.
  
  
  RESULTS
  Under optimal conditions (phantom perpendicular to the electromagnetic receiver at highest possible field strength), phantom accuracy to the center of the lesion was 2.6 ± 1.1 mm. This translated into hitting 84.4% (38/45) of targets in a single pass (1.1 ± 0.4 CT confirmations), which was significantly fewer than the 3.6 ± 1.3 CT checks required for conventional technique (p < 0.001). The mean targeting time was 38.8 ± 18.2 seconds per lesion. Including procedural planning (∼5.5 minutes) and final CT confirmation of placement (∼3.5 minutes), the full electromagnetic tracking procedure required significantly less time (551.6 ± 87.4 seconds [∼9 minutes]) than conventional CT (833.3 ± 283.8 seconds [∼14 minutes]) for successful targeting (p < 0.001). Less favorable conditions, including nonperpendicular relation between the axis of the machine and weaker field strength, resulted in statistically significant lower accuracy (3.7 ± 1 mm, p < 0.001). Nevertheless, first-pass biopsy accuracy was 58.3% (21/36) and second-pass (35/36) accuracy was 97.2%. Lesions farther from the skin than 20-25 cm were out of range for successful electromagnetic tracking.
  
  
  CONCLUSIONS
  Virtual electromagnetic tracking appears to have high accuracy in needle placement, potentially reducing time and radiation exposure compared with those of conventional CT techniques in the biopsy of small lesions.
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. liata@hadassah.org.il
authors.forename: Liat
authors.initials: L
authors.lastname: Appelbaum
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: Yizhak
authors.initials: Y
authors.lastname: Nissenbaum
authors.forename: Alexander
authors.initials: A
authors.lastname: Benshtein
authors.forename: S Nahum
authors.initials: SN
authors.lastname: Goldberg
mesh_terms: D001707:Biopsy, Needle / Q000295:instrumentation*; D055590:Electromagnetic Phenomena; D057918:Fiducial Markers; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation*; D008954:Models, Biological; D019047:Phantoms, Imaging; D015641:Radiography, Interventional / Q000295:instrumentation*; D015203:Reproducibility of Results; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*