title: Simultaneous tracking of catheters and guidewires: comparison to standard fluoroscopic guidance for arterial cannulation.
abstract: OBJECTIVE
  The purpose of this in vitro study was to clinically assess the feasibility of a three-dimensional (3D) electromagnetic (EM) navigator, including sensorized catheters and guidewires, to determine any reduction in radiation dose and contrast medium injection.
  
  
  METHODS
  The study was performed using a navigator prototype developed at the EndoCAS center. The system includes catheters and guidewires simultaneously tracked with an EM localizer (Aurora, Northern Digital, Waterloo, Canada). Tests were performed on a commercial abdominal aortic aneurysm model. Fifteen operators were asked to cannulate renal arteries using the conventional fluoroscopic guidance and the EM navigator without fluoroscopic support. Each trial was video-recorded and analyzed for timing and success of completing the cannulation task by two blinded and independent observers. Performances were also qualitatively evaluated using the Imperial College Endovascular Cannulation Scoring Tool (IC3ST). Moreover, a questionnaire was administered to participants to evaluate the navigator potentialities.
  
  
  RESULTS
  Quantitative analysis results show no significant difference between the fluoroscopic and EM guidance regarding the total procedure time (median 2.36 minutes [interquartile range {IQR} = 1.26-4.7) vs. 2.95 min [IQR = 1.35-5.38], respectively; p = .93); number of total hits with catheter/guidewire tip to vessels wall (median 5.50 [IQR = 2.00-10.00] vs. 3.50 [IQR = 2.50-7.00], respectively; p = .65); and number of attempts at cannulation (median 4.0 [IQR = 2.00-5.00] vs. 4.0 [IQR = 2.00-5.00], respectively; p = .72]. Moreover, there was no significant difference between the IC3ST score obtained using the EM navigator and the traditional method (average 22.37 [STD = 7.95] vs. 21.58 [STD = 6.86]; p = .92). Finally, questionnaire results indicate a general agreement concerning the navigator usefulness, which clearly shows the positions of instruments inside the 3D model of the patient's anatomy. Participants also agreed that the navigator can reduce the amount of contrast media delivered to the patient, as well as fluoroscopy time.
  
  
  CONCLUSIONS
  This work provides proof of concept that simultaneous EM navigation of guidewires and catheters is feasible without the use of live fluoroscopic images.
authors.affiliation: EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy. Electronic address: sara.condino@endocas.org.
authors.forename: S
authors.initials: S
authors.lastname: Condino
authors.affiliation: EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: E M
authors.initials: EM
authors.lastname: Calabrò
authors.affiliation: Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Alberti
authors.affiliation: EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Parrini
authors.affiliation: Division of Diagnostic and Interventional Radiology, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Cioni
authors.affiliation: Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: R N
authors.initials: RN
authors.lastname: Berchiolli
authors.affiliation: Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Gesi
authors.affiliation: EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ferrari
authors.affiliation: EndoCAS Center, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Italy; Unit of Vascular Surgery of the Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Ferrari
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000628:therapy; D001027:Aortography / Q000379:methods; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D002983:Clinical Competence; D003287:Contrast Media; D055590:Electromagnetic Phenomena; D005240:Feasibility Studies; D005471:Fluoroscopy; D006801:Humans; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D011829:Radiation Dosage; D015641:Radiography, Interventional / Q000379:methods; D012077:Renal Artery / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D062666:Vascular Access Devices; D014741:Video Recording
chemical_list: D003287:Contrast Media
keywords: Electromagnetic navigation; Endovascular navigation; Sensorized catheters and guidewire