title: Combining C-arm CT with a new remote operated positioning and guidance system for guidance of minimally invasive spine interventions.
abstract: OBJECTIVE
  To report our experience using C-arm cone beam CT (C-arm CBCT) combined with the new remote operated positioning and guidance system, iSYS1, for needle guidance during spinal interventions.
  
  
  METHODS
  A C-arm CBCT with a flat panel angiography system was acquired (Artis Zeego; Siemens Healthcare Sector, Forchheim, Germany). Reconstruction of CT-like images and planning of the needle path were performed using a common workstation. The needle holder of iSYS1 acted as a guide during insertion of Kirschner (K) wires. 20 percutaneous K wires were placed in the pedicles at T2-T3, T7-T12, and L1-L2 in a cadaver specimen. Postprocedure C-arm CBCT scans were obtained to confirm the accuracy of the K wire placement.
  
  
  RESULTS
  All K wire placements were successfully performed. Mean planning time with Syngo iGuide was 4:16 min, mean positioning time of iSYS1 was 3:35 min, and mean placement time of the K wires was 2:22 min. Mean total intervention time was 10:13 min per pedicle. A mean deviation of 0.35 mm between the planned path and the placed K wire with a mean path length of 6.73 cm was documented.
  
  
  CONCLUSIONS
  Our results demonstrate the potential of combining C-arm CBCT with iSYS1 for safe and accurate percutaneous placement of pedicle K wires in spinal interventions.
authors.affiliation: Department of Trauma Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Czerny
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Eichler
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Yann
authors.initials: Y
authors.lastname: Croissant
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Boris
authors.initials: B
authors.lastname: Schulz
authors.affiliation: Austrian Centre for Medical Innovation and Technology-ACMIT, Wiener Neustadt, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Kronreif
authors.affiliation: iSYS Medizintechnik GmbH, Kitzbuehel, Austria.
authors.forename: Renate
authors.initials: R
authors.lastname: Schmidt
authors.affiliation: Siemens AG, Healthcare Sector, Forchheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: von Roden
authors.affiliation: Fachbereich Medizin der Goethe-Universität, Dr Senckenbergische Anatomie, Frankfurt am Main, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Schomerus
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Vogl
authors.affiliation: Department of Trauma Surgery, University Hospital Frankfurt, Goethe-University Frankfurt, Frankfurt am Main, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe-University, Frankfurt am Main, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Zangos
mesh_terms: D054893:Cone-Beam Computed Tomography / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D012371:Robotics / Q000295:instrumentation / Q000379:methods*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*
keywords: CT; Intervention; Navigation; Spine; guidewire