title: Interventional real-time ultrasound imaging with an integrated electromagnetic field generator.
abstract: OBJECTIVE
  Ultrasound (US) guided procedures are frequently performed for diagnosis and treatment of many diseases. However, there are safety and procedure duration limitations in US-guided interventions due to poor image quality and inadequate visibility of medical instruments in the field of view. To address this issue, we propose an interventional imaging system based on a mobile electromagnetic (EM) field generator (FG) attached to a US probe.
  
  
  METHODS
  A standard US probe was integrated with an EM FG to allow combined movement of the FG with real-time imaging to achieve (1) increased tracking accuracy for medical instruments are located near the center of the tracking volume, (2) increased robustness because the FG is distant to large metallic objects, and (3) reduced setup complexity since time-consuming placement of the FG is not required. The new integrated US-FG imaging system was evaluated by assessing tracking and calibration accuracy in a clinical setting. To demonstrate clinical applicability, the prototype US-EMFG probe was tested in needle puncture procedures.
  
  
  RESULTS
  The mobile EMFG attached to a US probe yielded sub-millimeter tracking accuracy despite the presence of metal close to the FG. Calibration errors were in the range of 1-2 mm. In an initial phantom study on US-guided needle punctures, targeting errors of about 3 mm were achieved.
  
  
  CONCLUSIONS
  A combined US-EMFG probe is feasible and effective for tracking medical instruments relative to US images with high accuracy and robustness while keeping hardware complexity low.
authors.affiliation: Division of Medical and Biological Informatics, Subdivsion Computer-assisted Interventions, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, 69120 , Heidelberg, Germany, k.maerz@dkfz-heidelberg.de.
authors.forename: K
authors.initials: K
authors.lastname: März
authors.forename: A M
authors.initials: AM
authors.lastname: Franz
authors.forename: A
authors.initials: A
authors.lastname: Seitel
authors.forename: A
authors.initials: A
authors.lastname: Winterstein
authors.forename: M
authors.initials: M
authors.lastname: Hafezi
authors.forename: A
authors.initials: A
authors.lastname: Saffari
authors.forename: R
authors.initials: R
authors.lastname: Bendl
authors.forename: B
authors.initials: B
authors.lastname: Stieltjes
authors.forename: H-P
authors.initials: HP
authors.lastname: Meinzer
authors.forename: A
authors.initials: A
authors.lastname: Mehrabi
authors.forename: L
authors.initials: L
authors.lastname: Maier-Hein
mesh_terms: D002138:Calibration; D004574:Electromagnetic Fields; D006801:Humans; D019047:Phantoms, Imaging; D018084:Ultrasonography, Interventional / Q000379:methods*