Comparison of CT Fluoroscopy-Guided Manual and CT-Guided Robotic Positioning System for In Vivo Needle Placements in Swine Liver.
OBJECTIVE
To compare CT fluoroscopy-guided manual and CT-guided robotic positioning system (RPS)-assisted needle placement by experienced IR physicians to targets in swine liver.


METHODS
Manual and RPS-assisted needle placement was performed by six experienced IR physicians to four 5 mm fiducial seeds placed in swine liver (n = 6). Placement performance was assessed for placement accuracy, procedure time, number of confirmatory scans, needle manipulations, and procedure radiation dose. Intra-modality difference in performance for each physician was assessed using paired t test. Inter-physician performance variation for each modality was analyzed using Kruskal-Wallis test.


RESULTS
Paired comparison of manual and RPS-assisted placements to a target by the same physician indicated accuracy outcomes was not statistically different (manual: 4.53 mm; RPS: 4.66 mm; p = 0.41), but manual placement resulted in higher total radiation dose (manual: 1075.77 mGy/cm; RPS: 636.4 mGy/cm; p = 0.03), required more confirmation scans (manual: 6.6; RPS: 1.6; p < 0.0001) and needle manipulations (manual: 4.6; RPS: 0.4; p < 0.0001). Procedure time for RPS was longer than manual placement (manual: 6.12 min; RPS: 9.7 min; p = 0.0003). Comparison of inter-physician performance during manual placement indicated significant differences in the time taken to complete placements (p = 0.008) and number of repositions (p = 0.04) but not in other study measures (p > 0.05). Comparison of inter-physician performance during RPS-assisted placement suggested statistically significant differences in procedure time (p = 0.02) and not in other study measures (p > 0.05).


CONCLUSIONS
CT-guided RPS-assisted needle placement reduced radiation dose, number of confirmatory scans, and needle manipulations when compared to manual needle placement by experienced IR physicians, with equivalent accuracy.
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.|Department of Radiology, Pellegrin Hospital, Place Amélie Raba Léon, 33076, Bordeaux, France.
F
F
Cornelis
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
H
H
Takaki
Perfint Healthcare Inc, Chennai, Tamil Nadu, India.
M
M
Laskhmanan
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
J C
JC
Durack
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
J P
JP
Erinjeri
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
G I
GI
Getrajdman
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
M
M
Maybody
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
C T
CT
Sofocleous
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
S B
SB
Solomon
Interventional Radiology Service, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA. srimaths@mskcc.org.
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G
Srimathveeravalli
D000818:Animals; D005260:Female; D005471:Fluoroscopy; D008099:Liver / Q000000981:diagnostic imaging*; D009339:Needles; D015641:Radiography, Interventional; D012371:Robotics; D025321:Surgery, Computer-Assisted; D014057:Tomography, X-Ray Computed
Image-guided biopsy; Navigation system; Needle placement; Robotic guidance