title: Accuracy of flat panel detector CT with integrated navigational software with and without MR fusion for single-pass needle placement.
abstract: OBJECTIVE
  Fluoroscopic systems in modern interventional suites have the ability to perform flat panel detector CT (FDCT) with navigational guidance. Fusion with MR allows navigational guidance towards FDCT occult targets. We aim to evaluate the accuracy of this system using single-pass needle placement in a deep brain stimulation (DBS) phantom.
  
  
  METHODS
  MR was performed on a head phantom with DBS lead targets. The head phantom was placed into fixation and FDCT was performed. FDCT and MR datasets were automatically fused using the integrated guidance system (iGuide, Siemens). A DBS target was selected on the MR dataset. A 10 cm, 19 G needle was advanced by hand in a single pass using laser crosshair guidance. Radial error was visually assessed against measurement markers on the target and by a second FDCT. Ten needles were placed using CT-MR fusion and 10 needles were placed without MR fusion, with targeting based solely on FDCT and fusion steps repeated for every pass.
  
  
  RESULTS
  Mean radial error was 2.75±1.39 mm as defined by visual assessment to the centre of the DBS target and 2.80±1.43 mm as defined by FDCT to the centre of the selected target point. There were no statistically significant differences in error between MR fusion and non-MR guided series.
  
  
  CONCLUSIONS
  Single pass needle placement in a DBS phantom using FDCT guidance is associated with a radial error of approximately 2.5-3.0 mm at a depth of approximately 80 mm. This system could accurately target sub-centimetre intracranial lesions defined on MR.
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
authors.forename: Marc C
authors.identifier: http://orcid.org/0000-0002-4538-0823
authors.initials: MC
authors.lastname: Mabray
authors.affiliation: Siemens Healthcare AG, Forchheim, Germany.
authors.forename: Sanjit
authors.initials: S
authors.lastname: Datta
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
authors.forename: Prasheel V
authors.initials: PV
authors.lastname: Lillaney
authors.affiliation: Siemens Healthcare AG, Forchheim, Germany.
authors.forename: Teri
authors.initials: T
authors.lastname: Moore
authors.affiliation: Siemens Healthcare AG, Forchheim, Germany.
authors.forename: Sonja
authors.initials: S
authors.lastname: Gehrisch
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
authors.forename: Jason F
authors.initials: JF
authors.lastname: Talbott
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Department of Neurological Surgery, University of Washington, Seattle, Washington, USA Department of Radiology, University of Washington, Seattle, Washington, USA.
authors.forename: Basavaraj V
authors.initials: BV
authors.lastname: Ghodke
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Larson
authors.affiliation: Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
mesh_terms: D046690:Deep Brain Stimulation / Q000295:instrumentation / Q000592:standards*; D005471:Fluoroscopy / Q000295:instrumentation / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation / Q000592:standards*; D009339:Needles / Q000592:standards*; D019047:Phantoms, Imaging / Q000592:standards*; D012984:Software / Q000592:standards*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000592:standards*
keywords: CT; Intervention; MRI; Navigation