title: Laser-assisted flat-detector CT-guided intracranial access.
abstract: OBJECTIVE
  Flat-detector CT can be integrated with C-arm fluoroscopy for CT-guided neurosurgical and endovascular procedures. We studied the accuracy of this technique with laser assistance in targeting intracranial lesions in a cranial model.
  
  
  METHODS
  An acrylic scale-model skull containing foam parenchyma was embedded with 2.16-mm-diameter targets. A flat-detector CT was acquired and registered to the skull's position. Ten targets were accessed with biopsy needles under fluoroscopic guidance, flat-detector CT overlay, and laser assistance. Accuracy was measured from the needle tip to the target center using flat-detector CT.
  
  
  RESULTS
  Ten targets were accessed successfully using XperGuide software. Needles were placed within 1.30 [Formula: see text] 0.63 mm of target isocenter. Accuracy did not vary by entry site, operator, location, or lesion depth.
  
  
  CONCLUSIONS
  Laser-assisted flat-detector CT-guided targeting of all intracranial targets was successful with excellent accuracy. This technique can be applied to other minimally invasive neurosurgical procedures.
authors.affiliation: Division of Neurointerventional Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Cooke
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA. mlevitt@u.washington.edu.|Department of Radiology, University of Washington, Seattle, WA, USA. mlevitt@u.washington.edu.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Levitt
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.|Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Kim
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.|Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Danial K
authors.initials: DK
authors.lastname: Hallam
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.
authors.forename: Laligam N
authors.initials: LN
authors.lastname: Sekhar
authors.affiliation: Department of Neurological Surgery, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359924, Seattle, WA, 98104-2499, USA.|Department of Radiology, University of Washington, Seattle, WA, USA.
authors.forename: Basavaraj V
authors.initials: BV
authors.lastname: Ghodke
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007834:Lasers; D019047:Phantoms, Imaging; D011880:Radiotherapy Planning, Computer-Assisted; D012016:Reference Values; D014057:Tomography, X-Ray Computed / Q000295:instrumentation* / Q000379:methods
keywords: Biopsy; C-arm; Cone beam computed tomography; Dimensional measurement accuracy; Flat-panel detector; Image-guided surgery; Phantom study