title: Intra-operative navigation of a 3-dimensional needle localization system for precision of irreversible electroporation needles in locally advanced pancreatic cancer.
abstract: BACKGROUND
  Irreversible electroporation (IRE) uses multiple needles and a series of electrical pulses to create pores in cell membranes and cause cell apoptosis. One of the demands of IRE is the precise needle spacing required. Two-dimensional intraoperative ultrasound (2-D iUS) is currently used to measure inter-needle distances but requires significant expertise. This study evaluates the potential of three-dimensional (3-D) image guidance for placing IRE needles and calculating needle spacing.
  
  
  METHODS
  A prospective clinical evaluation of a 3-D needle localization system (Explorer™) was evaluated in consecutive patients from April 2012 through June 2013 for unresectable pancreatic adenocarcinoma. 3-D reconstructions of patients' anatomy were generated from preoperative CT images, which were aligned to the intraoperative space.
  
  
  RESULTS
  Thirty consecutive patients with locally advanced pancreatic cancer were treated with IRE. The needle localization system setup added an average of 6.5 min to each procedure. The 3-D needle localization system increased surgeon confidence and ultimately reduced needle placement time.
  
  
  CONCLUSIONS
  IRE treatment efficacy is highly dependent on accurate needle spacing. The needle localization system evaluated in this study aims to mitigate these issues by providing the surgeon with additional visualization and data in 3-D. The Explorer™ system provides valuable guidance information and inter-needle distance calculations.
authors.affiliation: Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, 315 East Broadway - Rm 311, Louisville, KY 40202, USA.
authors.forename: L
authors.initials: L
authors.lastname: Bond
authors.affiliation: Department of Radiology, University of Louisville School of Medicine, 530 South Jackson Street, CCB-C07, Louisville, KY 40202, USA.
authors.forename: B
authors.initials: B
authors.lastname: Schulz
authors.affiliation: Department of Radiology, University of Louisville School of Medicine, 530 South Jackson Street, CCB-C07, Louisville, KY 40202, USA.
authors.forename: T
authors.initials: T
authors.lastname: VanMeter
authors.affiliation: Division of Surgical Oncology, Department of Surgery and James Graham Brown Cancer Center, University of Louisville School of Medicine, 315 East Broadway - Rm 311, Louisville, KY 40202, USA. Electronic address: Robert.martin@louisville.edu.
authors.forename: R C G
authors.initials: RC
authors.lastname: Martin
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000328:Adult; D018274:Electroporation / Q000295:instrumentation*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007432:Intraoperative Period; D008297:Male; D009339:Needles; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000628:therapy*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Electroporation; Pancreatic carcinoma; X-ray computed tomography