CBCT-Based Image Guidance for Percutaneous Access: Electromagnetic Navigation Versus 3D Image Fusion with Fluoroscopy Versus Combination of Both Technologies-A Phantom Study

Purpose: We set out to compare three types of three-dimensional CBCT-based imaging guidance modalities in a phantom study: image fusion with fluoroscopy (IF), electromagnetic navigation (EMN) and the association of both technologies (CEMNIF).

Materials and methods: Four targets with a median diameter of 11 mm [first quartile (Q1): 10; third quartile (Q3): 12] with acute angle access (z-axis < 45°) and four targets of 10 mm [8-15] with large angle access (z-axis > 45°) were defined on an abdominal phantom (CIRS, Meditest, Tabuteau, France). Acute angle access targets were punctured using IF, EMN or CEMNIF and large angle access targets with EMN by four operators with various experiences. Efficacy (target reached), accuracy (distance between needle tip and target center), procedure time, radiation exposure and reproducibility were explored and compared.

Results: All targets were reached (100% efficacy) by all operators. For targets with acute angle access, procedure times (EMN: 265 s [236-360], IF: 292 s [260-345], CEMNIF: 320 s [240-333]) and accuracy (EMN: 3 mm [2-5], IF: 2 mm [1-3], CEMNIF: 3 mm [2-4]) were similar. Radiation exposure (EMN: 0; IF: 708 mGy.cm² [599-1128]; CEMNIF: 51 mGy.cm² [15-150]; p < 0.001) was significantly higher with IF than with CEMNIF and EMN. For targets with large angle access, procedure times (EMN: 345 s [259-457], CEMNIF: 425 s [340-473]; p = 0.01) and radiation exposure (EMN: 0, CEMIF: 159 mGy.cm² [39-316]; p < 0.001) were significantly lower with EMN but with lower accuracy (EMN: 4 mm [4-6] and CEMNIF: 4 mm [3, 4]; p = 0.01). The operator's experience did not impact the tested parameters regardless of the technique.

Conclusion: In this phantom study, EMN was not limited to acute angle targets. Efficacy and accuracy of puncture for acute angle access targets with EMN, IF or CEMNIF were similar. CEMNIF is more accurate for large angle access targets at the cost of a slightly higher procedure time and radiation exposure.