Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques
Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided proc...
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| Veröffentlicht in: | PloS one 2016-02, Vol.11 (2), p.e0148199-e0148199 |
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| creator | Pishnamaz, Miguel Wilkmann, Christoph Na, Hong-Sik Pfeffer, Jochen Hänisch, Christoph Janssen, Max Bruners, Philipp Kobbe, Philipp Hildebrand, Frank Schmitz-Rode, Thomas Pape, Hans-Christoph |
| description | Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures.
Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.
160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).
Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects. |
| doi_str_mv | 10.1371/journal.pone.0148199 |
| format | Article |
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Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.
160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).
Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0148199</identifier><identifier>PMID: 26863310</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accuracy ; Biomimetic Materials - chemistry ; Biopsy ; Bone Screws ; Care and treatment ; Coils ; Computed tomography ; Data processing ; Diagnosis ; Electromagnetic Radiation ; Electromagnetism ; Engineering and Technology ; Feasibility studies ; Ferromagnetism ; Fluoroscopy ; Fracture Fixation, Internal - instrumentation ; Fracture Fixation, Internal - methods ; Fractures ; Fractures, Bone - diagnostic imaging ; Fractures, Bone - pathology ; Fractures, Bone - surgery ; Group dynamics ; Hospitals ; Humans ; Ilium - diagnostic imaging ; Ilium - pathology ; Ilium - surgery ; Imaging, Three-Dimensional - instrumentation ; Imaging, Three-Dimensional - methods ; Medical imaging ; Medical research ; Medicine and Health Sciences ; Models, Anatomic ; Navigation ; Navigation systems ; Physical Sciences ; Placement ; Radiation ; Radiation effects ; Real time ; Research and Analysis Methods ; Risk factors ; Robots ; Sacrum ; Sacrum - diagnostic imaging ; Sacrum - pathology ; Sacrum - surgery ; Stainless steel ; Surgery ; Surgery, Computer-Assisted - instrumentation ; Surgery, Computer-Assisted - methods ; Test procedures ; Time Factors ; Tomography, X-Ray Computed - instrumentation ; Tomography, X-Ray Computed - methods ; Trauma ; Vascular diseases ; Visual control ; Wire</subject><ispartof>PloS one, 2016-02, Vol.11 (2), p.e0148199-e0148199</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Pishnamaz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2016 Pishnamaz et al 2016 Pishnamaz et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-521f02383beafdb5b60660ed3fb02b6d989d9e9e4bdce9ab9c38cec6807ddc813</citedby><cites>FETCH-LOGICAL-c692t-521f02383beafdb5b60660ed3fb02b6d989d9e9e4bdce9ab9c38cec6807ddc813</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749384/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4749384/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26863310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pishnamaz, Miguel</creatorcontrib><creatorcontrib>Wilkmann, Christoph</creatorcontrib><creatorcontrib>Na, Hong-Sik</creatorcontrib><creatorcontrib>Pfeffer, Jochen</creatorcontrib><creatorcontrib>Hänisch, Christoph</creatorcontrib><creatorcontrib>Janssen, Max</creatorcontrib><creatorcontrib>Bruners, Philipp</creatorcontrib><creatorcontrib>Kobbe, Philipp</creatorcontrib><creatorcontrib>Hildebrand, Frank</creatorcontrib><creatorcontrib>Schmitz-Rode, Thomas</creatorcontrib><creatorcontrib>Pape, Hans-Christoph</creatorcontrib><title>Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures.
Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.
160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).
Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.</description><subject>Accuracy</subject><subject>Biomimetic Materials - chemistry</subject><subject>Biopsy</subject><subject>Bone Screws</subject><subject>Care and treatment</subject><subject>Coils</subject><subject>Computed tomography</subject><subject>Data processing</subject><subject>Diagnosis</subject><subject>Electromagnetic Radiation</subject><subject>Electromagnetism</subject><subject>Engineering and Technology</subject><subject>Feasibility studies</subject><subject>Ferromagnetism</subject><subject>Fluoroscopy</subject><subject>Fracture Fixation, Internal - instrumentation</subject><subject>Fracture Fixation, Internal - methods</subject><subject>Fractures</subject><subject>Fractures, Bone - diagnostic imaging</subject><subject>Fractures, Bone - pathology</subject><subject>Fractures, Bone - surgery</subject><subject>Group dynamics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ilium - diagnostic imaging</subject><subject>Ilium - pathology</subject><subject>Ilium - surgery</subject><subject>Imaging, Three-Dimensional - instrumentation</subject><subject>Imaging, Three-Dimensional - methods</subject><subject>Medical imaging</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Models, Anatomic</subject><subject>Navigation</subject><subject>Navigation systems</subject><subject>Physical Sciences</subject><subject>Placement</subject><subject>Radiation</subject><subject>Radiation effects</subject><subject>Real time</subject><subject>Research and Analysis Methods</subject><subject>Risk factors</subject><subject>Robots</subject><subject>Sacrum</subject><subject>Sacrum - diagnostic imaging</subject><subject>Sacrum - pathology</subject><subject>Sacrum - surgery</subject><subject>Stainless steel</subject><subject>Surgery</subject><subject>Surgery, Computer-Assisted - instrumentation</subject><subject>Surgery, Computer-Assisted - methods</subject><subject>Test procedures</subject><subject>Time Factors</subject><subject>Tomography, X-Ray Computed - instrumentation</subject><subject>Tomography, X-Ray Computed - methods</subject><subject>Trauma</subject><subject>Vascular diseases</subject><subject>Visual control</subject><subject>Wire</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk81u1DAQxyMEoqXwBggsISE47GLHXifmgFRVbVmpolVberUce5J1ldjb2KnaB-I9cXa3VRf1gHJI7PnNfz4yk2XvCZ4SWpBv137onWqnS-9gigkriRAvsl0iaD7hOaYvn3zvZG9CuMZ4RkvOX2c7OS85pQTvZn8OW9Cx951qHESr0TmoFl3aDtAvdWsbFa13yDoUF5BszXjy9ep05kOE3voenUF7O7pa13xH-w4d3i2ToQMXk9bcTa5sioCOQAVb2dbGe3QRB3OPlDPowHdL1duw1p2nPAAdD9aAQZegF87eDBDeZq9q1QZ4t3nvZb-PDi8Pfk5OTo_nB_snE81FHieznNQ4pyWtQNWmmlUcc47B0LrCecWNKIURIIBVRoNQldC01KB5iQtjdEnoXvZxrbtsfZCbDgdJCs4oywueJ2K-JoxX13KZqlT9vfTKytWF7xup-tTHFqQ2rBIsRa4BM8V0yYuUQVlxUDkvNE5aPzbRhqqDlJKLvWq3RLctzi5k428lK5igJUsCXzYCvR_bFGVng4a2VQ78sMp7RtKw5CKhn_5Bn69uQzUqFWBd7VNcPYrKfcZyQWYYF4maPkOlx0BndRrH2qb7LYevWw6JiXAXGzWEIOcX5__Pnl5ts5-fsIs0uXERfDuMMxu2QbYGde9D6KF-bDLBctymh27IcZvkZpuS24enP-jR6WF96F_Jaxyx</recordid><startdate>20160210</startdate><enddate>20160210</enddate><creator>Pishnamaz, Miguel</creator><creator>Wilkmann, Christoph</creator><creator>Na, Hong-Sik</creator><creator>Pfeffer, Jochen</creator><creator>Hänisch, Christoph</creator><creator>Janssen, Max</creator><creator>Bruners, Philipp</creator><creator>Kobbe, Philipp</creator><creator>Hildebrand, Frank</creator><creator>Schmitz-Rode, Thomas</creator><creator>Pape, Hans-Christoph</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20160210</creationdate><title>Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques</title><author>Pishnamaz, Miguel ; Wilkmann, Christoph ; Na, Hong-Sik ; Pfeffer, Jochen ; Hänisch, Christoph ; Janssen, Max ; Bruners, Philipp ; Kobbe, Philipp ; Hildebrand, Frank ; Schmitz-Rode, Thomas ; Pape, Hans-Christoph</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-521f02383beafdb5b60660ed3fb02b6d989d9e9e4bdce9ab9c38cec6807ddc813</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Accuracy</topic><topic>Biomimetic Materials - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pishnamaz, Miguel</au><au>Wilkmann, Christoph</au><au>Na, Hong-Sik</au><au>Pfeffer, Jochen</au><au>Hänisch, Christoph</au><au>Janssen, Max</au><au>Bruners, Philipp</au><au>Kobbe, Philipp</au><au>Hildebrand, Frank</au><au>Schmitz-Rode, Thomas</au><au>Pape, Hans-Christoph</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2016-02-10</date><risdate>2016</risdate><volume>11</volume><issue>2</issue><spage>e0148199</spage><epage>e0148199</epage><pages>e0148199-e0148199</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Electromagnetic tracking is a relatively new technique that allows real time navigation in the absence of radiation. The aim of this study was to prove the feasibility of this technique for the treatment of posterior pelvic ring fractures and to compare the results with established image guided procedures.
Tests were performed in pelvic specimens (Sawbones®) with standardized sacral fractures (Type Denis I or II). A gel matrix simulated the operative approach and a cover was used to disable visual control. The electromagnetic setup was performed by using a custom made carbon reference plate and a prototype stainless steel K-wire with an integrated sensor coil. Four different test series were performed: Group OCT: Optical navigation using preoperative CT-scans; group O3D: Optical navigation using intraoperative 3-D-fluoroscopy; group Fluoro: Conventional 2-D-fluoroscopy; group EMT: Electromagnetic navigation combined with a preoperative Dyna-CT. Accuracy of screw placement was analyzed by standardized postoperative CT-scan for each specimen. Operation time and intraoperative radiation exposure for the surgeon was documented. All data was analyzed using SPSS (Version 20, 76 Chicago, IL, USA). Statistical significance was defined as p< 0.05.
160 iliosacral screws were placed (40 per group). EMT resulted in a significantly higher incidence of optimal screw placement (EMT: 36/40) compared to the groups Fluoro (30/40; p< 0.05) and OCT (31/40; p< 0.05). Results between EMT and O3D were comparable (O3D: 37/40; n.s.). Also, the operation time was comparable between groups EMT and O3D (EMT 7.62 min vs. O3D 7.98 min; n.s.), while the surgical time was significantly shorter compared to the Fluoro group (10.69 min; p< 0.001) and the OCT group (13.3 min; p< 0.001).
Electromagnetic guided iliosacral screw placement is a feasible procedure. In our experimental setup, this method was associated with improved accuracy of screw placement and shorter operation time when compared with the conventional fluoroscopy guided technique and compared to the optical navigation using preoperative CT-scans. Further studies are necessary to rule out drawbacks of this technique regarding ferromagnetic objects.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26863310</pmid><doi>10.1371/journal.pone.0148199</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2016-02, Vol.11 (2), p.e0148199-e0148199 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1764342762 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; PLoS - Public Library of Sciencem (Open Access); PubMed Central; Free Full-Text Journals in Chemistry; EZB Electronic Journals Library |
| subjects | Accuracy Biomimetic Materials - chemistry Biopsy Bone Screws Care and treatment Coils Computed tomography Data processing Diagnosis Electromagnetic Radiation Electromagnetism Engineering and Technology Feasibility studies Ferromagnetism Fluoroscopy Fracture Fixation, Internal - instrumentation Fracture Fixation, Internal - methods Fractures Fractures, Bone - diagnostic imaging Fractures, Bone - pathology Fractures, Bone - surgery Group dynamics Hospitals Humans Ilium - diagnostic imaging Ilium - pathology Ilium - surgery Imaging, Three-Dimensional - instrumentation Imaging, Three-Dimensional - methods Medical imaging Medical research Medicine and Health Sciences Models, Anatomic Navigation Navigation systems Physical Sciences Placement Radiation Radiation effects Real time Research and Analysis Methods Risk factors Robots Sacrum Sacrum - diagnostic imaging Sacrum - pathology Sacrum - surgery Stainless steel Surgery Surgery, Computer-Assisted - instrumentation Surgery, Computer-Assisted - methods Test procedures Time Factors Tomography, X-Ray Computed - instrumentation Tomography, X-Ray Computed - methods Trauma Vascular diseases Visual control Wire |
| title | Electromagnetic Real Time Navigation in the Region of the Posterior Pelvic Ring: An Experimental In-Vitro Feasibility Study and Comparison of Image Guided Techniques |
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