Robotic versus Freehand Needle Positioning in CT-guided Ablation of Liver Tumors: A Randomized Controlled Trial
Robotic versus Freehand Needle Positioning in CT-guided Ablation of Liver Tumors: A Randomized Controlled Trial
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DOI：
10.1148/radiol.2018181698
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发表时间：
2019-03-01
期刊：
影响因子：
19.7
通讯作者：
de Jong, Koert P.
中科院分区：
文献类型：
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作者：
Heerink, Wouter J.;Ruiter, Simeon J. S.;de Jong, Koert P.
目的：比较 CT 引导的肝脏肿瘤微波消融 (MWA) 中徒手与机器人天线放置的准确性。材料和方法：本研究是一项前瞻性单中心非盲随机对照试验（荷兰试验注册中心，NTR6023）。符合条件的研究参与者接受了临床指示的 CT 引导肝脏肿瘤 MWA 治疗，并能够接受 CT 造影剂。在对比材料增强 CT 图像上进行识别后，对每个肿瘤进行随机化。主要结果是天线重新定位的次数，通过曼-惠特尼 U 测试进行比较。次要结果是按平面内和平面外目标以及瞄准时间分层的横向瞄准误差。结果：2017 年 2 月 14 日至 11 月 12 日期间，纳入了 31 名平均年龄为 63 岁（范围，25-88 岁）的参与者：17 名女性（平均年龄，57 岁；范围，25-77 岁）和 14 名男性（平均年龄，70 岁；范围，52-88 岁）年）。徒手学习臂由 19 名参与者组成，而机器人学习臂由 18 名参与者组成；双臂均包括六名患有多个肿瘤的参与者。评估了 47 个肿瘤；由于技术限制，五个肿瘤被排除在分析之外。在机械臂中，不需要重新定位天线。在徒手手臂中，中位数需要一次重新定位（范围，零到七次重新定位；P < .001）。对于平面外目标，徒手和机器人程序的横向瞄准误差分别为 10.1 毫米 +/- 4.0 和 5.9 毫米 +/- 2.9 (P = .007)，而对于平面内目标，横向瞄准误差分别为 6.2 毫米 +/- 2.7 和 7.7 毫米 +/- 5.9 (P = .51)。徒手手术和机器人手术的平均瞄准时间分别为 19 分钟（范围，8-55 分钟）和 36 分钟（范围，3-70 分钟；P = .001）。结论：机器人天线引导减少了微波消融中重新定位天线以准确瞄准肝脏肿瘤的需要，并提高了平面外目标的准确性。然而，机器人引导的瞄准时间比徒手瞄准的时间更长。 (C) 北美放射学会，2019
Purpose: To compare the accuracy of freehand versus robotic antenna placement in CT-guided microwave ablation (MWA) of liver tumors.Materials and Methods: This study was conducted as a prospective single-center nonblinded randomized controlled trial (Netherlands Trial Registry, NTR6023). Eligible study participants had undergone clinically indicated CT-guided MWA of liver tumors and were able to receive a CT contrast agent. Randomization was performed per tumor after identification on contrast material-enhanced CT images. The primary outcome was the number of antenna repositionings, which was compared by using the Mann-Whitney U test. Secondary outcomes were lateral targeting error stratified by in-plane and out-of-plane targets and targeting time.Results: Between February 14 and November 12, 2017, 31 participants with a mean age of 63 years (range, 25-88 years) were included: 17 women (mean age, 57 years; range, 25-77 years) and 14 men (mean age, 70 years; range, 52-88 years). The freehand study arm consisted of 19 participants, while the robotic study arm consisted of 18 participants; six participants with multiple tumors were included in both arms. Forty-seven tumors were assessed; five tumors were excluded from the analysis because of technical limitations. In the robotic arm, no antenna repositioning was required. In the freehand arm, a median of one repositioning was required (range, zero to seven repositionings; P < .001). For out-of-plane targets, lateral targeting error was 10.1 mm +/- 4.0 and 5.9 mm +/- 2.9 (P = .007) for freehand and robotic procedures, respectively, and for in-plane targets, lateral targeting error was 6.2 mm +/- 2.7 and 7.7 mm +/- 5.9, respectively (P = .51). Mean targeting time was 19 minutes (range, 8-55 minutes) and 36 minutes (range, 3-70 minutes; P = .001) for freehand and robotic procedures, respectively.Conclusion: Robotic antenna guidance reduces the need for antenna repositioning in microwave ablation to accurately target liver tumors and increases accuracy for out-of-plane targets. However, targeting time was greater with robotic guidance than with freehand targeting. (C) RSNA, 2019