Testimonials & Publications
Pr. Franco Orsi – IEO, European Institute of Oncology, Milan, Italy
“In our daily practice, we usually need to safely “navigate” through the body, to perform percutaneous biopsies, complex ablations, and MSK procedures. CT-Navigation brings added safety, effectiveness and speed to our clinical routine by allowing to target multiple lesions, tight spaces and abnormal anatomy much easier. Whether it’s an experienced user or when we are training someone for the first time, the speed and ease of use, especially for out-of-plane trajectories, make this our navigation system of choice.“
Dr. Else Merete Ebbensgaard, Region Hospital, Holstebro, Denmark
“At the Regionhospital in Holstebro, Denmark, we are using Imactis CT-Navigation™ since April 2015. At that time, we have performed more than 1200 lung interventions and also multiple biopsies of bones, kidneys, liver, adrenal glands and retroperitoneal lymph nodes and abdominal and thoracic drainages. Compared to our prior method we have experienced with CT-Navigation™:
– Better precision, we can hit targets as small as 7 mm in lungs
– Quick biopsies
– CT-Navigation™ is less sensitive to patient motion
– The possibility to choose a safer path that can be out of the axial plane
– Fewer complications
All radiologists in Holstebro prefer Imactis CT-Navigation™ when doing CT-biopsies.“
Pr. Alban Denys – CHUV Lausanne, Switzerland
“Imactis is used in my centre on a daily basis. It is particularly useful for out-of-plane access to deeply located lesions like adrenal tumors or liver lesions located under the dome. It is extremely user-friendly, easy to manage and simple both for the nurses and technicians in my angio lab and for residents rotating every 3-6 months. It has a great potential in the future for complex treatment planning in ablation procedures.“
Pr. Eric de Kerviler – APHP, Saint-Louis Hospital, France
“The holy grail in CT-guided procedures is to be able to reach any target lesion quickly and safely. Imactis’s CT-Navigation™ is a very powerful tool as it allows to plan complex trajectories and determine the entry point of the needle simultaneously. Intra-procedurally, the system is particularly efficient in difficult cases for which a double oblique trajectory is mandatory, even with target near the diaphragm. For every procedure, the system also reduces the number of control scans, and therefore maintains the radiation as low a dose as possible for both patients and radiologists. Allowing unlimited trajectories, Imactis opens new horizons, making reachable the unreachable targets“
Dr. Christian Sengel – Grenoble Hospital, France
“I personally used CT-Navigation™ assistance for over 5 years. I am an interventional radiologist specialized in pelvic and abdominal cancer treatment. For me, the system’s benefits are with percutaneous thermal ablations (radiofrequency, microwave and cryoablation) particularly for both deep and mobile nodules, like nodules in segment 7 (Couinaud). CT-Navigation™ considerably increases your accuracy in the first punctions. This also means reducing the number of CT scan controls, without using fluoroscanner, seeing fewer complications in the trajectory, and delivering treatment with more precision (therefore reducing recurrences). Even though in theory the system does not take internal breathing movements into account, the radiologist can move into the acquired volume dynamically, see the shifting of the image of interest and easily extrapolate to obtain the exact path to the target.“
Pr. Ivan Bricault – Grenoble Hospital, France
“The Imactis navigation station provides valuable assistance by increasing the accuracy and reducing the number of control scans. It would be difficult for me to imagine completing certain complex interventions (double-oblique trajectories for example) without the safety and comfort provided by the Imactis CT-Navigation™ station. The system’s ease-of-use has also helped less experienced radiologists to become acquainted with CT-guided interventions; these radiologists would have been reluctant to perform procedures without the assistance of navigation.”
Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial
To assess the accuracy and usability of an electromagnetic navigation system designed to assist Computed Tomography (CT) guided interventions.
Materials and methods
120 patients requiring a percutaneous CT intervention (drainage, biopsy, tumor ablation, infiltration, sympathicolysis) were included in this prospective randomized trial. Nineteen radiologists participated. Conventional procedures (CT group) were compared with procedures assisted by a navigation system prototype using an electromagnetic localizer to track the position and orientation of a needle holder (NAV group). The navigation system displays the needle path in real-time on 2D reconstructed CT images extracted from the 3D CT volume. The regional ethics committee approved this study and all patients gave written informed consent. The main outcome was the distance between the planned trajectory and the achieved needle trajectory calculated from the initial needle placement.
120 patients were analyzable in intention-to-treat (NAV: 60; CT: 60). Accuracy improved when the navigation system was used: distance error (in millimeters: median[P25%; P75%]) with NAV = 4.1[2.7; 9.1], vs. with CT = 8.9[4.9; 15.1] (p<0.001). After the initial needle placement and first control CT, fewer subsequent CT acquisitions were necessary to reach the target using the navigation system: NAV = 2[2; 3]; CT = 3[2; 4] (p = 0.01).
The tested system was usable in a standard clinical setting and provided significant improvement in accuracy; furthermore, with the help of navigation, targets could be reached with fewer CT control acquisitions.
Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial P. Durand ,A. Moreau-Gaudry ,AS. Silvent ,J. Frandon ,E. Chipon ,M. Médici ,I. Bricault
PlosOne, March 15,2017
Electromagnetic navigation system combined with High-Frequency-Jet-Ventilation for CT-guided hepatic ablation of small US-Undetectable and difficult to access lesions
To report the feasibility and efficacy of percutaneous ablation of small hepatic malignant tumors that are invisible on ultrasound and inaccessible using in-plane CT guidance, using a combination of high-frequency jet-ventilation (HFJV) and electromagnetic (EM) needle tracking.
This study reviewed 27 percutaneous ablations of small hepatic tumors (<2 cm) performed using EM navigation-based probe placement and HFJV. All lesions were invisible on ultrasound and difficult to reach on CT requiring a double-oblique approach. The primary outcome was technical efficacy, defined as complete lesion coverage, and evaluated on contrast enhanced MRI after 3 and 6 months. Needle placement accuracy, the number of control CT acquisitions, procedure time, complications and radiation doses were assessed.
Twenty-one patients with 27 treated lesions (14 hepatocellular carcinomas and 13 metastases) were included in this study. Mean tumor size was 12 ± 5.7 mm. Thirty-three percent of the lesions were located on the hepatic dome. Complete ablation was obtained in 100% at the 3- and 6-month MRI follow-up. The ablation probe was correctly placed on the first pass in 96%, with a mean path-to-tumor angle of 7 ± 4 degrees and a mean tip-to-tumor distance of 22 ± 19mm. A readjustment for additional overlapping application resulted in complete treatment in 4 patients. Needle placement took a mean 23 ± 12 min with mean radiation doses of 558 mGy*cm. No major complications were reported.
Percutaneous liver ablation of lesions that cannot be seen on US and requiring out-of-plane CT access can be successfully and safely treated using electromagnetic-based navigation and jet-ventilation.
Electromagnetic navigation system combined with High-Frequency-Jet-Ventilation for CT-guided hepatic ablation of small US-Undetectable and difficult to access lesions S. Volpi, G. Tsoumakidou, A. Loriaud, A. Hocquelet, R. Duran, A. Denys
International Journal of Hyperthermia, October 17, 2019
CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS)
To evaluate electromagnetic navigation system (ENS) for percutaneous fixation by internal cemented screw (FICS) under CT guidance.
Materials and methods
In this single-center retrospective study, we reviewed all consecutive cancer patients treated with percutaneous FICS under ENS-assisted CT guidance for the prevention or palliation of pelvic or femoral neck fractures. The primary endpoint was technical success. Secondary endpoints were screw placement accuracy (defined by proximal deviation p, distal deviation d, and angle deviation θ), radiation dose exposure, number of CT acquisitions, duration of procedures, and complications.
Mean duration of FICS procedures was 111 ± 51 min. Mean post-procedure hospitalization length was 2.1 days. Technical success was achieved in 48 cases (96%) with a total of 76 screws inserted. Mean distance p, mean distance d, and mean angle θ were respectively 8.0 ± 4.5 mm, 7.5 ± 4.4 mm, and 5.4 ± 2°. Angle θ accuracy was higher for screws with a craniocaudal angulation of less than 20° (4.4° vs 6.4°, p = 0.02). The mean number of CT acquisitions during procedures was 6.4 ± 3.0. The mean dose length product was 1524 ± 953 mGy cm and the mean dose area product was 12 ± 8 Gy cm2. Five complications occurred in 4 patients.
CT guidance assisted by ENS is an effective approach for percutaneous FICS.
- ENS-assisted CT enables screw insertion in the pelvic ring and femoral neck, with a wide range of trajectories, even when a significant craniocaudal angulation is required.
- ENS-assisted CT can be used as an alternative to CBCT guidance for percutaneous fixation by internal cemented screw.
- ENS-assisted CT provides high technical success rate with excellent placement accuracy.
CT guidance assisted by electromagnetic navigation system for percutaneous fixation by internal cemented screws (FICS). B. Moulin, L. Tselikas, T. De Baere, F. Varin, A. Abed, L. Debays, C. Bardoulat, A. Hakime, C. Teriitehau, F. Deschamps, G.
European Radiology, September 2, 2019
Use of an Electromagnetic Navigation System on a Phantom as a Training Simulator for CT-Guided Procedures
Description of the problem
CT-guided procedures are an essential part of the clinical work at many hospitals across the United States and throughout the world. CT guidance is used for biopsies, abscess drainages, and ablations. Currently, radiology residents and fellows acquire their CT procedural skills on real patients. Both diagnostic and interventional radiologists perform some of these procedures, and therefore the experience and skill set in performing these procedures can vary widely .
Although CT-guided procedures have been used to successfully diagnose and treat a wide range of pathologies, it is at the expense of increased radiation exposure to both operators and patients. Limiting radiation exposure in interventional radiology has been an important discussion point, and societies such as the Cardiovascular and Interventional Radiological Society of Europe and the Society of Interventional Radiology have provided strong recommendations in an effort to reduce excessive radiation exposure.
Over the past several years, multiple new navigational tools have entered the market, helping guide fully trained interventional radiologists during CT-guided procedures. Using fiducials and optical or electromagnetic tracking, these tools create a “global positioning system” of the internal organs and can allow the needle to be tracked in real time. These navigational tools also allow a simulated CT experience, enabling a phantom to be imaged on a CT scanner and a biopsy procedure simulated at a location and time separate from the planning CT scan, without the need for additional radiation to the patient and operator.
Although navigational systems may offer an alternative for training and performing CT-guided procedures in the future for both interventional and noninterventional radiologists, little is known about the difficulty and the amount of procedural experience needed to successfully use these navigational systems.
The purpose of this study was to compare the diagnostic and interventional radiologist trainee’s CT-guided procedural skills using an electromagnetic navigational guidance system (EMN, Imactis, La Tronche, France) that mimics a CT-guided biopsy and determine whether prior experience predicts technical success using these systems.
This prospective study was reviewed and exempted by the institutional review board. A total of 19 fellows (12 interventional fellows and 7 diagnostic fellows) participated in the study. The study was performed 3 months into the fellows’ training (September 2014).
The study consisted of a skills test that simulated a CT-guided procedure. The simulation consisted of two parts: One part allowed targeting of three progressively difficult lesions on a phantom using standard manual/conventional skills. A second part tested targeting of the same lesions using an EMN.
Publication of study protocol
Use of an Electromagnetic Navigation System on a Phantom as a Training Simulator for CT-Guided Procedures, Yadiel Sánchez, BA, Dmitry S. Trifanov, MD, Taj M. Kattapuram, MD, Haiyang Tao, MD, PhD, Anand M. Prabhakar, MD, MBA, Ronald S. Arellano, MD, Raul N. Uppot, MD
Published on JACR (Journal of the American College of Radiology), June 2017, Volume 14, Issue 6, Pages 795–799
Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure
To compare morbidity, oncological and functional outcomes of percutaneous radiofrequency ablation (RFA) and partial nephrectomy in indications of renal tumor treatment with imperative nephron-sparing procedure.
Patients and methods
Between January 2005 and December 2010, 50 consecutive patients were referred in our center for NP or RFA for a renal tumor with either a renal function impairment defined as estimated glomerular filtration (eGFR) less than 60 mL/min/1.73 m2, and/or solitary kidney and/or bilateral tumors. Perioperative outcomes were compared.
The puncture had been assisted with magnetic sensors positioned on the base of the coaxial needle and with IMACTIS CT-Navigation system.
Publication of study protocol
Perioperative outcomes and mid-term results of radiofrequency ablation and partial nephrectomy in indications of renal tumor treatment and imperative nephron-sparing procedure, V.Arnoux, J.-L. Descotes, C. Sengel, N. Terrier, J.-J.Rambeaud, J.-A. Long.
Published on Elsevier, “Progrès en Urologie”, Volume 23, Issue 2, February 2013, Pages 99-104
Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur.
To retrospectively evaluate the outcome of patients who underwent radiological percutaneous osteosynthesis and cementoplasty (RPOC) for stabilization of malignant pathological fracture of the proximal femur.
Materials and methods
The clinical files of 12 patients who underwent RPOC for stabilization of malignant pathological fracture of the proximal femur were reviewed. There were 9 men and 3 women with a mean age of 56 years ± 13 (SD) (range: 35–82 years). All patients had metastases of proximal femur and a high fracture risk (Mirels score ≥ 8) and were not eligible for surgical stabilization. The primary endpoint was the occurrence of a fracture after RPOC. Secondary endpoints were the procedure time, early complications of RPOC, pain reduction as assessed using a visual analog scale (VAS) and duration of hospital stay.
No patients treated with RPOC had a fracture during a mean follow-up time of 382 days ± 274 (SD) (range: 11–815 days). RPOC was performed under general (n = 10) or locoregional (n = 2) anesthesia. The average duration of the procedure was 95 min ± 17 (SD) (range: 73–121 min). The technical success rate was 100%. All patients were able to walk on the day following RPOC. The average duration of hospital stay was 4 days ± 3 (SD) (range: 2–10 days). No major complication occurred. One patient complained of hypoesthesia in the lateral thigh. For symptomatic patients (n = 7), VAS score decreased from 6.8 ± 1.2 (SD) (range: 5–9) before treatment, to 2.3 ± 1.1 (SD) (range: 1–4) one month later.
IMACTIS Ct-Navigation was used for needle positionning.
Publication of study protocol
Percutaneous osteosynthesis and cementoplasty for stabilization of malignant pathologic fractures of the proximal femur, E. Mavrovi, J.-B. Pialat, H. Beji, A.-C.Kalenderian, G. Vaz, B. Richioud
Published on Elsevier, Diagnostic and Interventional Imaging, Volume 98, Issue 6, June 2017, Pages 483-489
Evaluation of a Computed Assisted Medical Intervention (CAMI) in scientific autopsy
This study is the first step of an ambitious project to use pre-operative post-mortem computed tomography (CT) imaging and a Computer Assisted Medical intervention (CAMI) device for guidance of targeted biopsy in an effort to demonstrate the continuing scientific value of the autopsy in clinical practice and therefore increase the number of autopsies carried out.
The main objectives are :
- Build the first step of the vision associating Computed Assisted Medical Interventions and forensic science.
- Show the possibility to perform mini-invasive autopsy in the autopsy room without a CT-scan in it with a radiology interventional tool.
- Show the limitations and the advantages of the device in this use.
- Show the difficulties linked to the state of the corpse.
- Draw conclusions on the possibilities to improve this protocol, including a per-operative tool, and continue research in this way.
Publication of study protocol
Evaluation of a Computed Assisted Medical Intervention (CAMI) systems in scientific autopsy, Grenier F., Voros S., Scolan V., Paysant F., Boutonnat J., Bricault I., Moreau-Gaudry A.
Journal of Forensic Radiology and Imaging, Volume 11, December 2017, Pages 6-11
Clinical study CT-NAV II
Clinical study CT-NAV II is a multicentric, comparative, prospective and randomized clinical study. It took place in 9 French publics hospitals, more than 450 patients were enrolled.
The aim of this trial is to evaluate the clinical benefit of the navigation system by comparing the results obtained in the navigation-assisted group with those obtained in the conventional group during CT-guided procedures.
Three criterias are used:
- Safety: The number of AEs that are considered to be major.
- Efficacy: The number of targets reached
- Performance: The number of control scans acquired during the needle insertion.
Publication of study protocol
Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial. RC. Rouchy, A. Moreau-Gaudry, E. Chipon, S. Aubry, L. Pazart, B. Lapuyade, M. Durand, M. Hajjam, S. Pottier, B. Renard, R. Logier, X. Orry, A. Cherifi, E. Quehen, G. Kervio, O. Favelle, F. Patat, E. De Kerviler, C. Hughes, M. Medici, J. Ghelfi, A. Mounier and I. Bricault.
Trials, July, 6, 2017.
Clinical study CT-NAV I – Increased accuracy and fewer controls
IMACTIS CT-Navigation was successfully validated during a comparative, prospective, randomized clinical study on 120 patients at the Grenoble University Hospital on various procedures (drainage, biopsy, tumor ablation, infiltration, sympathicolysis).
The clinical study shows, that when compared to conventional procedures, the use of IMACTIS leads to:
- Increased accuracy (gain in distance and angle accuracy higher than 50%)
- Fewer controls are necessary to reach the target.
Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial. P. Durand, A. Moreau-Gaudry, A. Silvent, J. Frandon, E. Chipon, M. Medici, I. Bricault.
PLoS One, March, 15, 2017.