CT data-based navigation for post-mortem biopsy – A feasibility study

Aghayev, Emin; Ebert, Lars C.; Christe, Andreas; Jackowski, Christian; Rudolph, Tobias; Kowal, Jens; Vock, Peter; Thali, Michael J.

doi:10.1016/j.jflm.2008.02.007

« Previous Next »Journal of Forensic and Legal Medicine
Volume 15, Issue 6 , Pages 382-387, August 2008

CT data-based navigation for post-mortem biopsy – A feasibility study

Emin Aghayev, MD (Research Assistant)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
- Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Centre, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
- Corresponding author. Address: Institute for Evaluative Research in Orthopaedic Surgery, MEM Research Centre, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland. Tel.: +41 31 631 59 30; fax: +41 31 631 59 31.
Lars C. Ebert, (PhD Student)
- Institute for Surgical Technology and Biomechanics, MEM Research Centre, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
Andreas Christe, MD (Radiologist)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
- Institute of Diagnostic Radiology, University Hospital, CH-3010 Bern, Switzerland
Christian Jackowski, MD (Resident at the Institute of Forensic Medicine)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland
Tobias Rudolph, (PhD Student)
- Institute for Surgical Technology and Biomechanics, MEM Research Centre, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
Jens Kowal, (Group Head – Smart Surgical Instrumentation)
- Institute for Surgical Technology and Biomechanics, MEM Research Centre, University of Bern, Stauffacherstrasse 78, CH-3014 Bern, Switzerland
Peter Vock, MD (Chief of the Department of Diagnostic Radiology)
- Institute of Diagnostic Radiology, University Hospital, CH-3010 Bern, Switzerland
Michael J. Thali, MD (Chief of the Institute of Forensic Medicine)
- Institute of Forensic Medicine, University of Bern, Buehlstrasse 20, CH-3012 Bern, Switzerland

Received 18 September 2007; received in revised form 14 January 2008; accepted 8 February 2008.

Abstract

Introduction

Recent advances in medical imaging have brought post-mortem minimally invasive computed tomography (CT) guided percutaneous biopsy to public attention.

Aims

The goal of the following study was to facilitate and automate post-mortem biopsy, to suppress radiation exposure to the investigator, as may occur when tissue sampling under computer tomographic guidance, and to minimize the number of needle insertion attempts for each target for a single puncture.

Methods and materials

Clinically approved and post-mortem tested ACN-III biopsy core needles (14 gauge×160mm) with an automatic pistol device (Bard Magnum, Medical Device Technologies, Denmark) were used for probe sampling. The needles were navigated in gelatine/peas phantom, ex vivo porcine model and subsequently in two human bodies using a navigation system (MEM centre/ISTB Medical Application Framework, Marvin, Bern, Switzerland) with guidance frame and a CT (Emotion 6, Siemens, Germany).

Results

Biopsy of all peas could be performed within a single attempt. The average distance between the inserted needle tip and the pea centre was 1.4mm (n=10; SD 0.065mm; range 0–2.3mm).

The targets in the porcine liver were also accurately punctured. The average of the distance between the needle tip and the target was 0.5mm (range 0–1mm).

Biopsies of brain, heart, lung, liver, pancreas, spleen, and kidney were performed on human corpses. For each target the biopsy needle was only inserted once. The examination of one body with sampling of tissue probes at the above-mentioned locations took approximately 45min.

Conclusions

Post-mortem navigated biopsy can reliably provide tissue samples from different body locations. Since the continuous update of positional data of the body and the biopsy needle is performed using optical tracking, no control CT images verifying the positional data are necessary and no radiation exposure to the investigator need be taken into account. Furthermore, the number of needle insertions for each target can be minimized to a single one with the ex vivo proven adequate accuracy and, in contrast to conventional CT guided biopsy, the insertion angle may be oblique.

Navigation for minimally invasive tissue sampling is a useful addition to post-mortem CT guided biopsy.

Keywords: Virtopsy, Forensic radiology, Post-mortem biopsy, Computed tomography, Navigated biopsy, Needle autopsy