TIPS Placement in Swine, Guided by Electromagnetic Real-Time Needle Tip Localization Displayed on Previously Acquired 3-D CT

Purpose: To determine the feasibility of guiding a transjugular intrahepatic portosystemic shunt (TIPS) procedure with an electromagnetic real-time needle tip position sensor coupled to previously acquired 3-dimensional (3-D) computed tomography (CT) images. Methods: An electromagnetic position sensor was placed at the tip of a Colapinto needle. The real-time position and orientation of the needle tip was then displayed on previously acquired 3-D CT images which were registered with the five swine. Portal vein puncture was then attempted in all animals. Results: The computer calculated accuracy of the position sensor was on average 3 mm. Four of five portal vein punctures were successful. In the successes, only one or two attempts were necessary and success was achieved in minutes. Conclusion: A real-time position sensor attached to the tip of a Colapinto needle and coupled to previously acquired 3-D CT images may potentially aid in entering the portal vein during the TIPS procedure