Integration of free-hand 3D ultrasound and mobile C-arm cone-beam CT: Feasibility and characterization for real-time guidance of needle insertion

Abstract This work presents development of an integrated ultrasound (US)–cone-beam CT (CBCT) system for image-guided needle interventions, combining a low-cost ultrasound system (Interson VC 7.5 MHz, Pleasanton, CA) with a mobile C-arm for fluoroscopy and CBCT via use of a surgical tracker. Imaging performance of the ultrasound system was characterized in terms of depth-dependent contrast-to-noise ratio (CNR) and spatial resolution. US–CBCT system was evaluated in phantom studies simulating three needle-based procedures: drug delivery, tumor ablation, and lumbar puncture. Low-cost ultrasound provided flexibility but exhibited modest CNR and spatial resolution that is likely limited to fairly superficial applications within a ∼10 cm depth of view. Needle tip localization demonstrated target registration error 2.1–3.0 mm using fiducial-based registration.