Background Placement accuracy of ventriculostomy catheters is reported in a wide and variable range. approach in a skull phantom. Without Smart Stylet guidance the operator was successful 4/10 (40 %) from the right frontal approach and 6/10 (60 %60 %) from your left frontal approach. In a separate experiment resident operators were successful 2/4 (50%) when targeting the shifted ipsilateral frontal horn with Smart Stylet guidance and 0/4 (0 %) without image-guidance using a skull phantom. Conclusions Smart Stylet may improve the ability to successfully target the ventricles during frontal ventriculostomy. dictates a limit of three attempts for the operator to successfully target the ventricle . The same survey referenced above reports a wider range of clinical practice with 46 percent of respondents having witnessed five or fewer passes . Associations between multiple attempts to successfully cannulate the ventricle and intracranial hemorrhage have not been thoroughly analyzed . Properly placed catheters malfunction less generally and require less frequent alternative to maintain patent circulation of cerebrospinal fluid . Catheter replacement has been significantly associated with ventriculostomy-related contamination . In this article we present the development of Smart Stylet as a response to the need for improved catheter placement accuracy. This statement presents initial measurements of overall performance for the prototype Smart Stylet system. We first established baseline anticipations for system and operator CRT0044876 error. We then requested neurosurgical resident operators to target the ipsilateral frontal horn of the ventricular system in a phantom model using Smart Stylet. 2 METHODS 2.1 Smart Stylet Components An electromagnetic (EM) tracking system a conventional ventriculostomy stylet and catheter TNFRSF16 and a Dell (Round Rock TX) Precision personal computer with display were used to assemble the Smart Stylet system. (Physique 1) All components are suitable for clinical use and commercially available for a total cost of approximately 20 0 USD. We used a pulsed direct current EM tracking system designed and marketed by Ascension Technologies (Shelburne VT). A prototype portable smooth plate consisting of three EM transmitters (Physique 2) provided the local EM field where the position and orientation of the EM tracker coils could be interrogated by the system. The plate was designed to be under the patient’s head on a hospital bed and composed of a proprietary material to protect the EM field from ferromagnetic objects below the transmitter. Physique 1 Smart Stylet CRT0044876 system component flowchart. Physique 2 Prototype smooth plate EM transmitter. The transmitter can be situated and removed from under the individual’s CRT0044876 head at the bedside. Three small cube transmitters are positioned on a plate to create a working volume round the patient’s head. … Smart Stylet’s software module was implemented CRT0044876 in 3D Slicer 2.7 open-access research software for image analysis and image-guided therapy (www.slicer.org). The software interface consists of a three-dimensional segmented display two reformatted CT displays and three traditional radiology CT imaging views. All imaging displays were dynamically viewed using coordinates transmitted from your EM system. Within the segmented display two trajectories were defined – one along the path of the stylet (incident) and the other an ideal straight-line trajectory from the tip of the catheter to the target (planned). The three-dimensional display was designed to simulate the operator’s environment at the head of the patient bed and help provide orientation during navigation. (Physique 3 – Below Display) The simulation displays the stylet in relation to surrounding anatomy at twenty frames per second. Oblique axial slices (Physique 3 – Above Left) display dynamically at an angle perpendicular to the stylet trajectory and in the plane of the target ventricular system. The image frame was designed to help the operator align incident and planned trajectories. The stylet’s incident trajectory was defined as a reddish circle that translates across the oblique axial slice view. The origin of the x- and y-axes represent the planned trajectory..