Imaging/Radiology I Podium Friday, May 16, 2014 3:30 PM-5:30 PM PD4-01 NOVEL NAVIGATION SYSTEM INTEGRATING GPS TECHNOLOGY WITH MOVABLE TABLET DISPLAY OF SURGICAL 3D MODEL FOR PERCUTANEOUS INTERVENTION Osamu Ukimura*, Andre Luis de Cadtro Abreu, Arnaud Marien, Sunao Shoji, Toru Matsugasumi, Raed Azhar, Mihir Desai, Inderbir Gill, Los Angeles, CA INTRODUCTION AND OBJECTIVES: We present the first application of a percutaneous navigation system (TranslucentÔ Medical, Inc.) which integrates GPS technology with a movable tablet display of virtual 3D models. Both the surgical tools and the movable tablet display are tracked by GPS technology and digitally aligned with each other. In real- time, this system displays the internal anatomy, superimposed surgical tools, and navigation aids (such as predicted puncture line). The objective of our study was to assess the feasibility and accuracy of this system in a cadaver model for targeted interventions of the prostate and kidney. METHODS: Gold fiducial-markers (CIVCO Medical), which served as target center of the virtual tumor (Target-fiducial), were needle-implanted in kidney and prostate parenchyma. Then a pre- operative CT scan was obtained, and CT-DICOM data were transferred to the system to construct 3D surgical models. A needle, with built-in GPS sensors, was used as the therapeutic puncture needle. When the system indicated coincidence of the needle-tip and target-fiducial, another gold fiducial (Treatment-fiducial) was placed through the outer- sheath of the therapeutic needle. A post-operative CT was acquired to measure distance between the Target and Treatment fiducials. For each Target-fiducial, two placements of a Treatment-fiducial were attempted (from two different skin incisions >2 cm apart). RESULTS: Real-time display of the needle puncture trajectory superimposed on the 3D model allowed successful navigation in all pro- cedures. Navigation was further enhanced by color-coded changes to the needle-icon, which indicated whether or not the current trajectory was on-track to intersect the surgical target. Median time to target was 43 sec. Mean distance from needle-tip to target was 2.5mm (as calculated by the tracking system). Distance between the Target- and Treatment-fiducial was 16.6 mm in the prostate and 12 mm in the kidney. Distance between the paired Treatment-fiducials was 7.7mm. Analyzing each axial compo- nent, errors were significantly greater along z-axis (p<0.01), likely due to the intra-operative compression of the organ during puncture, resulting in possible rotation, shift, or deformation of the soft-tissue cadaveric organ. CONCLUSIONS: This virtual navigation system, integrating GPS-technology with movable tablet display, is promising for percuta- neous interventions. In order to minimize possible errors, further work is needed to augment the tracking system for intra-corporeal organ mo- tion/deformation. Source of Funding: None PD4-02 FLUORESCENCE LABELED TILMANOCEPT DETECTION OF SENTINEL LYMPH NODES DURING ROBOTIC SURGERY IN AN ANIMAL MODEL Michael A. Liss*, Salman Farchshchi-Heydari, Zhengtao Qin, Sean A. Hickey, David J. Hall, David R. Vera, Christopher J. Kane, La Jolla, CA INTRODUCTION AND OBJECTIVES: In order to identify metastasis at robotic radical prostatectomy (RRP), increasingly extensive lymph node dissections are required. Sentinel lymph node (SNL) mapping is an evolving concept in RRP to provide a targeted LND to increase accuracy and reduce dissection. We investigate the ability of fluorescent labeled Tilmanocept, a CD206 LN receptor tar- geted radiopharmaceutical, to be retained in SNL for up to 36 hours for flexibility in preoperative and intraoperative imaging. METHODS: We injected the footpads of 25 New Zealand white rabbits with 100 umol Technetium-99m-labeled IRDye 800CW-Tilma- nocept. Two doses were examined at time points of 1 and 36 hours (n¼4/group) compared to control indocyanine green (ICG). Sentinel and second level lymph nodes were dissected with the assistance of fluo- rescence using the FireFly endoscope and DaVinci Si surgical system modified to reduce background white light. We confirmed fluorescence intensity ex vivo (Optix MX2). Analysis with the Friedman test was used to compare within the same groups and a Mann-Whitney U Exact test between groups. RESULTS: The ICG control group showed passage through the SNL to the second level nodes within 15 min (p>0.05). In contrast, both doses (1.7 and 8.4 nmol) had higher optical fluorescence intensity in the popliteal compared to paraaortic nodes at 1 hour (p¼0.050 and p¼0.097, respectively) and 36 hours (p¼0.039 and p¼0.050, respec- tively) from foot pad injection. Higher fluorescence intensity with a 8.4 nmol dose in the SNL at 1-hour compared to 36-hours (Mann-Whitney U; 19100 vs. 11629 cpsmW-1; p¼0.028) and no difference in the 1.7 nmol dose (p¼0.195). The SNL with 8.4 nmol had higher fluorescence than 1.7 nmol dose at both 1-hr and 36-hr time points (p<0.001 and p¼0.025, respectively). CONCLUSIONS: Tilmanocept labeled with IRDye 800CW is dose dependent and can be retained in SNL for at least 36 hours, which may allow image acquisition and subsequent surgical verification. Source of Funding: National Cancer Institute (CA023100 and CA128346) and Intuitive Surgical (Sunnyvale, CA, U.S.A). PD4-03 A RANDOMIZED TRIAL OF ULTRASOUND VERSUS COMPUTED TOMOGRAPHY FOR IMAGING PATIENTS WITH SUSPECTED NEPHROLITHIASIS Marshall Stoller*, San Francisco, CA; Chandra Aubin, Saint Louis, MO; John Bailitz, Chicago, IL; Rimon Bengiamin, Fresno, CA; Carlos Camargo, Boston, MA; Thomas Chi, San Francisco, CA; Jill Corbo, Bronx, NY; Anthony Dean, Philadelphia, PA; Richard Griffey, Saint Louis, MO; Gregory Jay, Providence, RI; Tarina Kang, Los Angeles, CA; Dana Robertson-Kriesel, Ruth Goldstein, San Francisco, CA; Michael Mallin, Salt Lake City, UT; James Miner, Minnetrista, MN; John Ma, Portland, OR; William Manson, Atlanta, GA; Diane Miglioretti, Davis, CA; Sarah Miller, Houston, TX; Michelle Moghadassi, San Francisco, CA; Vicki Noble, Boston, MA; Gregory Press, Houston, TX; Victoria Valencia, San Francisco, CA; Jessica Wang, Bronx, NY; Vol. 191, No. 4S, Supplement, Friday, May 16, 2014 THE JOURNAL OF UROLOGY â e51