A Novel Technique to Determine the Puncture Direction and Position for Percutaneous Dilatational Tracheostomy Using an Electromagnetic Tracking System

Percutaneous Dilatational Tracheostomy (PDT) is commonly performed on patients in intensive care units. As the most critical step, inaccurate needle insertion can lead to adverse complications, and its position and direction are determined by neck palpation. Real-time ultrasound was proposed for determining puncture direction, but has not been widely adopted in clinical practice and lacks puncture position measurement. To quantitatively identify the puncture direction and position, we propose a new technique utilising an electromagnetic tracking system. This could facilitate future robotic PDT to reduce errors and adverse outcomes. This technique involves rotating an electromagnetic sensor inside the trachea to collect pose data, enabling calculations of the puncture direction and position. Simulated measuring procedures (480) were performed on a mannequin by sixteen participants to evaluate the accuracy of puncture direction and position. Results demonstrated the mean midline deviation of 10.58±3.95° and mean error of 1.68 ± 1.26mm from the ideal puncture position. The mean procedure time was 64.61 ± 11.12 s. We quantified 10 to 20 required to observe the gradual reduction in procedure time while achieving consistent measurement accuracy. This technique is 22.8% more accurate in direction measurement than real-time ultrasound and can determine the puncture position, demonstrating the potential as an accurate tool for PDT.