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Background and Purpose: Percutaneous renal access in the context ofpercutaneous nephrolithotomy (PCNL) is a difficult technique, requiring rapidand precise access to a particular calix. We present a computerized systemdesigned to improve percutaneous renal access by projecting the ultrasoundpuncture tract onto fluoroscopic images. Materials and Methods: The systemconsists of a computer and a localizer allowing spatial localization of theposition of the various instruments. Without any human intervention, theultrasound nephrostomy tract is superimposed in real time onto fluoroscopicimages acquired in various views. Results: We tested our approach by laboratoryexperiments on a phantom. Also, after approval by our institution's EthicsCommittee, we validated this technique in the operating room during PCNL in onepatient. Conclusion: Our system is reliable, and the absence ofimage-processing procedures makes it robust. We have initiated a prospectivestudy to validate this technique both for PCNL specialists and as a learningtool.

Aid to Percutaneous Renal Access by Virtual Projection of the Ultrasound Puncture Tract onto Fluoroscopic Images