51
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Lee TF, Chao PJ, Fang FM, Su TJ, Leung SW, Hsu HC. Helical tomotherapy for single and multiple liver tumours. Radiat Oncol 2010; 5:58. [PMID: 20576108 PMCID: PMC2900282 DOI: 10.1186/1748-717x-5-58] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 06/24/2010] [Indexed: 12/25/2022] Open
Abstract
Purpose Dosimetric evaluations of single and multiple liver tumours performed using intensity-modulated helical tomotherapy (HT) were quantitatively investigated. Step-and-shoot intensity-modulated radiotherapy (SaS-IMRT) was used as a benchmark. Methods Sixteen patients separated into two groups with primary hepatocellular carcinomas or metastatic liver tumours previously treated using SaS-IMRT were examined and re-planned by HT. The dosimetric indices used included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), max/mean dose, quality index (QI), normal tissue complication probability (NTCP), V30 Gy, and V50% for the specified organs at risk (OARs). The monitor units per fraction (MU/fr) and delivery time were also analysed. Results For the single tumour group, both planning systems satisfied the required PTV prescription, but no statistical significance was shown by the indexes checking. A shorter delivery time and lower MU/fr value were achieved by the SaS-IMRT. For the group of multiple tumours, the average improvement in CI and HI was 14% and 4% for HT versus SaS-IMRT, respectively. Lower V50%, V30 Gy and QI values were found, indicating a significant dosimetric gain in HT. The NTCP value of the normal liver was 20.27 ± 13.29% for SaS-IMRT and 2.38 ± 2.25% for HT, indicating fewer tissue complications following HT. The latter also required a shorter delivery time. Conclusions Our study suggests dosimetric benefits of HT over SaS-IMRT plans in the case of multiple liver tumours, especially with regards sparing of OARs. No significant dosimetric difference was revealed in the case of single liver tumour, but SaS-IMRT showed better efficiency in terms of MU/fr and delivery time.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Lab, (EE), National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan.
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52
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Holbrook AB, Santos JM, Kaye E, Rieke V, Pauly KB. Real-time MR thermometry for monitoring HIFU ablations of the liver. Magn Reson Med 2010; 63:365-73. [PMID: 19950255 DOI: 10.1002/mrm.22206] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A high-resolution and high-speed pulse sequence is presented for monitoring high-intensity focused ultrasound ablations in the liver in the presence of motion. The sequence utilizes polynomial-order phase saturation bands to perform outer volume suppression, followed by spatial-spectral excitation and three readout segmented echo-planar imaging interleaves. Images are processed with referenceless thermometry to create temperature-rise images every frame. The sequence and reconstruction were implemented in RTHawk and used to image stationary and moving sonications in a polyacrylamide gel phantom (62.4 acoustic W, 50 sec, 550 kHz). Temperature-rise images were compared between moving and stationary experiments. Heating spots and corresponding temperature-rise plots matched very well. The stationary sonication had a temperature standard deviation of 0.15 degrees C compared to values of 0.28 degrees C and 0.43 degrees C measured for two manually moved sonications at different velocities. Moving the phantom (while not heating) with respect to the transducer did not cause false temperature rises, despite susceptibility changes. The system was tested on nonheated livers of five normal volunteers. The mean temperature rise was -0.05 degrees C, with a standard deviation of 1.48 degrees C. This standard deviation is acceptable for monitoring high-intensity focused ultrasound ablations, suggesting real-time imaging of moving high-intensity focused ultrasound sonications can be clinically possible.
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Affiliation(s)
- Andrew B Holbrook
- Department of Bioengineering, Stanford University, Stanford, California, USA.
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53
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Maier-Hein L, Müller SA, Pianka F, Wörz S, Müller-Stich BP, Seitel A, Rohr K, Meinzer HP, Schmied BM, Wolf I. Respiratory motion compensation for CT-guided interventions in the liver. ACTA ACUST UNITED AC 2010; 13:125-38. [DOI: 10.3109/10929080802091099] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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54
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Furuta T, Maeda E, Akai H, Hanaoka S, Yoshioka N, Akahane M, Watadani T, Ohtomo K. Hepatic Segments and Vasculature: Projecting CT Anatomy onto Angiograms. Radiographics 2009; 29:e37. [DOI: 10.1148/rg.e37] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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55
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Markert M, Koschany A, Lueth T. Tracking of the liver for navigation in open surgery. Int J Comput Assist Radiol Surg 2009; 5:229-35. [DOI: 10.1007/s11548-009-0395-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 07/10/2009] [Indexed: 11/28/2022]
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56
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Coughlin G, Samavedi S, Palmer KJ, Patel VR. Role of image-guidance systems during NOTES. J Endourol 2009; 23:803-12. [PMID: 19438294 DOI: 10.1089/end.2008.0121] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) is a developing field with the potential to revolutionize our approach to abdominal surgery. Performing operations via a flexible endoscope introduced through a natural orifice presents several challenges to physicians. Orientation and interpretation of the endoscopic video image can be difficult. The surgeon must also learn to operate with the camera and instruments "in line." Advances in technology are currently addressing the challenges of NOTES. Image-guided navigation could potentially provide invaluable assistance during NOTES. Real-time information on spatial positioning and orientation as well as assistance with the identification of anatomy and localization of pathology are some of the possibilities. Image-guided surgery has become commonplace in disciplines such as neurosurgery where the anatomy is relatively rigid. To become widespread in intra-abdominal procedures and NOTES, advances that will allow systems to adapt to moving and deforming anatomy are needed. This article reviews the basics of image-guided surgery, the various image-guided systems, and their potential application to NOTES.
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Affiliation(s)
- Geoff Coughlin
- Global Robotics Institute, Florida Hospital Celebration Health, Orlando, 34747, USA.
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57
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Nicolau S, Pennec X, Soler L, Buy X, Gangi A, Ayache N, Marescaux J. An augmented reality system for liver thermal ablation: Design and evaluation on clinical cases. Med Image Anal 2009; 13:494-506. [DOI: 10.1016/j.media.2009.02.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 02/06/2009] [Accepted: 02/09/2009] [Indexed: 10/21/2022]
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58
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Piliere G, Van Horn MH, Dixon R, Stavas J, Aylward S, Bullitt E. Vessel target location estimation during the TIPS procedure. Med Image Anal 2009; 13:519-29. [PMID: 19332378 DOI: 10.1016/j.media.2009.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 02/20/2009] [Accepted: 02/24/2009] [Indexed: 01/01/2023]
Abstract
Creation of a transjugular intrahepatic portosystemic shunt (TIPS) requires passage of a needle toward a moving target that is only seen transiently by X-ray prior to needle passage. Intraoperative, 3D target localization would facilitate target access and improve the safety of the procedure. The clinical assumption is that patients undergoing the TIPS procedure possess rigid, cirrhotic livers that undergo only intraoperative translation without significant deformation or rotation. Based upon this assumption, we hypothesize that the position of any unseen, 3D target point within the liver can be determined intraoperatively by precalculation of the relative positions of the target point to a different 3D point that can be tracked intraoperatively. This paper examines this hypothesis using intraoperatively acquired, biplane, X-ray images of seven patients. In six, we tracked the effects of cardiac and respiratory motion, and in three the effects of needle pressure. Methods involved reconstruction of 3D vessel bifurcation and other trackable intrahepatic points from biplane angiograms, measurement of liver deformation by examining changing distances between these 3D points over time, and comparison of expected to actual displacements of these points with respect to a fixed reference point in the liver. We conclude that, for the rigid livers associated with patients undergoing TIPS, that there is less intraoperative deformation than previously reported by other groups addressing healthy liver deformation, and that the location of an unseen target can be predicted within 3mm accuracy.
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Affiliation(s)
- Guillaume Piliere
- CASILab, Division of Neurosurgery, University of North Carolina-CH, Chapel Hill, NC 27599, USA
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59
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Maier-Hein L, Tekbas A, Franz AM, Tetzlaff R, Müller SA, Pianka F, Wolf I, Kauczor HU, Schmied BM, Meinzer HP. On combining internal and external fiducials for liver motion compensation. ACTA ACUST UNITED AC 2009; 13:369-76. [PMID: 19085236 DOI: 10.3109/10929080802610674] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This paper presents an in-vivo accuracy study on combining skin markers (external fiducials) and fiducial needles (internal fiducials) for motion compensation during liver interventions. We compared the target registration error (TRE) for different numbers of skin markers n(s) and fiducial needles n(f), as well as for different transformation types, in two swine using the tip of an additional tracked needle as the target. During continuous breathing, n(f) had the greatest effect on the accuracy, yielding mean root mean square (RMS) errors of 4.8 +/- 1.1 mm (n(f) = 0), 2.0 +/- 0.9 mm (n(f) = 1) and 1.7 +/- 0.8 mm (n(f) = 2) when averaged over multiple tool arrangements (n = 18, 36, 18) with n(s) = 4. These values correspond to error reductions of 11%, 64% and 70%, respectively, compared to the case when no motion compensation is performed, i.e., when the target position is assumed to be constant. At expiration, the mean RMS error ranged from 1.1 mm (n(f) = 0) to 0.8 mm (n(f) = 2), which is of the order of magnitude of the target displacement. Our study further indicates that the fiducial registration error (FRE) of a rigid transformation reflecting tissue motion generally correlates strongly with the TRE. Our findings could be used in practice to (1) decide on a suitable combination of fiducials for a given intervention, considering the trade-off between high accuracy and low invasiveness, and (2) provide an intra-interventional measure of confidence for the accuracy of the system based on the FRE.
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Affiliation(s)
- Lena Maier-Hein
- Division of Medical and Biological Informatics, German Cancer Research Center, Heidelberg, Germany.
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60
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Martens V, Schlichting S, Besirevic A, Kleemann M. LapAssistent — a laparoscopic liver surgery assistance system. IFMBE PROCEEDINGS 2009. [DOI: 10.1007/978-3-540-89208-3_31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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61
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Maier-Hein L, Tekbas A, Seitel A, Pianka F, Müller SA, Satzl S, Schawo S, Radeleff B, Tetzlaff R, Franz AM, Müller-Stich BP, Wolf I, Kauczor HU, Schmied BM, Meinzer HP. In vivoaccuracy assessment of a needle-based navigation system for CT-guided radiofrequency ablation of the liver. Med Phys 2008; 35:5385-96. [DOI: 10.1118/1.3002315] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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62
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Analysis of respiration-related movement of upper abdominal arteries: preliminary measurement for the development of a respiratory motion compensation technique of roadmap navigation. Radiol Phys Technol 2008; 1:178-82. [DOI: 10.1007/s12194-008-0025-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/01/2008] [Accepted: 05/07/2008] [Indexed: 11/30/2022]
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63
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Meyer BC, Peter O, Nagel M, Hoheisel M, Frericks BB, Wolf KJ, Wacker FK. Electromagnetic field-based navigation for percutaneous punctures on C-arm CT: experimental evaluation and clinical application. Eur Radiol 2008; 18:2855-64. [DOI: 10.1007/s00330-008-1063-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 04/26/2008] [Indexed: 11/29/2022]
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64
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Hansen C, Köhn A, Schlichting S, Weiler F, Zidowitz S, Kleemann M, Peitgen HO. Intraoperative modification of resection plans for liver surgery. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-008-0161-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
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65
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Respiratory liver motion simulator for validating image-guided systems ex-vivo. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-007-0140-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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66
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67
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Moche M, Trampel R, Kahn T, Busse H. Navigation concepts for MR image-guided interventions. J Magn Reson Imaging 2008; 27:276-91. [DOI: 10.1002/jmri.21262] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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68
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Müller SA, Maier-Hein L, Mehrabi A, Pianka F, Rietdorf U, Wolf I, Grenacher L, Richter G, Gutt CN, Schmidt J, Meinzer HP, Schmied BM. Creation and establishment of a respiratory liver motion simulator for liver interventions. Med Phys 2007; 34:4605-8. [DOI: 10.1118/1.2805475] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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69
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Noterdaeme O, Gleeson F, Phillips RR, Brady M. Quantification of missing and overlapping data in multiple breath hold abdominal imaging. Eur J Radiol 2007; 64:273-8. [PMID: 17418517 DOI: 10.1016/j.ejrad.2007.02.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 02/15/2007] [Accepted: 02/23/2007] [Indexed: 11/24/2022]
Abstract
Magnetic resonance imaging (MRI) of the abdomen is often performed in multiple breath holds which are designed to contiguously cover the region of interest. This technique may result in a failure to image all the appropriate area, and the extent of this failure is difficult to appreciate on a set of 2D slices. With reference to three patient cases, we present a method to quantify the extent of this problem and suggest a solution. First, we manually delineate the region of interest on a single breath hold fast spoiled gradient echo (FSPGR) sequence. Subsequently, we align images acquired in separate breath holds to this reference volume. A coloured 3D presentation makes the extent of unimaged and repeatedly imaged areas clearly visible to the clinician. The alignment also helps radiologists to accurately determine the location of individual slices. The described method can easily be automated and is ideally implemented at the scanner console, ensuring the availability of contiguously sampled datasets to radiologists with minimum user interaction from the radiographer. Such datasets enable the deployment of robust 3D analysis algorithms.
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Affiliation(s)
- Olivier Noterdaeme
- Wolfson Medical Vision Laboratory, Department of Engineering Science, University of Oxford, Oxford OX1 3PJ, UK.
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70
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Locklin JK, Yanof J, Luk A, Varro Z, Patriciu A, Wood BJ. Respiratory biofeedback during CT-guided procedures. J Vasc Interv Radiol 2007; 18:749-55. [PMID: 17538137 PMCID: PMC2562717 DOI: 10.1016/j.jvir.2007.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Respiratory motion can be a complicating factor during image-guided interventions. The ability to reproduce breath-holds may facilitate safer needle-based procedures. The purpose of this study was to evaluate if respiratory biofeedback decreased variability among breath-holds and if the signals from the respiratory bellows belt can be used to measure target motion. MATERIALS AND METHODS In phase 1 of the study, a respiratory bellows belt was applied to patients before image-guided interventional procedures. Belt stretch from respiratory motion was converted into voltage readings and displayed on a monitor as biofeedback. Patients were asked to perform inspiratory, expiratory, and midcycle breath-holds with and without the biofeedback. The variability in voltage readings between breath-holds with and without biofeedback was compared. In phase 2, the respiratory bellows belt was used during computed tomography (CT)-guided procedures with the patients blinded to the biofeedback. Voltage readings and CT series numbers were recorded as patients were asked to hold their breath during scans. The variability of CT z-axis targets was compared with the variability of voltage readings. RESULTS A significant decrease in variability was found during expiratory breath-holds (P = .0083) with trends toward significance with midcycle and inspiratory breath-holds. A positive correlation (Kendall tau = 0.5; P = .024) was shown between CT z-axis and belt stretch variability in subjects who received smaller doses of moderate sedation compared with those who received larger doses or general anesthesia. CONCLUSIONS Biofeedback may help the patient to have a more consistent breath-hold. The belt could decrease the error and unpredictability from craniocaudal motion of targets during image-guided interventions.
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Affiliation(s)
- Julia K Locklin
- Diagnostic Radiology Department, National Institutes of Health, Clinical Center, Bethesda , Maryland 20892, USA.
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71
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Cash DM, Miga MI, Glasgow SC, Dawant BM, Clements LW, Cao Z, Galloway RL, Chapman WC. Concepts and preliminary data toward the realization of image-guided liver surgery. J Gastrointest Surg 2007; 11:844-59. [PMID: 17458587 PMCID: PMC3839065 DOI: 10.1007/s11605-007-0090-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Image-guided surgery provides navigational assistance to the surgeon by displaying the surgical probe position on a set of preoperative tomograms in real time. In this study, the feasibility of implementing image-guided surgery concepts into liver surgery was examined during eight hepatic resection procedures. Preoperative tomographic image data were acquired and processed. Accompanying intraoperative data on liver shape and position were obtained through optically tracked probes and laser range scanning technology. The preoperative and intraoperative representations of the liver surface were aligned using the iterative closest point surface matching algorithm. Surface registrations resulted in mean residual errors from 2 to 6 mm, with errors of target surface regions being below a stated goal of 1 cm. Issues affecting registration accuracy include liver motion due to respiration, the quality of the intraoperative surface data, and intraoperative organ deformation. Respiratory motion was quantified during the procedures as cyclical, primarily along the cranial-caudal direction. The resulting registrations were more robust and accurate when using laser range scanning to rapidly acquire thousands of points on the liver surface and when capturing unique geometric regions on the liver surface, such as the inferior edge. Finally, finite element models recovered much of the observed intraoperative deformation, further decreasing errors in the registration. Image-guided liver surgery has shown the potential to provide surgeons with important navigation aids that could increase the accuracy of targeting lesions and the number of patients eligible for surgical resection.
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Affiliation(s)
- David M Cash
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
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72
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Micu R, Jakobs TF, Urschler M, Navab N. A new registration/visualization paradigm for CT-fluoroscopy guided RF liver ablation. ACTA ACUST UNITED AC 2007; 9:882-90. [PMID: 17354974 DOI: 10.1007/11866565_108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
2D-3D slice-to-volume registration for abdominal organs like liver is difficult due to the breathing motion and tissue deformation. The purpose of our approach is to ease CT-fluoroscopy (CT-fluoro) based needle insertion for the Radiofrequency Liver Ablation procedure using high resolution contrasted preoperative data. In this case, low signal-to-noise ratio, absence of contrast and additional presence of needle in CT-fluoro makes it difficult to guarantee the solution of any deformable slice-to-volume registration algorithm. In this paper, we first propose a method for creating a set of ground truth (GT) simulation data based on a non-linear deformation of the CT-fluoro volume obtained from real patients. Second, we split the CT-fluoro image and apply intensity based rigid and affine registration to each section. We then propose a novel solution, which consists of intuitive visualization sequences of optimal sub-volumes of preinterventional data based on the registration results. Experiments on synthetic and real patient data and direct feedback of two interventionalists validate our alternative approach.
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Affiliation(s)
- Ruxandra Micu
- Chair for Computer Aided Medical Procedures, TU Munich, Germany.
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73
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Zhang H, Banovac F, Lin R, Glossop N, Wood BJ, Lindisch D, Levy E, Cleary K. Electromagnetic tracking for abdominal interventions in computer aided surgery. COMPUTER AIDED SURGERY : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR COMPUTER AIDED SURGERY 2006; 11:127-36. [PMID: 16829506 PMCID: PMC4136656 DOI: 10.3109/10929080600751399] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Electromagnetic tracking has great potential for assisting physicians in precision placement of instruments during minimally invasive interventions in the abdomen, since electromagnetic tracking is not limited by the line-of-sight restrictions of optical tracking. A new generation of electromagnetic tracking has recently become available, with sensors small enough to be included in the tips of instruments. To fully exploit the potential of this technology, our research group has been developing a computer aided, image-guided system that uses electromagnetic tracking for visualization of the internal anatomy during abdominal interventions. As registration is a critical component in developing an accurate image-guided system, we present three registration techniques: 1) enhanced paired-point registration (time-stamp match registration and dynamic registration); 2) orientation-based registration; and 3) needle shape-based registration. Respiration compensation is another important issue, particularly in the abdomen, where respiratory motion can make precise targeting difficult. To address this problem, we propose reference tracking and affine transformation methods. Finally, we present our prototype navigation system, which integrates the registration, segmentation, path-planning and navigation functions to provide real-time image guidance in the clinical environment. The methods presented here have been tested with a respiratory phantom specially designed by our group and in swine animal studies under approved protocols. Based on these tests, we conclude that our system can provide quick and accurate localization of tracked instruments in abdominal interventions, and that it offers a user-friendly display for the physician.
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Affiliation(s)
- Hui Zhang
- Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University, Washington, DC, USA
| | - Filip Banovac
- Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University, Washington, DC, USA
| | - Ralph Lin
- Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University, Washington, DC, USA
| | | | | | - David Lindisch
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Elliot Levy
- Department of Radiology, Georgetown University Hospital, Washington, DC, USA
| | - Kevin Cleary
- Imaging Science and Information Systems (ISIS) Center, Department of Radiology, Georgetown University, Washington, DC, USA
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74
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Wacker FK, Vogt S, Khamene A, Jesberger JA, Nour SG, Elgort DR, Sauer F, Duerk JL, Lewin JS. An Augmented Reality System for MR Image–guided Needle Biopsy: Initial Results in a Swine Model. Radiology 2006; 238:497-504. [PMID: 16436814 DOI: 10.1148/radiol.2382041441] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate an augmented reality (AR) system in combination with a 1.5-T closed-bore magnetic resonance (MR) imager as a navigation tool for needle biopsies. MATERIALS AND METHODS The experimental protocol had institutional animal care and use committee approval. Seventy biopsies were performed in phantoms by using 20 tube targets, each with a diameter of 6 mm, and 50 virtual targets. The position of the needle tip in AR and MR space was compared in multiple imaging planes, and virtual and real needle tip localization errors were calculated. Ten AR-guided biopsies were performed in three pigs, and the duration of each procedure was determined. After successful puncture, the distance to the target was measured on MR images. The confidence limits for the achieved in-plane hit rate and for lateral deviation were calculated. A repeated measures analysis of variance was used to determine whether the placement error in a particular dimension (x, y, or z) differed from the others. RESULTS For the 50 virtual targets, a mean error of 1.1 mm +/- 0.5 (standard deviation) was calculated. A repeated measures analysis of variance indicated no statistically significant difference (P > .99) in the errors in any particular orientation. For the real targets, all punctures were inside the 6-mm-diameter tube in the transverse plane. The needle depth was within the target plane in 11 biopsy procedures; the mean distance to the center of the target was 2.55 mm (95% confidence interval: 1.77 mm, 3.34 mm). For nine biopsy procedures, the needle tip was outside the target plane, with a mean distance to the edge of the target plane of 1.5 mm (range, 0.07-3.46 mm). In the animal experiments, the puncture was successful in all 10 cases, with a mean target-needle distance of 9.6 mm +/- 4.85. The average procedure time was 18 minutes per puncture. CONCLUSION Biopsy procedures performed with a combination of a closed-bore MR system and an AR system are feasible and accurate.
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Affiliation(s)
- Frank K Wacker
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA
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75
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Real Time Simulation of Organ Motions Induced by Breathing: First Evaluation on Patient Data. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/11790273_2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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76
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Olbrich B, Traub J, Wiesner S, Wichert A, Feussner H, Navab N. Respiratory motion analysis: Towards gated augmentation of the liver. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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77
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Zhang H, Banovac F, Cleary K. Increasing registration precision for liver movement with respiration using electromagnetic tracking. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wacker FK, Vogt S, Khamene A, Sauer F, Wendt M, Duerk JL, Lewin JS, Wolf KJ. MR image-guided needle biopsies with a combination of augmented reality and MRI: A pilot study in phantoms and animals. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.ics.2005.03.300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kettenbach J, Kronreif G, Figl M, Fürst M, Birkfellner W, Hanel R, Ptacek W, Bergmann H. Robot-Assisted Biopsy Using Computed Tomography-Guidance. Invest Radiol 2005; 40:219-28. [PMID: 15770140 DOI: 10.1097/01.rli.0000155285.05672.cf] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We sought to develop a robotic system for computed tomography (CT)-guided biopsy to validate the feasibility, accuracy, and efficacy of the system using phantom tests. MATERIALS AND METHODS Ten peas (mean diameter 9.9+/-0.4 mm) embedded within a gel phantom were selected for biopsy. Once the best access was defined on CT images, the position of the phantom was recorded by an optical tracking system. Positional data about the phantom and the corresponding CT image was transferred to the robot planning system (Linux-based industrial PC equipped with video capture card). Once the appropriate position, angulation, and pitch were calculated, the robotic arm moved automatically with 7 degrees-of-freedom to the planned insertion path, aiming the needle-trajectory at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured and short cut pieces of a guidewire were pushed into the target to evaluate the deviation of the actual needle track from the target. RESULTS In all targets, biopsy specimens (mean length 5.6+/-1.4 mm) were harvested with only 1 needle pass required. The mean deviation of the needle tip from the center of the target in the x and z axes was 1.2+/-0.9 mm and 0.6+/-0.4 mm, respectively. CONCLUSIONS Robotic-assisted biopsies in vitro, using CT guidance, were feasible and provided high accuracy.
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Affiliation(s)
- Joachim Kettenbach
- Department of Radiology, Medical University Vienna, General Hospital, Vienna, Vienna, Austria.
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Nicolau SA, Pennec X, Soler L, Ayache N. A Complete Augmented Reality Guidance System for Liver Punctures: First Clinical Evaluation. LECTURE NOTES IN COMPUTER SCIENCE 2005; 8:539-47. [PMID: 16685888 DOI: 10.1007/11566465_67] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We provided in an augmented reality guidance system for liver punctures, which has been validated on a static abdominal phantom. In this paper, we report the first in vivo experiments. We developed a strictly passive protocol to directly evaluate our system on patients. We show that the system algorithms work efficiently and we highlight the clinical constraints that we had to overcome (small operative field, weight and sterility of the tracked marker attached to the needle...). Finally, we investigate to what extent breathing motion can be neglected for free breathing patient. Results show that the guiding accuracy, close to 1 cm, is sufficient for large targets only (above 3 cm of diameter) when the breathing motion is neglected. In the near future, we aim at validating our system on smaller targets using a respiratory gating technique.
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Affiliation(s)
- S A Nicolau
- INRIA Sophia, Epidaure, 2004 Rte des Lucioles, F-06902 Sophia-Antipolis, Cedex.
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Kettenbach J, Kronreif G, Figl M, Fürst M, Birkfellner W, Hanel R, Bergmann H. Robot-assisted biopsy using ultrasound guidance: initial results from in vitro tests. Eur Radiol 2004; 15:765-71. [PMID: 15449006 DOI: 10.1007/s00330-004-2487-x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2004] [Revised: 06/28/2004] [Accepted: 08/06/2004] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to develop a robotic system for ultrasound (US)-guided biopsy and to validate the feasibility, accuracy and efficacy using phantom tests. Twenty peas (mean diameter 9.3+/-0.1 mm) embedded within a gel-phantom were selected for biopsy. Once the best access was defined, the position of the US transducer was recorded by an optical tracking system. Positional data of the transducer and the corresponding US image were transferred to the roboter planning system (LINUX-based industrial PC equipped with video capture card). Once the appropriate position, angulation and pitch were calculated, the robotic arm moved automatically with seven degrees-of-freedom to the planned insertion path, aiming the needle-positioning unit at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured, and the deviation of the actual needle tract from the center of the target was evaluated sonographically. In all targets, the biopsy specimen (mean length 5+/-1.2 mm) was harvested with only one needle pass required The mean deviation of the needle tip from the center of the target was 1.1+/-0.8 mm. Robotic assisted biopsies in-vitro using US-guidance were feasible and provided high accuracy.
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Affiliation(s)
- Joachim Kettenbach
- Division of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital, Währinger Guertel 18-20, 1090 Vienna, Austria.
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Wong K, VanMeter J, Fricke S, Maurer C, Cleary K. MRI for modeling of liver and skin respiratory motion. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.ics.2004.03.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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83
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Liver Motion Due to Needle Pressure, Cardiac, and Respiratory Motion During the TIPS Procedure. ACTA ACUST UNITED AC 2004. [DOI: 10.1007/978-3-540-30136-3_9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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