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Ambrosini P, AzizianAmiri S, Zeestraten E, van Ginhoven T, Marroquim R, van Walsum T. 3D magnetic seed localization for augmented reality in surgery. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03066-6. [PMID: 38492147 DOI: 10.1007/s11548-024-03066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/18/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE For tumor resection, surgeons need to localize the tumor. For this purpose, a magnetic seed can be inserted into the tumor by a radiologist and, during surgery, a magnetic detection probe informs the distance to the seed for localization. In this case, the surgeon still needs to mentally reconstruct the position of the tumor from the probe's information. The purpose of this study is to develop and assess a method for 3D localization and visualization of the seed, facilitating the localization of the tumor. METHODS We propose a method for 3D localization of the magnetic seed by extending the magnetic detection probe with a tracking-based localization. We attach a position sensor (QR-code or optical marker) to the probe in order to track its 3D pose (respectively, using a head-mounted display with a camera or optical tracker). Following an acquisition protocol, the 3D probe tip and seed position are subsequently obtained by solving a system of equations based on the distances and the 3D probe poses. RESULTS The method was evaluated with an optical tracking system. An experimental setup using QR-code tracking (resp. using an optical marker) achieves an average of 1.6 mm (resp. 0.8 mm) 3D distance between the localized seed and the ground truth. Using a breast phantom setup, the average 3D distance is 4.7 mm with a QR-code and 2.1 mm with an optical marker. CONCLUSION Tracking the magnetic detection probe allows 3D localization of a magnetic seed, which opens doors for augmented reality target visualization during surgery. Such an approach should enhance the perception of the localized region of interest during the intervention, especially for breast tumor resection where magnetic seeds can already be used in the protocol.
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Affiliation(s)
- Pierre Ambrosini
- Department of Surgical Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
- Computer and Graphics Visualization Group, Delft University of Technology, Delft, The Netherlands.
| | - Sara AzizianAmiri
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | | | - Tessa van Ginhoven
- Department of Surgical Oncology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ricardo Marroquim
- Computer and Graphics Visualization Group, Delft University of Technology, Delft, The Netherlands
| | - Theo van Walsum
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Butz I, Fernandez M, Uneri A, Theodore N, Anderson WS, Siewerdsen JH. Performance assessment of surgical tracking systems based on statistical process control and longitudinal QA. Comput Assist Surg (Abingdon) 2023; 28:2275522. [PMID: 37942523 DOI: 10.1080/24699322.2023.2275522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
A system for performance assessment and quality assurance (QA) of surgical trackers is reported based on principles of geometric accuracy and statistical process control (SPC) for routine longitudinal testing. A simple QA test phantom was designed, where the number and distribution of registration fiducials was determined drawing from analytical models for target registration error (TRE). A tracker testbed was configured with open-source software for measurement of a TRE-based accuracy metric ε and Jitter (J ). Six trackers were tested: 2 electromagnetic (EM - Aurora); and 4 infrared (IR - 1 Spectra, 1 Vega, and 2 Vicra) - all NDI (Waterloo, ON). Phase I SPC analysis of Shewhart mean (x ¯ ) and standard deviation (s ) determined system control limits. Phase II involved weekly QA of each system for up to 32 weeks and identified Pass, Note, Alert, and Failure action rules. The process permitted QA in <1 min. Phase I control limits were established for all trackers: EM trackers exhibited higher upper control limits than IR trackers in ε (EM: x ¯ ε ∼ 2.8-3.3 mm, IR: x ¯ ε ∼ 1.6-2.0 mm) and Jitter (EM: x ¯ jitter ∼ 0.30-0.33 mm, IR: x ¯ jitter ∼ 0.08-0.10 mm), and older trackers showed evidence of degradation - e.g. higher Jitter for the older Vicra (p-value < .05). Phase II longitudinal tests yielded 676 outcomes in which a total of 4 Failures were noted - 3 resolved by intervention (metal interference for EM trackers) - and 1 owing to restrictive control limits for a new system (Vega). Weekly tests also yielded 40 Notes and 16 Alerts - each spontaneously resolved in subsequent monitoring.
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Affiliation(s)
- I Butz
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - M Fernandez
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - N Theodore
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - W S Anderson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Eppenga R, Heerink W, Smit J, Kuhlmann K, Ruers T, Nijkamp J. Real-Time Wireless Tumor Tracking in Navigated Liver Resections: An Ex Vivo Feasibility Study. Ann Surg Oncol 2022; 29:3951-3960. [PMID: 35195825 PMCID: PMC9072277 DOI: 10.1245/s10434-022-11364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/08/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Surgical navigation systems generally require intraoperative steps, such as intraoperative imaging and registration, to link the system to the patient anatomy. Because this hampers surgical workflow, we developed a plug-and-play wireless navigation system that does not require any intraoperative steps. In this ex vivo study on human hepatectomy specimens, the feasibility was assessed of using this navigation system to accurately resect a planned volume with small margins to the lesion. METHODS For ten hepatectomy specimens, a planning CT was acquired in which a virtual spherical lesion with 5 mm margin was delineated, inside the healthy parenchyma. Using two implanted trackers, the real-time position of this planned resection volume was visualized on a screen, relative to the used tracked pointer. Experienced liver surgeons were asked to accurately resect the nonpalpable planned volume, fully relying on the navigation screen. Resected and planned volumes were compared using CT. RESULTS The surgeons resected the planned volume while cutting along its border with a mean accuracy of - 0.1 ± 2.4 mm and resected 98 ± 12% of the planned volume. Nine out of ten resections were radical and one case showed a cut of 0.8 mm into the lesion. The sessions took approximately 10 min each, and no considerable technical issues were encountered. CONCLUSIONS This ex vivo liver study showed that it is feasible to accurately resect virtual hepatic lesions with small planned margins using our novel navigation system, which is promising for clinical applications where nonpalpable hepatic metastases have to be resected with small resection margins.
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Affiliation(s)
- Roeland Eppenga
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Wout Heerink
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jasper Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Nanobiophysics Group, Faculty TNW, University of Twente, Enschede, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Ivashchenko OV, Kuhlmann KFD, van Veen R, Pouw B, Kok NFM, Hoetjes NJ, Smit JN, Klompenhouwer EG, Nijkamp J, Ruers TJM. CBCT-based navigation system for open liver surgery: Accurate guidance toward mobile and deformable targets with a semi-rigid organ approximation and electromagnetic tracking of the liver. Med Phys 2021; 48:2145-2159. [PMID: 33666243 PMCID: PMC8251891 DOI: 10.1002/mp.14825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose The surgical navigation system that provides guidance throughout the surgery can facilitate safer and more radical liver resections, but such a system should also be able to handle organ motion. This work investigates the accuracy of intraoperative surgical guidance during open liver resection, with a semi‐rigid organ approximation and electromagnetic tracking of the target area. Methods The suggested navigation technique incorporates a preoperative 3D liver model based on diagnostic 4D MRI scan, intraoperative contrast‐enhanced CBCT imaging and electromagnetic (EM) tracking of the liver surface, as well as surgical instruments, by means of six degrees‐of‐freedom micro‐EM sensors. Results The system was evaluated during surgeries with 35 patients and resulted in an accurate and intuitive real‐time visualization of liver anatomy and tumor's location, confirmed by intraoperative checks on visible anatomical landmarks. Based on accuracy measurements verified by intraoperative CBCT, the system’s average accuracy was 4.0 ± 3.0 mm, while the total surgical delay due to navigation stayed below 20 min. Conclusions The electromagnetic navigation system for open liver surgery developed in this work allows for accurate localization of liver lesions and critical anatomical structures surrounding the resection area, even when the liver was manipulated. However, further clinically integrating the method requires shortening the guidance‐related surgical delay, which can be achieved by shifting to faster intraoperative imaging like ultrasound. Our approach is adaptable to navigation on other mobile and deformable organs, and therefore may benefit various clinical applications.
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Affiliation(s)
- Oleksandra V Ivashchenko
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Koert F D Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ruben van Veen
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Bas Pouw
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Niels F M Kok
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Nikie J Hoetjes
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jasper N Smit
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Elisabeth G Klompenhouwer
- Department of Radiology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Theodoor J M Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Faculty of Science and Technology (TNW), University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
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Eppenga R, Kuhlmann K, Ruers T, Nijkamp J. Accuracy assessment of target tracking using two 5-degrees-of-freedom wireless transponders. Int J Comput Assist Radiol Surg 2019; 15:369-377. [PMID: 31724113 PMCID: PMC6989619 DOI: 10.1007/s11548-019-02088-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/04/2019] [Indexed: 12/22/2022]
Abstract
Purpose Surgical navigation systems are generally only applied for targets in rigid areas. For non-rigid areas, real-time tumor tracking can be included to compensate for anatomical changes. The only clinically cleared system using a wireless electromagnetic tracking technique is the Calypso® System (Varian Medical Systems Inc., USA), designed for radiotherapy. It is limited to tracking maximally three wireless 5-degrees-of-freedom (DOF) transponders, all used for tumor tracking. For surgical navigation, a surgical tool has to be tracked as well. In this study, we evaluated whether accurate 6DOF tumor tracking is possible using only two 5DOF transponders, leaving one transponder to track a tool. Methods Two methods were defined to derive 6DOF information out of two 5DOF transponders. The first method uses the vector information of both transponders (TTV), and the second method combines the vector information of one transponder with the distance vector between the transponders (OTV). The accuracy of tracking a rotating object was assessed for each method mimicking clinically relevant and worst-case configurations. Accuracy was compared to using all three transponders to derive 6DOF (Default method). An optical tracking system was used as a reference for accuracy. Results The TTV method performed best and was as accurate as the Default method for almost all transponder configurations (median errors < 0.5°, 95% confidence interval < 3°). Only when the angle between the transponders was less than 2°, the TTV method was inaccurate and the OTV method may be preferred. The accuracy of both methods was independent of the angle of rotation, and only the OTV method was sensitive to the plane of rotation. Conclusion These results indicate that accurate 6DOF tumor tracking is possible using only two 5DOF transponders. This encourages further development of a wireless EM surgical navigation approach using a readily available clinical system.
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Affiliation(s)
- Roeland Eppenga
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Koert Kuhlmann
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Theo Ruers
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
- Nanobiophysics Group, Faculty TNW, University of Twente, Enschede, The Netherlands.
| | - Jasper Nijkamp
- Department of Surgical Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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