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Grote A, Neumann F, Menzler K, Carl B, Nimsky C, Bopp MHA. Augmented Reality in Extratemporal Lobe Epilepsy Surgery. J Clin Med 2024; 13:5692. [PMID: 39407752 PMCID: PMC11477171 DOI: 10.3390/jcm13195692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Revised: 09/20/2024] [Accepted: 09/21/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Epilepsy surgery for extratemporal lobe epilepsy (ETLE) is challenging, particularly when MRI findings are non-lesional and seizure patterns are complex. Invasive diagnostic techniques are crucial for accurately identifying the epileptogenic zone and its relationship with surrounding functional tissue. Microscope-based augmented reality (AR) support, combined with navigation, may enhance intraoperative orientation, particularly in cases involving subtle or indistinct lesions, thereby improving patient outcomes and safety (e.g., seizure freedom and preservation of neuronal integrity). Therefore, this study was conducted to prove the clinical advantages of microscope-based AR support in ETLE surgery. Methods: We retrospectively analyzed data from ten patients with pharmacoresistant ETLE who underwent invasive diagnostics with depth and/or subdural grid electrodes, followed by resective surgery. AR support was provided via the head-up displays of the operative microscope, with navigation based on automatic intraoperative computed tomography (iCT)-based registration. The surgical plan included the suspected epileptogenic lesion, electrode positions, and relevant surrounding functional structures, all of which were visualized intraoperatively. Results: Six patients reported complete seizure freedom following surgery (ILAE 1), one patient was seizure-free at the 2-year follow-up, and one patient experienced only auras (ILAE 2). Two patients developed transient neurological deficits that resolved shortly after surgery. Conclusions: Microscope-based AR support enhanced intraoperative orientation in all cases, contributing to improved patient outcomes and safety. It was highly valued by experienced surgeons and as a training tool for less experienced practitioners.
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Affiliation(s)
- Alexander Grote
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.N.); (B.C.); (C.N.)
| | - Franziska Neumann
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.N.); (B.C.); (C.N.)
| | - Katja Menzler
- Department of Neurology, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany;
| | - Barbara Carl
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.N.); (B.C.); (C.N.)
- Department of Neurosurgery, Helios Dr. Horst Schmidt Kliniken, Ludwig-Erhard-Straße 100, 65199 Wiesbaden, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.N.); (B.C.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
| | - Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, Baldingerstrasse, 35043 Marburg, Germany; (F.N.); (B.C.); (C.N.)
- Center for Mind, Brain and Behavior (CMBB), 35043 Marburg, Germany
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2
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Influence of surgical position and registration methods on clinical accuracy of navigation systems in brain tumor surgery. Sci Rep 2023; 13:2644. [PMID: 36788314 PMCID: PMC9929322 DOI: 10.1038/s41598-023-29710-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
The aim of this study was to evaluate the influence of skin distortion due to surgical positioning on the clinical accuracy of the navigation system. The distance errors were measured in four fiducial markers (anterior, posterior, right, and left of the head) after the registration of the navigation system. The distance errors were compared between the surface-merge registration (SMR) method using preoperative imaging and the automatic intraoperative registration (AIR) method using intraoperative imaging. The comparison of the distance errors were performed in various surgical positions. The AIR method had the significant accuracy in the lateral markers than the SMR method (lateral position, 3.8 mm vs. 8.95 mm; p < 0.0001; prone position, 4.5 mm vs. 13.9 mm; p = 0.0001; 5.2 mm vs. 11.5 mm; p = 0.0070). The smallest distance errors were obtained close to the surgical field in the AIR method (3.25-3.85 mm) and in the forehead in the SMR method (3.3-8.1 mm). The AIR method was accurate and recommended for all the surgical positions if intraoperative imaging was available. The SMR method was only recommended for the supine position, because skin distortion was frequently observed in the lateral region.
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3
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Design and implementation of a surgical planning system for robotic assisted mandible reconstruction with fibula free flap. Int J Comput Assist Radiol Surg 2022; 17:2291-2303. [PMID: 36166164 DOI: 10.1007/s11548-022-02748-3] [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: 01/12/2022] [Accepted: 09/05/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE Free fibula flap is the gold standard for the treatment of mandibular defects. However, the existing preoperative planning protocol is cumbersome to execute, costly to learn, and poorly collaborative with the robot-assisted cutting of the fibular osteotomy plane. METHODS A surgical planning system for robotic assisted mandibular reconstruction with fibula free flap is proposed in this study. A fibular osteotomy planning algorithm is presented so that the virtual surgical planning of the fibular osteotomy segments can be obtained automatically with selected mandibular anatomical landmarks. The planned osteotomy planes are then converted into the motion path of the robotic arm, and the automatic fibula osteotomy is completed under optical navigation. RESULTS Surgical planning was performed on 35 patients to verify the feasibility of our system's virtual surgical planning module, with an average time of 13 min. Phantom experiments were performed to evaluate the reliability and stability of this system. The average distance and angular deviations of the osteotomy planes are 1.04 ± 0.68 mm and 1.56 ±1.10°, respectively. CONCLUSIONS Our system can achieve not only precise and convenient preoperative planning, but also safe and reliable osteotomy trajectory. The clinical applications of our system for mandibular reconstruction surgery are expected soon.
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Bopp MHA, Saß B, Pojskić M, Corr F, Grimm D, Kemmling A, Nimsky C. Use of Neuronavigation and Augmented Reality in Transsphenoidal Pituitary Adenoma Surgery. J Clin Med 2022; 11:jcm11195590. [PMID: 36233457 PMCID: PMC9571217 DOI: 10.3390/jcm11195590] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to report on the clinical experience with microscope-based augmented reality (AR) in transsphenoidal surgery compared to the classical microscope-based approach. AR support was established using the head-up displays of the operating microscope, with navigation based on fiducial-/surface- or automatic intraoperative computed tomography (iCT)-based registration. In a consecutive single surgeon series of 165 transsphenoidal procedures, 81 patients underwent surgery without AR support and 84 patients underwent surgery with AR support. AR was integrated straightforwardly within the workflow. ICT-based registration increased AR accuracy significantly (target registration error, TRE, 0.76 ± 0.33 mm) compared to the landmark-based approach (TRE 1.85 ± 1.02 mm). The application of low-dose iCT protocols led to a significant reduction in applied effective dosage being comparable to a single chest radiograph. No major vascular or neurological complications occurred. No difference in surgical time was seen, time to set-up patient registration prolonged intraoperative preparation time on average by twelve minutes (32.33 ± 13.35 vs. 44.13 ± 13.67 min), but seems justifiable by the fact that AR greatly and reliably facilitated surgical orientation and increased surgeon comfort and patient safety, not only in patients who had previous transsphenoidal surgery but also in cases with anatomical variants. Automatic intraoperative imaging-based registration is recommended.
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Affiliation(s)
- Miriam H. A. Bopp
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany
- Correspondence:
| | - Benjamin Saß
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
| | - Mirza Pojskić
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
| | - Felix Corr
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - Dustin Grimm
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- EDU Institute of Higher Education, Villa Bighi, Chaplain’s House, KKR 1320 Kalkara, Malta
| | - André Kemmling
- Department of Neuroradiology, University of Marburg, 35043 Marburg, Germany
| | - Christopher Nimsky
- Department of Neurosurgery, University of Marburg, 35043 Marburg, Germany
- Marburg Center for Mind, Brain and Behavior (CMBB), 35032 Marburg, Germany
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5
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de Geer AF, van Alphen MJA, Zuur CL, Loeve AJ, van Veen RLP, Karakullukcu MB. A hybrid registration method using the mandibular bone surface for electromagnetic navigation in mandibular surgery. Int J Comput Assist Radiol Surg 2022; 17:1343-1353. [PMID: 35441961 DOI: 10.1007/s11548-022-02610-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To utilize navigated mandibular (reconstructive) surgery, accurate registration of the preoperative CT scan with the actual patient in the operating room (OR) is required. In this phantom study, the feasibility of a noninvasive hybrid registration method is assessed. This method consists of a point registration with anatomic landmarks for initialization and a surface registration using the bare mandibular bone surface for optimization. METHODS Three mandible phantoms with reference notches on two osteotomy planes were 3D printed. An electromagnetic tracking system in combination with 3D Slicer software was used for navigation. Different configurations, i.e., different surface point areas and number and configuration of surface points, were tested with a dentate phantom (A) in a metal-free environment. To simulate the intraoperative environment and different anatomies, the registration procedure was also performed with an OR bed using the dentate phantom and two (partially) edentulous phantoms with atypical anatomy (B and C). The accuracy of the registration was calculated using the notches on the osteotomy planes and was expressed as the target registration error (TRE). TRE values of less than 2.0 mm were considered as clinically acceptable. RESULTS In all experiments, the mean TRE was less than 2.0 mm. No differences were found using different surface point areas or number or configurations of surface points. Registration accuracy in the simulated intraoperative setting was-mean (SD)-0.96 (0.22), 0.93 (0.26), and 1.50 (0.28) mm for phantom A, phantom B, and phantom C. CONCLUSION Hybrid registration is a noninvasive method that requires only a small area of the bare mandibular bone surface to obtain high accuracy in phantom setting. Future studies should test this method in clinical setting during actual surgery.
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Affiliation(s)
- A F de Geer
- Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Educational Program Technical Medicine, Leiden University Medical Center, Delft University of Technology, Erasmus University Medical Center, Leiden, Delft, Rotterdam, The Netherlands
| | - M J A van Alphen
- Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.
| | - C L Zuur
- Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands.,Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - A J Loeve
- Department of BioMechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands
| | - R L P van Veen
- Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M B Karakullukcu
- Verwelius 3D Lab, Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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6
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Fan X, Mirza SK, Li C, Evans LT, Ji S, Paulsen KD. Accuracy of Stereovision-Updated Versus Preoperative CT-Based Image Guidance in Multilevel Lumbar Pedicle Screw Placement: A Cadaveric Swine Study. JB JS Open Access 2022; 7:JBJSOA-D-21-00129. [PMID: 35350121 PMCID: PMC8937011 DOI: 10.2106/jbjs.oa.21.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Change in vertebral position between preoperative imaging and the surgical procedure reduces the accuracy of image-guided spinal surgery, requiring repeated imaging and surgical field registration, a process that takes time and exposes patients to additional radiation. We developed a handheld, camera-based, deformable registration system (intraoperative stereovision, iSV) to register the surgical field automatically and compensate for spinal motion during surgery without further radiation exposure. Methods We measured motion-induced errors in image-guided lumbar pedicle screw placement in 6 whole-pig cadavers using state-of-the-art commercial spine navigation (StealthStation; Medtronic) and iSV registration that compensates for intraoperative vertebral motion. We induced spinal motion by using preoperative computed tomography (pCT) of the lumbar spine performed in the supine position with accentuated lordosis and performing surgery with the animal in the prone position. StealthStation registration of pCT occurred using metallic fiducial markers implanted in each vertebra, and iSV data were acquired to perform a deformable registration between pCT and the surgical field. Sixty-eight pedicle screws were placed in 6 whole-pig cadavers using iSV and StealthStation registrations in random order of vertebral level, relying only on image guidance without invoking the surgeon's judgment. The position of each pedicle screw was assessed with post-procedure CT and confirmed via anatomical dissection. Registration errors were assessed on the basis of implanted fiducials. Results The frequency and severity of pedicle screw perforation were lower for iSV registration compared with StealthStation (97% versus 68% with Grade 0 medial perforation for iSV and StealthStation, respectively). Severe perforation occurred only with StealthStation (18% versus 0% for iSV). The overall time required for iSV registration (computational efficiency) was ∼10 to 15 minutes and was comparable with StealthStation registration (∼10 min). The mean target registration error was smaller for iSV relative to StealthStation (2.81 ± 0.91 versus 8.37 ± 1.76 mm). Conclusions Pedicle screw placement was more accurate with iSV registration compared with state-of-the-art commercial navigation based on preoperative CT when alignment of the spine changed during surgery. Clinical Relevance The iSV system compensated for intervertebral motion, which obviated the need for repeated vertebral registration while providing efficient, accurate, radiation-free navigation during open spinal surgery.
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Affiliation(s)
- Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Sohail K. Mirza
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,PEERClinic for Back Pain and Spine Surgery, Fairfax, Virginia
| | - Chen Li
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Linton T. Evans
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Keith D. Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire,Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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7
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García-Sevilla M, Moreta-Martinez R, García-Mato D, Arenas de Frutos G, Ochandiano S, Navarro-Cuéllar C, Sanjuán de Moreta G, Pascau J. Surgical Navigation, Augmented Reality, and 3D Printing for Hard Palate Adenoid Cystic Carcinoma En-Bloc Resection: Case Report and Literature Review. Front Oncol 2022; 11:741191. [PMID: 35059309 PMCID: PMC8763795 DOI: 10.3389/fonc.2021.741191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/26/2021] [Indexed: 12/18/2022] Open
Abstract
Adenoid Cystic Carcinoma is a rare and aggressive tumor representing less than 1% of head and neck cancers. This malignancy often arises from the minor salivary glands, being the palate its most common location. Surgical en-bloc resection with clear margins is the primary treatment. However, this location presents a limited line of sight and a high risk of injuries, making the surgical procedure challenging. In this context, technologies such as intraoperative navigation can become an effective tool, reducing morbidity and improving the safety and accuracy of the procedure. Although their use is extended in fields such as neurosurgery, their application in maxillofacial surgery has not been widely evidenced. One reason is the need to rigidly fixate a navigation reference to the patient, which often entails an invasive setup. In this work, we studied three alternative and less invasive setups using optical tracking, 3D printing and augmented reality. We evaluated their precision in a patient-specific phantom, obtaining errors below 1 mm. The optimum setup was finally applied in a clinical case, where the navigation software was used to guide the tumor resection. Points were collected along the surgical margins after resection and compared with the real ones identified in the postoperative CT. Distances of less than 2 mm were obtained in 90% of the samples. Moreover, the navigation provided confidence to the surgeons, who could then undertake a less invasive and more conservative approach. The postoperative CT scans showed adequate resection margins and confirmed that the patient is free of disease after two years of follow-up.
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Affiliation(s)
- Mónica García-Sevilla
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Rafael Moreta-Martinez
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - David García-Mato
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Gema Arenas de Frutos
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Santiago Ochandiano
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Carlos Navarro-Cuéllar
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Cirugía Oral y Maxilofacial, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Guillermo Sanjuán de Moreta
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Servicio de Otorrinolaringología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Pascau
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Dge T, L S, J G, B AN, M G, Pw K. Marker-free registration for intraoperative navigation using the transverse palatal rugae. Int J Med Robot 2021; 18:e2362. [PMID: 34972255 DOI: 10.1002/rcs.2362] [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: 12/05/2021] [Revised: 12/24/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Registration is most important in navigation-assisted-surgery including the matching between the coordinates of the actual patient space and the medical image. Marker-based techniques mostly include marker application with subsequent radiography. In the edentulous patient, maker-free methods are generally less accurate and reproducible. This new method of a marker-free registration uses the transverse palatal rugae as registration structures. METHODS (1)Segmentation of bone and hard palatal mucosa from initial 3D imaging (DICOM), (2)Maxillary intraoral-scan (IOS) with transfer to the 3D imaging using an Iterative-Closest-Point-Algorithm (ICP), (3)Marking digital registration points with holes within IOS-stl, (4)Transformation of the spatially aligned IOS-stl to LabelMap and storage in DICOM (IOS-DICOM), (5)Alignment of DICOM and IOS-DICOM, (6)Controlled positioning of digital reg.points and clinical correlation. RESULTS Fiducial localization error (0.48mm) and target registration error (0.65mm) is comparable to those of tooth-supported registration methods. CONCLUSION This methodology is a promising approach to marker-free navigation-assisted-surgery in the edentulous patient. This approach of marker-free registration for navigation-assisted-surgery could improve the treatment in edentulous patients avoiding additional imaging and invasive marker insertion. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thiem Dge
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Seifert L
- Department of Oral and Maxillofacial surgery, Facial Plastic Surgery, Goethe University Medical Centre Frankfurt, 60590, Frankfurt, Germany
| | - Graef J
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Al-Nawas B
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Gielisch M
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Kämmerer Pw
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Cunningham BW, Brooks DM, McAfee PC. Accuracy of Robotic-Assisted Spinal Surgery-Comparison to TJR Robotics, da Vinci Robotics, and Optoelectronic Laboratory Robotics. Int J Spine Surg 2021; 15:S38-S55. [PMID: 34607917 PMCID: PMC8532535 DOI: 10.14444/8139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optoelectronic camera source and data interpolation serve as the foundation for navigational integrity in the robotic-assisted surgical platform. The objective of the current systematic review serves to provide a basis for the numerical disparity that exists when comparing the intrinsic accuracy of optoelectronic cameras: accuracy observed in the laboratory setting versus accuracy in the clinical operative environment. It is postulated that there exists a greater number of connections in the optoelectronic kinematic chain when analyzing the clinical operative environment to the laboratory setting. This increase in data interpolation, coupled with intraoperative workflow challenges, reduces the degree of accuracy based on surgical application and to that observed in controlled musculoskeletal kinematic laboratory investigations. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic optoelectronic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 147 references make up the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy of optoelectronic tracking equaled or was less than 0.1 mm of translation and 0.1° of rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm of translation and 0.1°-1.0° of rotation per array. There is a huge falloff in clinical applications: accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm of translation and 1.5° to 5.0° of rotation when comparing planned to final implant position. Total Joint Robotics and da Vinci urologic robotics computed accuracy, as predicted, lies between these two extremes-1.02 mm for da Vinci and 2 mm for MAKO. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration, and intraoperative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position. The key determining factors limiting navigation resolution accuracy are highlighted by this Cochrane research analysis.
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Affiliation(s)
- Bryan W. Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
| | - Daina M. Brooks
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Paul C. McAfee
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
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10
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Rong Y, Rosu-Bubulac M, Benedict SH, Cui Y, Ruo R, Connell T, Kashani R, Latifi K, Chen Q, Geng H, Sohn J, Xiao Y. Rigid and Deformable Image Registration for Radiation Therapy: A Self-Study Evaluation Guide for NRG Oncology Clinical Trial Participation. Pract Radiat Oncol 2021; 11:282-298. [PMID: 33662576 PMCID: PMC8406084 DOI: 10.1016/j.prro.2021.02.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The registration of multiple imaging studies to radiation therapy computed tomography simulation, including magnetic resonance imaging, positron emission tomography-computed tomography, etc. is a widely used strategy in radiation oncology treatment planning, and these registrations have valuable roles in image guidance, dose composition/accumulation, and treatment delivery adaptation. The NRG Oncology Medical Physics subcommittee formed a working group to investigate feasible workflows for a self-study credentialing process of image registration commissioning. METHODS AND MATERIALS The American Association of Physicists in Medicine (AAPM) Task Group 132 (TG132) report on the use of image registration and fusion algorithms in radiation therapy provides basic guidelines for quality assurance and quality control of the image registration algorithms and the overall clinical process. The report recommends a series of tests and the corresponding metrics that should be evaluated and reported during commissioning and routine quality assurance, as well as a set of recommendations for vendors. The NRG Oncology medical physics subcommittee working group found incompatibility of some digital phantoms with commercial systems. Thus, there is still a need to provide further recommendations in terms of compatible digital phantoms, clinical feasible workflow, and achievable thresholds, especially for future clinical trials involving deformable image registration algorithms. Nine institutions participated and evaluated 4 commonly used commercial imaging registration software and various versions in the field of radiation oncology. RESULTS AND CONCLUSIONS The NRG Oncology Working Group on image registration commissioning herein provides recommendations on the use of digital phantom/data sets and analytical software access for institutions and clinics to perform their own self-study evaluation of commercial imaging systems that might be employed for coregistration in radiation therapy treatment planning and image guidance procedures. Evaluation metrics and their corresponding values were given as guidelines to establish practical tolerances. Vendor compliance for image registration commissioning was evaluated, and recommendations were given for future development.
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Affiliation(s)
- Yi Rong
- Department of Radiation Oncology, University of California Davis Cancer Center, Sacramento, California; Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Mihaela Rosu-Bubulac
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California Davis Cancer Center, Sacramento, California
| | - Yunfeng Cui
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Russell Ruo
- Department of Medical Physics, McGill University Health Center, Montreal, QC, Canada
| | - Tanner Connell
- Department of Medical Physics, McGill University Health Center, Montreal, QC, Canada
| | - Rojano Kashani
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kujtim Latifi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Quan Chen
- Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky
| | - Huaizhi Geng
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Sohn
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
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Nilius M, Nilius MH. How precise are oral splints for frameless stereotaxy in guided ear, nose, throat, and maxillofacial surgery: a cadaver study. Eur Radiol Exp 2021; 5:27. [PMID: 34195878 PMCID: PMC8245614 DOI: 10.1186/s41747-021-00223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 05/18/2021] [Indexed: 11/12/2022] Open
Abstract
Background Computer-assisted surgery optimises accuracy and serves to improve precise surgical procedures. We validated oral splints with fiducial markers by testing them against rigid bone markers. Methods We screwed twenty bone anchors as fiducial markers into different regions of a dried skull and measured the distances. After computed tomography (CT) scanning, the accuracy was evaluated by determining the markers’ position using frameless stereotaxy on a dry cadaver and indicated on the CT scan. We compared the accuracy of chairside fabricated oral splints to standard registration with bone markers immediately after fabrication and after a ten-time use. Accuracy was calculated as deviation (mean ± standard deviation). For statistical analysis, t test, Kruskal-Wallis, Tukey's, and various linear regression models, such as the Pearson's product–moment correlation coefficient, were used. Results Oral splints showed an accuracy of 0.90 mm ± 0.27 for viscerocranium, 1.10 mm ± 0.39 for skull base, and 1.45 mm ± 0.59 for neurocranium. We found an accuracy of less than 2 mm for both splints for a distance of up to 152 mm. The accuracy persisted even after ten times removing and reattaching the splints. Conclusions Oral splints offer a non-invasive indicator to improve the accuracy of image-guided surgery. The precision is dependent on the distance to the target. Up to 150-mm distance, a precision of fewer than 2 mm is possible. Dental splints provide sufficient accuracy than bone markers and may opt for higher precision combined with other non-invasive registration methods.
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Affiliation(s)
- Manfred Nilius
- NILIUSKLINIK Dortmund, Londoner Bogen 6, D-44269, Dortmund, Germany. .,Technische Universität Dresden, Dresden, Germany.
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12
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Herregodts S, Verhaeghe M, De Coninck B, Forward M, Verstraete MA, Victor J, De Baets P. An improved method for assessing the technical accuracy of optical tracking systems for orthopaedic surgical navigation. Int J Med Robot 2021; 17:e2285. [PMID: 34030213 DOI: 10.1002/rcs.2285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Optical tracking systems (OTSs) are essential components of many modern computer assisted orthopaedic surgery (CAOS) systems but patient movement is often neglected in the evaluation of the accuracy. The aim of this study was to develop a representative test to assess the accuracy of OTSs including patient movement and demonstrate the effect of pointer design and OTS choice. METHOD A mobile phantom with dynamic reference base (DRB) attached was designed and constructed. The point registration trueness and precision were evaluated for measurements with both a static and moving phantom. RESULTS The trueness of the total target registration error (TTRE) was 1.4 to 2.7 times worse with a moving phantom compared to a static phantom. CONCLUSION The accuracy of OTSs for CAOS applications should be evaluated by measurements with a moving phantom as the evaluation of the TTRE with a static frame significantly underestimates the measurement error.
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Affiliation(s)
- Stijn Herregodts
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.,Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Mathijs Verhaeghe
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium.,Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Bert De Coninck
- Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
| | - Malcolm Forward
- Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Matthias A Verstraete
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Jan Victor
- Department of Physical Medicine and Orthopaedic Surgery, Ghent University, Ghent, Belgium
| | - Patrick De Baets
- Department of Electrical Energy, Metal, Mechanical Construction and Systems, Ghent University, Ghent, Belgium
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13
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Wang YF, Dona O, Xu Y, Adamovics J, Wuu CS. Fiducial detection and registration for 3D IMRT QA with organ-specific dose information. J Appl Clin Med Phys 2021; 22:24-35. [PMID: 33792180 PMCID: PMC8130247 DOI: 10.1002/acm2.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Two-dimensional (2D) IMRT QA has been widely performed in Radiation Oncology clinic. However, concerns regarding its sensitivity in detecting delivery errors and its clinical meaning have been raised in publications. In this study, a robust methodology of three-dimensional (3D) IMRT QA using fiducial registration and structure-mapping was proposed to acquire organ-specific dose information. METHODS Computed tomography (CT) markers were placed on the PRESAGE dosimeter as fiducials before CT simulation. Subsequently, the images were transferred to the treatment planning system to create a verification plan for the examined treatment plan. Patient's CT images were registered to the CT images of the dosimeter for structure mapping according to the positions of the fiducials. After irradiation, the 3D dose distribution was read-out by an optical-CT (OCT) scanner with fiducials shown on the OCT dose images. An automatic localization algorithm was developed in MATLAB to register the markers in the OCT images to those in the CT images of the dosimeter. SlicerRT was used to show and analyze the results. Fiducial registration error was acquired by measuring the discrepancies in 20 fiducial registrations, and thus the fiducial localization error and target registration error (TRE) was estimated. RESULTS Dosimetry comparison between the calculated and measured dose distribution in various forms were presented, including 2D isodose lines comparison, 3D isodose surfaces with patient's anatomical structures, 2D and 3D gamma index, dose volume histogram and 3D view of gamma failing points. From the analysis of 20 fiducial registrations, fiducial registration error was measured to be 0.62 mm and fiducial localization error was calculated to be 0.44 mm. Target registration uncertainty of the proposed methodology was estimated to be within 0.3 mm in the area of dose measurement. CONCLUSIONS This study proposed a robust methodology of 3D measurement-based IMRT QA for organ-specific dose comparison and demonstrated its clinical feasibility.
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Affiliation(s)
- Yi-Fang Wang
- New York-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), New York, NY, USA
| | - Olga Dona
- New York-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), New York, NY, USA
| | - Yuanguang Xu
- New York-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), New York, NY, USA
| | | | - Cheng-Shie Wuu
- New York-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), New York, NY, USA
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14
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Jung K, Kim H, Kholinne E, Park D, Choi H, Lee S, Shin MJ, Kim DM, Hong J, Koh KH, Jeon IH. Navigation-assisted anchor insertion in shoulder arthroscopy: a validity study. BMC Musculoskelet Disord 2020; 21:812. [PMID: 33278892 PMCID: PMC7719245 DOI: 10.1186/s12891-020-03808-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to compare conventional and navigation-assisted arthroscopic rotator cuff repair in terms of anchor screw insertion. METHODS The surgical performance of five operators while using the conventional and proposed navigation-assisted systems in a phantom surgical model and cadaveric shoulders were compared. The participating operators were divided into two groups, the expert group (n = 3) and the novice group (n = 2). In the phantom model, the experimental tasks included anchor insertion in the rotator cuff footprint and sutures retrieval. A motion analysis camera system was used to track the surgeons' hand movements. The surgical performance metric included the total path length, number of movements, and surgical duration. In cadaveric experiments, the repeatability and reproducibility of the anchor insertion angle were compared among the three experts, and the feasibility of the navigation-assisted anchor insertion was validated. RESULTS No significant differences in the total path length, number of movements, and time taken were found between the conventional and proposed systems in the phantom model. In cadaveric experiments, however, the clustering of the anchor insertion angle indicated that the proposed system enabled both novice and expert operators to reproducibly insert the anchor with an angle close to the predetermined target angle, resulting in an angle error of < 2° (P = 0.0002). CONCLUSION The proposed navigation-assisted system improved the surgical performance from a novice level to an expert level. All the experts achieved high repeatability and reproducibility for anchor insertion. The navigation-assisted system may help surgeons, including those who are inexperienced, easily familiarize themselves to of suture anchors insertion in the right direction by providing better guidance for anchor orientation. LEVEL OF EVIDENCE A retrospective study (level 2).
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Affiliation(s)
- Kyunghwa Jung
- Department of Robotics Engineering, DGIST, Daegu, Republic of Korea
| | - Hyojune Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Erica Kholinne
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.,Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia
| | - Dongjun Park
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyunseok Choi
- Department of Robotics Engineering, DGIST, Daegu, Republic of Korea
| | - Seongpung Lee
- Department of Robotics Engineering, DGIST, Daegu, Republic of Korea
| | - Myung-Jin Shin
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Min Kim
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jaesung Hong
- Department of Robotics Engineering, DGIST, Daegu, Republic of Korea
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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15
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Wang J, Liu H, Ke J, Hu L, Zhang S, Yang B, Sun S, Guo N, Ma F. Image-guided cochlear access by non-invasive registration: a cadaveric feasibility study. Sci Rep 2020; 10:18318. [PMID: 33110188 PMCID: PMC7591497 DOI: 10.1038/s41598-020-75530-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 11/09/2022] Open
Abstract
Image-guided cochlear implant surgery is expected to reduce volume of mastoidectomy, accelerate recovery, and improve safety. The purpose of this study was to investigate the safety and effectiveness of image-guided cochlear implant surgery by a non-invasive registration method, in a cadaveric study. We developed a visual positioning frame that can utilize the maxillary dentition as a registration tool and completed the tunnels experiment on 5 cadaver specimens (8 cases in total). The accuracy of the entry point and the target point were 0.471 ± 0.276 mm and 0.671 ± 0.268 mm, respectively. The shortest distance from the margin of the tunnel to the facial nerve and the ossicular chain were 0.790 ± 0.709 mm and 1.960 ± 0.630 mm, respectively. All facial nerves, tympanic membranes, and ossicular chains were completely preserved. Using this approach, high accuracy was achieved in this preliminary study, suggesting that the non-invasive registration method can meet the accuracy requirements for cochlear implant surgery. Based on the above accuracy, we speculate that our method can also be applied to neurosurgery, orbitofacial surgery, lateral skull base surgery, and anterior skull base surgery with satisfactory accuracy.
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Affiliation(s)
- Jiang Wang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Hongsheng Liu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Jia Ke
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Lei Hu
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shaoxing Zhang
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Biao Yang
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Shilong Sun
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Na Guo
- The Robotics Institute, School of Mechanical Engineering and Automation, Beihang University, Beijing, China
| | - Furong Ma
- Department of Otorhinolaryngology - Head and Neck Surgery, Peking University Third Hospital, Peking University, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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16
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Schlüter M, Glandorf L, Gromniak M, Saathoff T, Schlaefer A. Concept for Markerless 6D Tracking Employing Volumetric Optical Coherence Tomography. SENSORS 2020; 20:s20092678. [PMID: 32397153 PMCID: PMC7248981 DOI: 10.3390/s20092678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022]
Abstract
Optical tracking systems are widely used, for example, to navigate medical interventions. Typically, they require the presence of known geometrical structures, the placement of artificial markers, or a prominent texture on the target’s surface. In this work, we propose a 6D tracking approach employing volumetric optical coherence tomography (OCT) images. OCT has a micrometer-scale resolution and employs near-infrared light to penetrate few millimeters into, for example, tissue. Thereby, it provides sub-surface information which we use to track arbitrary targets, even with poorly structured surfaces, without requiring markers. Our proposed system can shift the OCT’s field-of-view in space and uses an adaptive correlation filter to estimate the motion at multiple locations on the target. This allows one to estimate the target’s position and orientation. We show that our approach is able to track translational motion with root-mean-squared errors below 0.25 mm and in-plane rotations with errors below 0.3°. For out-of-plane rotations, our prototypical system can achieve errors around 0.6°.
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17
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Video-based augmented reality combining CT-scan and instrument position data to microscope view in middle ear surgery. Sci Rep 2020; 10:6767. [PMID: 32317726 PMCID: PMC7174368 DOI: 10.1038/s41598-020-63839-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 03/26/2020] [Indexed: 11/27/2022] Open
Abstract
The aim of the study was to develop and assess the performance of a video-based augmented reality system, combining preoperative computed tomography (CT) and real-time microscopic video, as the first crucial step to keyhole middle ear procedures through a tympanic membrane puncture. Six different artificial human temporal bones were included in this prospective study. Six stainless steel fiducial markers were glued on the periphery of the eardrum, and a high-resolution CT-scan of the temporal bone was obtained. Virtual endoscopy of the middle ear based on this CT-scan was conducted on Osirix software. Virtual endoscopy image was registered to the microscope-based video of the intact tympanic membrane based on fiducial markers and a homography transformation was applied during microscope movements. These movements were tracked using Speeded-Up Robust Features (SURF) method. Simultaneously, a micro-surgical instrument was identified and tracked using a Kalman filter. The 3D position of the instrument was extracted by solving a three-point perspective framework. For evaluation, the instrument was introduced through the tympanic membrane and ink droplets were injected on three middle ear structures. An average initial registration accuracy of 0.21 ± 0.10 mm (n = 3) was achieved with a slow propagation error during tracking (0.04 ± 0.07 mm). The estimated surgical instrument tip position error was 0.33 ± 0.22 mm. The target structures’ localization accuracy was 0.52 ± 0.15 mm. The submillimetric accuracy of our system without tracker is compatible with ear surgery.
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18
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Optimization Model for the Distribution of Fiducial Markers in Liver Intervention. J Med Syst 2020; 44:83. [PMID: 32152742 DOI: 10.1007/s10916-020-01548-z] [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: 11/26/2019] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
The distribution of fiducial markers is one of the main factors affected the accuracy of optical navigation system. However, many studies have been focused on improving the fiducial registration accuracy or the target registration accuracy, but few solutions involve optimization model for the distribution of fiducial markers. In this paper, we propose an optimization model for the distribution of fiducial markers to improve the optical navigation accuracy. The strategy of optimization model is reducing the distribution from three dimensional to two dimensional to obtain the 2D optimal distribution by using optimization algorithm in terms of the marker number and the expectation equation of target registration error (TRE), and then extend the 2D optimal distribution in two dimensional to three dimensional to calculate the optimal distribution according to the distance parameter and the expectation equation of TRE. The results of the experiments show that the averaged TRE for the human phantom is approximately 1.00 mm by applying the proposed optimization model, and the averaged TRE for the abdominal phantom is 0.59 mm. The experimental results of liver simulator model and ex-vivo porcine liver model show that the proposed optimization model can be effectively applied in liver intervention.
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19
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CLARK T, BURCA G, BOARDMAN R, BLUMENSATH T. Correlative X‐ray and neutron tomography of root systems using cadmium fiducial markers. J Microsc 2020; 277:170-178. [DOI: 10.1111/jmi.12831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. CLARK
- Faculty of Engineering and Physical SciencesUniversity of Southampton UK
- STFC, Rutherford Appleton LaboratoryISIS Facility Harwell UK
| | - G. BURCA
- STFC, Rutherford Appleton LaboratoryISIS Facility Harwell UK
| | - R. BOARDMAN
- μ‐VIS X‐ray Imaging CentreUniversity of Southampton UK
| | - T. BLUMENSATH
- ISVR Signal Processing and Control GroupUniversity of Southampton UK
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20
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Liu SZ, Cao Q, Osgood GM, Siewerdsen JH, Stayman JW, Zbijewski W. Quantitative Assessment of Weight-Bearing Fracture Biomechanics Using Extremity Cone-Beam CT. PROCEEDINGS OF SPIE--THE INTERNATIONAL SOCIETY FOR OPTICAL ENGINEERING 2020; 11317:113170I. [PMID: 33612913 PMCID: PMC7891844 DOI: 10.1117/12.2549768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
PURPOSE We investigate an application of multisource extremity Cone-Beam CT (CBCT) with capability of weight-bearing tomographic imaging to obtain quantitative measurements of load-induced deformation of metal internal fixation hardware (e.g. tibial plate). Such measurements are desirable to improve the detection of delayed fusion or non-union of fractures, potentially facilitating earlier return to weight-bearing activities. METHODS To measure the deformation, we perform a deformable 3D-2D registration of a prior model of the implant to its CBCT projections under load-bearing. This Known-Component Registration (KC-Reg) framework avoids potential errors that emerge when the deformation is estimated directly from 3D reconstructions with metal artifacts. The 3D-2D registration involves a free-form deformable (FFD) point cloud model of the implant and a 3D cubic B-spline representation of the deformation. Gradient correlation is used as the optimization metric for the registration. The proposed approach was tested in experimental studies on the extremity CBCT system. A custom jig was designed to apply controlled axial loads to a fracture model, emulating weight-bearing imaging scenarios. Performance evaluation involved a Sawbone tibia phantom with an ~4 mm fracture gap. The model was fixed with a locking plate and imaged under five loading conditions. To investigate performance in the presence of confounding background gradients, additional experiments were performed with a pre-deformed femoral plate placed in a water bath with Ca bone mineral density inserts. Errors were measured using eight reference BBs for the tibial plate, and surface point distances for the femoral plate, where a prior model of deformed implant was available for comparison. RESULTS Both in the loaded tibial plate case and for the femoral plate with confounding background gradients, the proposed KC-Reg framework estimated implant deformations with errors of <0.2 mm for the majority of the investigated deformation magnitudes (error range 0.14 - 0.25 mm). The accuracy was comparable between 3D-2D registrations performed from 12 x-ray views and registrations obtained from as few as 3 views. This was likely enabled by the unique three-source x-ray unit on the extremity CBCT scanner, which implements two off-central-plane focal spots that provided oblique views of the field-of-view to aid implant pose estimation. CONCLUSION Accurate measurements of fracture hardware deformations under physiological weight-bearing are feasible using an extremity CBCT scanner and FFD 3D-2D registration. The resulting deformed implant models can be incorporated into tomographic reconstructions to reduce metal artifacts and improve quantification of the mineral content of fracture callus in CBCT volumes.
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Affiliation(s)
- S. Z. Liu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205
| | - Q. Cao
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205
| | - G. M. Osgood
- Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, MD 21205
| | - J. H. Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205
- Russell H. Morgan Department of Radiology, Johns Hopkins Hospital, Baltimore, MD 21205
| | - J. W. Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205
| | - W. Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205
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Evans L, Olson JD, Cai Y, Fan X, Paulsen KD, Roberts DW, Ji S, Lollis SS. Stereovision Co-Registration in Image-Guided Spinal Surgery: Accuracy Assessment Using Explanted Porcine Spines. Oper Neurosurg (Hagerstown) 2019. [PMID: 29518246 DOI: 10.1093/ons/opy023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current methods of spine registration for image guidance have a variety of limitations related to accuracy, efficiency, and cost. OBJECTIVE To define the accuracy of stereovision-mediated co-registration of a spinal surgical field. METHODS A total of 10 explanted porcine spines were used. Dorsal soft tissue was removed to a variable degree. Bone screw fiducials were placed in each spine and high-resolution computed tomography (CT) scanning performed. Stereoscopic images were then obtained using a tracked, calibrated stereoscopic camera system; images were processed, reconstructed, and segmented in a semi-automated manner. A multistart registration of the reconstructed spinal surface with preoperative CT was performed. Target registration error (TRE) in the region of the laminae and facets was then determined, using bone screw fiducials not included in the original registration process. Each spine also underwent multilevel laminectomy, and TRE was then recalculated for varying amounts of bone removal. RESULTS The mean TRE of stereovision registration was 2.19 ± 0.69 mm when all soft tissue was removed and 2.49 ± 0.74 mm when limited soft tissue removal was performed. Accuracy of the registration process was not adversely affected by laminectomy. CONCLUSION Stereovision offers a promising means of registering an open, dorsal spinal surgical field. In this study, overall mean accuracy of the registration was 2.21 mm, even when bony anatomy was partially obscured by soft tissue or when partial midline laminectomy had been performed.
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Affiliation(s)
- Linton Evans
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan D Olson
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Yunliang Cai
- Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Xiaoyao Fan
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Keith D Paulsen
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - David W Roberts
- Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Songbai Ji
- Worcester Polytechnic Institute, Worcester, Massachusetts
| | - S Scott Lollis
- Division of Neurosurgery, University of Vermont Medical Center, Burlington, Vermont
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Lollis SS, Fan X, Evans L, Olson JD, Paulsen KD, Roberts DW, Mirza SK, Ji S. Use of Stereovision for Intraoperative Coregistration of a Spinal Surgical Field: A Human Feasibility Study. Oper Neurosurg (Hagerstown) 2019; 14:29-35. [PMID: 28658939 DOI: 10.1093/ons/opx132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 06/14/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The use of image guidance during spinal surgery has been limited by several anatomic factors such as intervertebral segment motion and ineffective spine immobilization. In its current form, the surgical field is coregistered with a preoperative computed tomography (CT), often obtained in a different spinal confirmation, or with intraoperative cross-sectional imaging. Stereovision offers an alternative method of registration. OBJECTIVE To demonstrate the feasibility of stereovision-mediated coregistration of a human spinal surgical field using a proof-of-principle study, and to provide preliminary assessments of the technique's accuracy. METHODS A total of 9 subjects undergoing image-guided pedicle screw placement also underwent stereovision-mediated coregistration with preoperative CT imaging. Stereoscopic images were acquired using a tracked, calibrated stereoscopic camera system mounted on an operating microscope. Images were processed, reconstructed, and segmented in a semi-automated manner. A multistart registration of the reconstructed spinal surface with preoperative CT was performed. Registration accuracy, measured as surface-to-surface distance error, was compared between stereovision registration and a standard registration. RESULTS The mean surface reconstruction error of the stereovision-acquired surface was 2.20 ± 0.89 mm. Intraoperative coregistration with stereovision was performed with a mean error of 1.48 ± 0.35 mm compared to 2.03 ± 0.28 mm using a standard point-based registration method. The average computational time for registration with stereovision was 95 ± 46 s (range 33-184 s) vs 10to 20 min for standard point-based registration. CONCLUSION Semi-automated registration of a spinal surgical field using stereovision is possible with accuracy that is at least comparable to current landmark-based techniques.
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Affiliation(s)
- S Scott Lollis
- Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Linton Evans
- Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jonathan D Olson
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - David W Roberts
- Division of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
| | - Sohail K Mirza
- Department of Orthopedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering, Dartmouth College, Hanover, New Hampshire
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Hwang YE, Kang SH, Kim HK. Errors according to the number of registered markers used in navigation-assisted surgery of the mandible. Head Face Med 2019; 15:6. [PMID: 30736796 PMCID: PMC6368779 DOI: 10.1186/s13005-019-0190-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 01/31/2019] [Indexed: 12/05/2022] Open
Abstract
Background The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible. Methods The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software. Results At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased. Conclusions This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.
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Affiliation(s)
- Young-Eun Hwang
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, South Korea
| | - Sang-Hoon Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Hang-Keun Kim
- Department of Biomedical Engineering, College of Health Science, Gachon University, Incheon, South Korea. .,Department of Health Sciences and Technology, GAIHST, Gachon University, Incheon, South Korea.
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Perspective pinhole model with planar source for augmented reality surgical navigation based on C-arm imaging. Int J Comput Assist Radiol Surg 2018; 13:1671-1682. [PMID: 30014167 DOI: 10.1007/s11548-018-1823-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE For augmented reality surgical navigation based on C-arm imaging, accuracy of the overlaid augmented reality onto the X-ray image is imperative. However, overlay displacement is generated when a conventional pinhole model describing a geometric relationship of a normal camera is adopted for C-arm calibration. Thus, a modified model for C-arm calibration is proposed to reduce this displacement, which is essential for accurate surgical navigation. METHOD Based on the analysis of displacement pattern generated for three-dimensional objects, we assumed that displacement originated by moving the X-ray source position according to the depth. In the proposed method, X-ray source movement was modeled as variable intrinsic parameters and represented in the pinhole model by replacing the point source with a planar source. RESULTS The improvement which represents a reduced displacement was verified by comparing overlay accuracy for augmented reality surgical navigation between the conventional and proposed methods. The proposed method achieved more accurate overlay on the X-ray image in spatial position as well as depth of the object volume. CONCLUSION We validated that intrinsic parameters that describe the source position were dependent on depth for a three-dimensional object and showed that displacement can be reduced and become independent of depth by using the proposed planar source model.
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Franaszek M, Cheok GS. Orientation Uncertainty Characteristics of Some Pose Measuring Systems. MATHEMATICAL PROBLEMS IN ENGINEERING 2017; 2017:2696108. [PMID: 29578548 PMCID: PMC5865224 DOI: 10.1155/2017/2696108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We investigate the performance of pose measuring systems which determine an object's pose from measurement of a few fiducial markers attached to the object. Such systems use point-based, rigid body registration to get the orientation matrix. Uncertainty in the fiducials' measurement propagates to the uncertainty of the orientation matrix. This orientation uncertainty then propagates to points on the object's surface. This propagation is anisotropic, and the direction along which the uncertainty is the smallest is determined by the eigenvector associated with the largest eigenvalue of the orientation data's covariance matrix. This eigenvector in the coordinate frame defined by the fiducials remains almost fixed for any rotation of the object. However, the remaining two eigenvectors vary widely and the direction along which the propagated uncertainty is the largest cannot be determined from the object's pose. Conditions that result in such a behavior and practical consequences of it are presented.
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Affiliation(s)
- Marek Franaszek
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
| | - Geraldine S Cheok
- National Institute of Standards and Technology, Gaithersburg, MD 20899, USA
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Grauvogel TD, Engelskirchen P, Semper-Hogg W, Grauvogel J, Laszig R. Navigation accuracy after automatic- and hybrid-surface registration in sinus and skull base surgery. PLoS One 2017; 12:e0180975. [PMID: 28700740 PMCID: PMC5507282 DOI: 10.1371/journal.pone.0180975] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 06/24/2017] [Indexed: 11/25/2022] Open
Abstract
Objective Computer-aided-surgery in ENT surgery is mainly used for sinus surgery but navigation accuracy still reaches its limits for skull base procedures. Knowledge of navigation accuracy in distinct anatomical regions is therefore mandatory. This study examined whether navigation accuracy can be improved in specific anatomical localizations by using hybrid registration technique. Study design Experimental phantom study. Setting Operating room. Subjects and methods The gold standard of screw registration was compared with automatic LED-mask-registration alone, and in combination with additional surface matching. 3D-printer-based skull models with individual fabricated silicone skin were used for the experiments. Overall navigation accuracy considering 26 target fiducials distributed over each skull was measured as well as the accuracy on selected anatomic localizations. Results Overall navigation accuracy was <1.0 mm in all cases, showing the significantly lowest values after screw registration (0.66 ± 0.08 mm), followed by hybrid registration (0.83± 0.08 mm), and sole mask registration (0.92 ± 0.13 mm).On selected anatomic localizations screw registration was significantly superior on the sphenoid sinus and on the internal auditory canal. However, mask registration showed significantly better accuracy results on the midface. Navigation accuracy on skull base localizations could be significantly improved by the combination of mask registration and additional surface matching. Conclusion Overall navigation accuracy gives no sufficient information regarding navigation accuracy in a distinct anatomic area. The non-invasive LED-mask-registration proved to be an alternative in clinical routine showing best accuracy results on the midface. For challenging skull base procedures a hybrid registration technique is recommendable which improves navigation accuracy significantly in this operating field. Invasive registration procedures are reserved for selected challenging skull base operations where the required high precision warrants the invasiveness.
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Affiliation(s)
- Tanja Daniela Grauvogel
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
- * E-mail:
| | - Paul Engelskirchen
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Wiebke Semper-Hogg
- Department of Oral and Maxillofacial Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Roland Laszig
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
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Coffee: the key to safer image-guided surgery-a granular jamming cap for non-invasive, rigid fixation of fiducial markers to the patient. Int J Comput Assist Radiol Surg 2017; 12:1069-1077. [PMID: 28361324 DOI: 10.1007/s11548-017-1569-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/15/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Accurate image guidance requires a rigid connection between tracked fiducial markers and the patient, which cannot be guaranteed by current non-invasive attachment techniques. We propose a new granular jamming approach to firmly, yet non-invasively, connect fiducials to the patient. METHODS Our granular jamming cap surrounds the head and conforms to the contours of the patient's skull. When a vacuum is drawn, the device solidifies in a manner conceptually like a vacuum-packed bag of ground coffee, providing a rigid structure that can firmly hold fiducial markers to the patient's skull. By using the new Polaris Krios optical tracker, we can also use more fiducials in advantageous configurations to reduce registration error. RESULTS We tested our new approach against a clinically used headband-based fiducial fixation device under perturbations that could reasonably be expected to occur in a real-world operating room. In bump testing, we found that the granular jamming cap reduced average TRE at the skull base from 2.29 to 0.56 mm and maximum TRE at the same point from 7.65 to 1.30 mm. Clinically significant TRE reductions were also observed in head repositioning and static force testing experiments. CONCLUSION The granular jamming cap concept increases the robustness and accuracy of image-guided sinus and skull base surgery by more firmly attaching fiducial markers to the patient's skull.
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Chen X, Xu L, Wang H, Wang F, Wang Q, Kikinis R. Development of a surgical navigation system based on 3D Slicer for intraoperative implant placement surgery. Med Eng Phys 2017; 41:81-89. [PMID: 28109564 PMCID: PMC5549678 DOI: 10.1016/j.medengphy.2017.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 11/08/2016] [Accepted: 01/01/2017] [Indexed: 11/29/2022]
Abstract
Implant placement has been widely used in various kinds of surgery. However, accurate intraoperative drilling performance is essential to avoid injury to adjacent structures. Although some commercially-available surgical navigation systems have been approved for clinical applications, these systems are expensive and the source code is not available to researchers. 3D Slicer is a free, open source software platform for the research community of computer-aided surgery. In this study, a loadable module based on Slicer has been developed and validated to support surgical navigation. This research module allows reliable calibration of the surgical drill, point-based registration and surface matching registration, so that the position and orientation of the surgical drill can be tracked and displayed on the computer screen in real time, aiming at reducing risks. In accuracy verification experiments, the mean target registration error (TRE) for point-based and surface-based registration were 0.31±0.06mm and 1.01±0.06mm respectively, which should meet clinical requirements. Both phantom and cadaver experiments demonstrated the feasibility of our surgical navigation software module.
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Affiliation(s)
- Xiaojun Chen
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Lu Xu
- Institute of Biomedical Manufacturing and Life Quality Engineering, State Key Laboratory of Mechanical System and Vibration, School of Mechanical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Huixiang Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fang Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiugen Wang
- Shanghai First People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ron Kikinis
- Surgical Planning Laboratory, Harvard Medical School, Boston, United States
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Lee W, Chung YA, Jung Y, Song IU, Yoo SS. Simultaneous acoustic stimulation of human primary and secondary somatosensory cortices using transcranial focused ultrasound. BMC Neurosci 2016; 17:68. [PMID: 27784293 PMCID: PMC5081675 DOI: 10.1186/s12868-016-0303-6] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/19/2016] [Indexed: 01/10/2023] Open
Abstract
Background Transcranial focused ultrasound (FUS) is gaining momentum as a novel non-invasive brain stimulation method, with promising potential for superior spatial resolution and depth penetration compared to transcranial magnetic stimulation or transcranial direct current stimulation. We examined the presence of tactile sensations elicited by FUS stimulation of two separate brain regions in humans—the primary (SI) and secondary (SII) somatosensory areas of the hand, as guided by individual-specific functional magnetic resonance imaging data. Results Under image-guidance, acoustic stimulations were delivered to the SI and SII areas either separately or simultaneously. The SII areas were divided into sub-regions that are activated by four types of external tactile sensations to the palmar side of the right hand—vibrotactile, pressure, warmth, and coolness. Across the stimulation conditions (SI only, SII only, SI and SII simultaneously), participants reported various types of tactile sensations that arose from the hand contralateral to the stimulation, such as the palm/back of the hand or as single/neighboring fingers. The type of tactile sensations did not match the sensations that are associated with specific sub-regions in the SII. The neuro-stimulatory effects of FUS were transient and reversible, and the procedure did not cause any adverse changes or discomforts in the subject’s mental/physical status. Conclusions The use of multiple FUS transducers allowed for simultaneous stimulation of the SI/SII in the same hemisphere and elicited various tactile sensations in the absence of any external sensory stimuli. Stimulation of the SII area alone could also induce perception of tactile sensations. The ability to stimulate multiple brain areas in a spatially restricted fashion can be used to study causal relationships between regional brain activities and their cognitive/behavioral outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12868-016-0303-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wonhye Lee
- Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea.,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yong An Chung
- Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Yujin Jung
- Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - In-Uk Song
- Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea
| | - Seung-Schik Yoo
- Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Republic of Korea. .,Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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30
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Registration using 3D-printed rigid templates outperforms manually scanned surface matching in image-guided temporal bone surgery. Int J Comput Assist Radiol Surg 2016; 11:2119-2127. [PMID: 27299347 DOI: 10.1007/s11548-016-1441-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/02/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Image-guided surgery (IGS) for otological procedures requires minimal invasiveness and a high degree of accuracy. We have recently developed a noninvasive registration method, the Surface Template-Assisted Marker Positioning (STAMP) method, which uses a rigid template of the surface of the temporal bone. However, the STAMP method is not applicable when the bony surface is not exposed, such as in endoscopic surgery. Thus, we extended our research to apply the STAMP method onto the skin and tested its feasibility in this study. METHODS We designed a phantom made of a rigid box and soft material for the study. The target registration error (TRE) was measured at preset measuring points in the phantom. We modified the STAMP method to be applicable for use on the skin around the ears (S-STAMP). The same phantom was also registered using the conventional, manually scanned surface matching method. We compared the TRE after the different registration methods. RESULTS The TRE after the S-STAMP registration method was significantly smaller than that of the conventional surface matching method at all error measurement points in the phantom. However, the TRE after the S-STAMP registration method was significantly larger than that of paired point registration using invasive fiducial markers. CONCLUSIONS The S-STAMP method using a rigid template on the soft surface yields a significantly smaller TRE than that of conventional, manually scanned surface matching registration. This strategy provides an alternative option to improve the accuracy of IGS without loading patients with additional invasive procedures.
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31
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Soteriou E, Grauvogel J, Laszig R, Grauvogel TD. Prospects and limitations of different registration modalities in electromagnetic ENT navigation. Eur Arch Otorhinolaryngol 2016; 273:3979-3986. [PMID: 27149874 DOI: 10.1007/s00405-016-4063-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/19/2016] [Indexed: 01/03/2023]
Abstract
The present study examined electromagnetic tracking technology for ENT navigation. Five different registration modalities were compared and navigation accuracy was assessed. Four skull models were individually fabricated with a three-dimensional printer, based on patients' computer tomography datasets. Individual silicone masks were fitted for skin and soft tissue simulation. Five registration modalities were examined: (1) invasive marker, (2) automatic, (3) surface matching (AccuMatch), (4) anatomic landmarks, and (5) oral splint registration. Overall navigation accuracy and accuracy on selected anatomic locations were assessed by targeting 26 titanium screws previously placed over the skull. Overall navigation accuracy differed significantly between all registration modalities. The target registration error was 0.94 ± 0.06 mm (quadratic mean ± standard deviation) for the invasive marker registration, 1.41 ± 0.04 mm for the automatic registration, 1.59 ± 0.14 mm for the surface matching registration, and 5.15 ± 0.66 mm (four landmarks) and 4.37 ± 0.73 mm (five landmarks) for the anatomic landmark registration. Oral splint registration proved itself to be inapplicable to this navigation system. Invasive marker registration was superior on most selected anatomic locations. However, on the ethmoid and sphenoid sinus the automatic registration process revealed significantly lower target registration error values. Only automatic and surface registration met the accuracy requirements for noninvasive registration. Particularly, the automatic image-to-world registration reaches target registration error values on the anterior skull base which are comparable with the gold standard of invasive screw registration.
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Affiliation(s)
- Eric Soteriou
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Juergen Grauvogel
- Department of Neurosurgery, Albert-Ludwigs-University Medical School Freiburg, Freiburg, Germany
| | - Roland Laszig
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany
| | - Tanja Daniela Grauvogel
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert-Ludwigs-University Medical School Freiburg, Killianstr. 5, 79106, Freiburg, Germany.
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Ji S, Fan X, Paulsen KD, Roberts DW, Mirza SK, Lollis SS. Intraoperative CT as a registration benchmark for intervertebral motion compensation in image-guided open spinal surgery. Int J Comput Assist Radiol Surg 2015; 10:2009-20. [PMID: 26194485 PMCID: PMC4734629 DOI: 10.1007/s11548-015-1255-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/30/2015] [Indexed: 02/19/2023]
Abstract
PURPOSE An accurate and reliable benchmark of registration accuracy and intervertebral motion compensation is important for spinal image guidance. In this study, we evaluated the utility of intraoperative CT (iCT) in place of bone-implanted screws as the ground-truth registration and illustrated its use to benchmark the performance of intraoperative stereovision (iSV). METHODS A template-based, multi-body registration scheme was developed to individually segment and pair corresponding vertebrae between preoperative CT and iCT of the spine. Intervertebral motion was determined from the resulting vertebral pair-wise registrations. The accuracy of the image-driven registration was evaluated using surface-to-surface distance error (SDE) based on segmented bony features and was independently verified using point-to-point target registration error (TRE) computed from bone-implanted mini-screws. Both SDE and TRE were used to assess the compensation accuracy using iSV. RESULTS The iCT-based technique was evaluated on four explanted porcine spines (20 vertebral pairs) with artificially induced motion. We report a registration accuracy of 0.57 [Formula: see text] 0.32 mm (range 0.34-1.14 mm) and 0.29 [Formula: see text] 0.15 mm (range 0.14-0.78 mm) in SDE and TRE, respectively, for all vertebrae pooled, with an average intervertebral rotation of [Formula: see text] (range 1.5[Formula: see text]-7.9[Formula: see text]). The iSV-based compensation accuracy for one sample (four vertebrae) was 1.32 [Formula: see text] 0.19 mm and 1.72 [Formula: see text] 0.55 mm in SDE and TRE, respectively, exceeding the recommended accuracy of 2 mm. CONCLUSION This study demonstrates the effectiveness of iCT in place of invasive fiducials as a registration ground truth. These findings are important for future development of on-demand spinal image guidance using radiation-free images such as stereovision and ultrasound on human subjects.
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Affiliation(s)
- Songbai Ji
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA.
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA.
| | - Xiaoyao Fan
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA
| | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, 14 Engineering Drive, Hanover, NH, 03755, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - David W Roberts
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - Sohail K Mirza
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
| | - S Scott Lollis
- Geisel School of Medicine, Dartmouth College, Hanover, NH, 03755, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, 03766, USA
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Fan X, Roberts DW, Ji S, Hartov A, Paulsen KD. Intraoperative fiducial-less patient registration using volumetric 3D ultrasound: a prospective series of 32 neurosurgical cases. J Neurosurg 2015; 123:721-31. [PMID: 26140481 DOI: 10.3171/2014.12.jns141321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fiducial-based registration (FBR) is used widely for patient registration in image-guided neurosurgery. The authors of this study have developed an automatic fiducial-less registration (FLR) technique to find the patient-to-image transformation by directly registering 3D ultrasound (3DUS) with MR images without incorporating prior information. The purpose of the study was to evaluate the performance of the FLR technique when used prospectively in the operating room and to compare it with conventional FBR. METHODS In 32 surgical patients who underwent conventional FBR, preoperative T1-weighted MR images (pMR) with attached fiducial markers were acquired prior to surgery. After craniotomy but before dural opening, a set of 3DUS images of the brain volume was acquired. A 2-step registration process was executed immediately after image acquisition: 1) the cortical surfaces from pMR and 3DUS were segmented, and a multistart sum-of-squared-intensity-difference registration was executed to find an initial alignment between down-sampled binary pMR and 3DUS volumes; and 2) the alignment was further refined by a mutual information-based registration between full-resolution grayscale pMR and 3DUS images, and a patient-to-image transformation was subsequently extracted. RESULTS To assess the accuracy of the FLR technique, the following were quantified: 1) the fiducial distance error (FDE); and 2) the target registration error (TRE) at anterior commissure and posterior commissure locations; these were compared with conventional FBR. The results showed that although the average FDE (6.42 ± 2.05 mm) was higher than the fiducial registration error (FRE) from FBR (3.42 ± 1.37 mm), the overall TRE of FLR (2.51 ± 0.93 mm) was lower than that of FBR (5.48 ± 1.81 mm). The results agreed with the intent of the 2 registration techniques: FBR is designed to minimize the FRE, whereas FLR is designed to optimize feature alignment and hence minimize TRE. The overall computational cost of FLR was approximately 4-5 minutes and minimal user interaction was required. CONCLUSIONS Because the FLR method directly registers 3DUS with MR by matching internal image features, it proved to be more accurate than FBR in terms of TRE in the 32 patients evaluated in this study. The overall efficiency of FLR in terms of the time and personnel involved is also improved relative to FBR in the operating room, and the method does not require additional image scans immediately prior to surgery. The performance of FLR and these results suggest potential for broad clinical application.
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Affiliation(s)
| | - David W Roberts
- Geisel School of Medicine, Dartmouth College, Hanover; and.,Norris Cotton Cancer Center and.,Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Songbai Ji
- Thayer School of Engineering and.,Geisel School of Medicine, Dartmouth College, Hanover; and
| | - Alex Hartov
- Thayer School of Engineering and.,Norris Cotton Cancer Center and
| | - Keith D Paulsen
- Thayer School of Engineering and.,Geisel School of Medicine, Dartmouth College, Hanover; and.,Norris Cotton Cancer Center and
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Spinczyk D. Image-based guidance of percutaneous abdomen intervention based on markers for semi-automatic rigid registration. Wideochir Inne Tech Maloinwazyjne 2014; 9:531-6. [PMID: 25561990 PMCID: PMC4280415 DOI: 10.5114/wiitm.2014.45048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/11/2014] [Accepted: 06/01/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For percutaneous abdomen intervention (e.g. liver radiofrequency (RF) tumor ablation, liver biopsy), surgeons lack real-time visual feedback about the location of the needle on planning images, typically computed tomography (CT). One difficulty lies in tracking and synchronizing both the tool movement and the patient breathing motion. AIM To verify the correspondence between rigid registration fiducial registration error signal and breathing phase. MATERIAL AND METHODS Designed markers that are clearly visible both in planning CT and on the patient during the intervention are proposed. Registration and breathing synchronization is then performed by a point-based approach. The method was tested in a clinical environment on 10 patients with liver cancer using 3D abdominal CT in the exhale position. Median rigid fiducial registration error (FRE) in the breathing cycle was used as a criterion to distinguish the inhale and exhale phase. RESULTS The correlation between breathing phase and FRE value can be observed for every patient. We obtained mean median FRE equal to 9.37 mm in exhale positions and 15.56 mm in the whole breathing cycle. CONCLUSIONS The presented real time approach, based on FRE calculation, was integrated in the clinical pipeline, and can help to select the best respiratory phase for needle insertion for percutaneous abdomen intervention, in cases where only 3D CT is performed. Moreover, this method allows semi-automated rigid registration to establish the correspondence between preoperative patient anatomical model and patient position.
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Affiliation(s)
- Dominik Spinczyk
- Faculty of Biomedical Engineering, Silesian University of Technology, Zabrze, Poland
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35
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A projected landmark method for reduction of registration error in image-guided surgery systems. Int J Comput Assist Radiol Surg 2014; 10:541-54. [PMID: 24866060 DOI: 10.1007/s11548-014-1075-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Image-guided surgery systems are limited by registration error, so practical and effective methods to improve accuracy are necessary. A projection point-based method for reducing the surface registration error in image-guided surgery was developed and tested. METHODS Checkerboard patterns are projected on visible surfaces to create projected landmarks over a region of interest. Surface information thus becomes available in the form of point clouds of surface point coordinates with submillimeter resolution. The reconstructed 3D point cloud is registered using iterative closest point (ICP) approximation to a 3D point cloud extracted from preoperative CT images of the same region of interest. The projected landmark surface registration method was compared with two other methods using a facial surface phantom: (a) landmark registration using anatomical features, and (b) surface matching based on an additional 40 surface points. RESULTS The mean error for the projected landmark surface registration method was 0.64 mm, which was 47.4 and 35.3 % lower relative to mean errors of the anatomical landmark registration and the surface-matching methods, respectively. After applying the proposed method, using target registration error as a gold standard, the resulting mean error was 1.1 mm or a reduction of 61.2 % compared to the anatomical landmark registration. CONCLUSION Optical checkerboard pattern projection onto visible surfaces was used to acquire surface point clouds for image-guided surgery registration. A projected landmark method eliminated the effects of unwanted and overlapping points by acquiring the desired points at specific locations. The results were more accurate than conventional landmark or surface registration.
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Continuous registration based on computed tomography for breathing motion compensation. Wideochir Inne Tech Maloinwazyjne 2013; 8:265-72. [PMID: 24501595 PMCID: PMC3908646 DOI: 10.5114/wiitm.2013.39505] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/14/2013] [Accepted: 11/24/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction Image guidance for intervention is applied for complex and difficult anatomical regions. Nowadays, it is typically used in neurosurgery, otolaryngology, orthopedics and dentistry. The application of the image-guided system for soft tissues is challenging due to various deformations caused by respiratory motion, tissue elasticity and peristalsis. Aim The main task for the presented approach is continuous registration of preoperative computed tomography (CT) and patient position in the operating room (OR) without touching the patient and compensation of breathing motion. This approach is being developed as a step to image-guided percutaneous liver RF tumor ablation. Material and methods Up to ten integrated radiological markers are placed on the patient's skin before CT scans. Then the anatomical model based on CT images is calculated. Point-to-point registration based on the Horn algorithm during a few breathing cycles is performed using a videometric tracking system. The transformation which corresponds to the minimum fiducial registration error (FRE) is found during the registration and it is treated as the initial transformation for calculating local deformation field of breathing motion compensation based on the spline approach. Results For manual registration of the abdominal phantom, the mean values of target registration error (TRE), fiducial localization error (FLE) and FRE are all below 4 mm for the rigid transformation and are below 1 mm for the affine transformation. For the patient's data they are all below 9 mm and 6 mm, respectively. For the automatic method, different marker configurations have been evaluated while dividing the respiratory cycle into inhale and exhale. Average median values for FRE, TRE rigid estimation and TRE based on spline deformation were 15.56 mm, 0.82 mm and 7.21 mm respectively. Conclusions In this application two registration methods of abdominal preoperative CT anatomical model and physical patient position in OR were presented and compared. The presented approach is being developed as a step to image-guided percutaneous liver radiofrequency ablation tumor ablation. Implementation of the automated registration method to clinical practice is easier because of shortening of preparation time in OR, no necessity of touching the patient, and no dependency on the physician's experience.
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Cohen EAK, Ober RJ. Analysis of Point Based Image Registration Errors With Applications in Single Molecule Microscopy. IEEE TRANSACTIONS ON SIGNAL PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2013; 61:6291-6306. [PMID: 24634573 PMCID: PMC3951128 DOI: 10.1109/tsp.2013.2284154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We present an asymptotic treatment of errors involved in point-based image registration where control point (CP) localization is subject to heteroscedastic noise; a suitable model for image registration in fluorescence microscopy. Assuming an affine transform, CPs are used to solve a multivariate regression problem. With measurement errors existing for both sets of CPs this is an errors-in-variable problem and linear least squares is inappropriate; the correct method being generalized least squares. To allow for point dependent errors the equivalence of a generalized maximum likelihood and heteroscedastic generalized least squares model is achieved allowing previously published asymptotic results to be extended to image registration. For a particularly useful model of heteroscedastic noise where covariance matrices are scalar multiples of a known matrix (including the case where covariance matrices are multiples of the identity) we provide closed form solutions to estimators and derive their distribution. We consider the target registration error (TRE) and define a new measure called the localization registration error (LRE) believed to be useful, especially in microscopy registration experiments. Assuming Gaussianity of the CP localization errors, it is shown that the asymptotic distribution for the TRE and LRE are themselves Gaussian and the parameterized distributions are derived. Results are successfully applied to registration in single molecule microscopy to derive the key dependence of the TRE and LRE variance on the number of CPs and their associated photon counts. Simulations show asymptotic results are robust for low CP numbers and non-Gaussianity. The method presented here is shown to outperform GLS on real imaging data.
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Affiliation(s)
- E. A. K. Cohen
- Eric Jonsson School of Electrical Engineering and Computer Science, University of Texas at Dallas, Richardson, TX 75083 USA. He is also with the Department of Mathematics, Imperial College London, SW7 2AZ U.K
| | - R. J. Ober
- Eric Jonsson School of Electrical Engineering and Computer Science, University of Texas at Dallas, Richardson, TX 75083 USA
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Nasreddine K, Benzinou A, Fablet R. Geodesics-based image registration: applications to biological and medical images depicting concentric ring patterns. IEEE TRANSACTIONS ON IMAGE PROCESSING : A PUBLICATION OF THE IEEE SIGNAL PROCESSING SOCIETY 2013; 22:4436-4446. [PMID: 23880058 DOI: 10.1109/tip.2013.2273670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In many biological or medical applications, images that contain sequences of shapes are common. The existence of high inter-individual variability makes their interpretation complex. In this paper, we address the computer-assisted interpretation of such images and we investigate how we can remove or reduce these image variabilities. The proposed approach relies on the development of an efficient image registration technique. We first show the inadequacy of state-of-the-art intensity-based and feature-based registration techniques for the considered image datasets. Then, we propose a robust variational method which benefits from the geometrical information present in this type of images. In the proposed non-rigid geodesics-based registration, the successive shapes are represented by a level-set representation, which we rely on to carry out the registration. The successive level sets are regarded as elements in a shape space and the corresponding matching is that of the optimal geodesic path. The proposed registration scheme is tested on synthetic and real images. The comparison against results of state-of-the-art methods proves the relevance of the proposed method for this type of images.
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Cho B, Matsumoto N, Hashizume M. Navigation for cochlear implantation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:5727-30. [PMID: 24111038 DOI: 10.1109/embc.2013.6610851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A cochlear implant is an artificial sensory organ for patients with severe to profound hearing loss who have little benefit from hearing aids. The fact that more patients with previous temporal bone surgery or cranial malformations are receiving cochlear implants implies that the number of atypical cochlear implantation will continue to grow. Surgical navigation, or image-guided surgery may be helpful for surgeons who perform atypical surgeries. We report our research on an image-guided system specifically designed for otologic surgery with an improved surgeon-computer interface.
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Uematsu M, Asato K, Ichihashi T, Umezu M, Nakaoka R, Matsuoka A, Aomi S, Iimura H, Suzuki T, Muragaki Y, Iseki H. A surgical navigation system for aortic vascular surgery: a practical approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2013:5327-30. [PMID: 24110939 DOI: 10.1109/embc.2013.6610752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
In aortic vascular surgery, a navigation system must represent the anatomical map of individual patient in order to detect the important artery. To provide a proper fit for positions along the dorsoventral axis, the spinous process was added to a currently used anatomical point set consisting of four anterior body landmarks. In addition, we attempted to reduce the registration error by compensating for alignment errors resulting from variations in tissue thickness at each landmark. The alignment values were examined using a human phantom consisting of a skeleton model with subcutaneous tissue in the semilateral position. Using this method, a phantom simulation and five clinical trials were performed. Target errors were evaluated at the orifice of the intercostal artery. In the phantom simulation, the error at the target point was 4.1 ± 2.7 mm. However, for one patient undergoing thoracoabdominal aortic aneurysm replacement surgery, the target error was 8.0 mm using the proposed method.
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Kral F, Gueler O, Perwoeg M, Bardosi Z, Puschban EJ, Riechelmann H, Freysinger W. Proof-of-concept of a laser mounted endoscope for touch-less navigated procedures. Lasers Surg Med 2013; 45:377-82. [PMID: 23737122 PMCID: PMC3791553 DOI: 10.1002/lsm.22148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2013] [Indexed: 11/08/2022]
Abstract
Background and Objectives During navigated procedures a tracked pointing device is used to define target structures in the patient to visualize its position in a registered radiologic data set. When working with endoscopes in minimal invasive procedures, the target region is often difficult to reach and changing instruments is disturbing in a challenging, crucial moment of the procedure. We developed a device for touch less navigation during navigated endoscopic procedures. Materials and Methods A laser beam is delivered to the tip of a tracked endoscope angled to its axis. Thereby the position of the laser spot in the video-endoscopic images changes according to the distance between the tip of the endoscope and the target structure. A mathematical function is defined by a calibration process and is used to calculate the distance between the tip of the endoscope and the target. The tracked tip of the endoscope and the calculated distance is used to visualize the laser spot in the registered radiologic data set. Results In comparison to the tracked instrument, the touch less target definition with the laser spot yielded in an over and above error of 0.12 mm. The overall application error in this experimental setup with a plastic head was 0.61 ± 0.97 mm (95% CI −1.3 to +2.5 mm). Conclusion Integrating a laser in an endoscope and then calculating the distance to a target structure by image processing of the video endoscopic images is accurate. This technology eliminates the need for tracked probes intraoperatively and therefore allows navigation to be integrated seamlessly in clinical routine. However, it is an additional chain link in the sequence of computer-assisted surgery thus influencing the application error. Lasers Surg. Med. 45:377–382, 2013. © 2013 Wiley Periodicals, Inc.
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Affiliation(s)
- Florian Kral
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
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Figl M, Kaar M, Hoffman R, Kratochwil A, Hummel J. An error analysis perspective for patient alignment systems. Int J Comput Assist Radiol Surg 2013; 8:849-56. [PMID: 23463386 DOI: 10.1007/s11548-013-0819-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 01/31/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE This paper analyses the effects of error sources which can be found in patient alignment systems. As an example, an ultrasound (US) repositioning system and its transformation chain are assessed. The findings of this concept can also be applied to any navigation system. METHODS AND MATERIALS In a first step, all error sources were identified and where applicable, corresponding target registration errors were computed. By applying error propagation calculations on these commonly used registration/calibration and tracking errors, we were able to analyse the components of the overall error. Furthermore, we defined a special situation where the whole registration chain reduces to the error caused by the tracking system. Additionally, we used a phantom to evaluate the errors arising from the image-to-image registration procedure, depending on the image metric used. We have also discussed how this analysis can be applied to other positioning systems such as Cone Beam CT-based systems or Brainlab's ExacTrac. RESULTS The estimates found by our error propagation analysis are in good agreement with the numbers found in the phantom study but significantly smaller than results from patient evaluations. We probably underestimated human influences such as the US scan head positioning by the operator and tissue deformation. Rotational errors of the tracking system can multiply these errors, depending on the relative position of tracker and probe. CONCLUSIONS We were able to analyse the components of the overall error of a typical patient positioning system. We consider this to be a contribution to the optimization of the positioning accuracy for computer guidance systems.
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Affiliation(s)
- Michael Figl
- Vienna General Hospital, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, 1090 , Vienna, Austria
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Gerber N, Gavaghan KA, Bell BJ, Williamson TM, Weisstanner C, Caversaccio MD, Weber S. High-accuracy patient-to-image registration for the facilitation of image-guided robotic microsurgery on the head. IEEE Trans Biomed Eng 2013; 60:960-8. [PMID: 23340586 DOI: 10.1109/tbme.2013.2241063] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Image-guided microsurgery requires accuracies an order of magnitude higher than today's navigation systems provide. A critical step toward the achievement of such low-error requirements is a highly accurate and verified patient-to-image registration. With the aim of reducing target registration error to a level that would facilitate the use of image-guided robotic microsurgery on the rigid anatomy of the head, we have developed a semiautomatic fiducial detection technique. Automatic force-controlled localization of fiducials on the patient is achieved through the implementation of a robotic-controlled tactile search within the head of a standard surgical screw. Precise detection of the corresponding fiducials in the image data is realized using an automated model-based matching algorithm on high-resolution, isometric cone beam CT images. Verification of the registration technique on phantoms demonstrated that through the elimination of user variability, clinically relevant target registration errors of approximately 0.1 mm could be achieved.
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Affiliation(s)
- Nicolas Gerber
- ARTORG Center for Biomedical Engineering Research, University of Bern, 3012 Bern, Switzerland.
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Potential use of computer navigation in the treatment of primary benign and malignant tumors in children. Curr Rev Musculoskelet Med 2012; 5:83-90. [PMID: 22488037 DOI: 10.1007/s12178-012-9124-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The treatment of benign and malignant primary bone tumors has progressed over time from relatively simple practice to complex resection and reconstruction techniques. Recently, computer-assisted orthopaedic surgery (CAOS) has been used to assist surgeons to enhance surgical precision in order to achieve these goals. Initially, software developed for CT-based spinal applications was used to perform simple intraoperative point localization. With advances in technique and software design, oncology surgeons have now performed joint sparing complex multiplanar osteotomies using combined CT and MRI image data with precision and accuracy. The purpose of this paper is to provide a review of the clinical progress to date, the different types of navigation available, methods for error management, and limitations of CAOS in the treatment of pediatric benign and malignant primary bone tumors.
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Dang H, Otake Y, Schafer S, Stayman JW, Kleinszig G, Siewerdsen JH. Robust methods for automatic image-to-world registration in cone-beam CT interventional guidance. Med Phys 2012; 39:6484-98. [PMID: 23039683 PMCID: PMC3477200 DOI: 10.1118/1.4754589] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 09/04/2012] [Accepted: 09/05/2012] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Real-time surgical navigation relies on accurate image-to-world registration to align the coordinate systems of the image and patient. Conventional manual registration can present a workflow bottleneck and is prone to manual error and intraoperator variability. This work reports alternative means of automatic image-to-world registration, each method involving an automatic registration marker (ARM) used in conjunction with C-arm cone-beam CT (CBCT). The first involves a Known-Model registration method in which the ARM is a predefined tool, and the second is a Free-Form method in which the ARM is freely configurable. METHODS Studies were performed using a prototype C-arm for CBCT and a surgical tracking system. A simple ARM was designed with markers comprising a tungsten sphere within infrared reflectors to permit detection of markers in both x-ray projections and by an infrared tracker. The Known-Model method exercised a predefined specification of the ARM in combination with 3D-2D registration to estimate the transformation that yields the optimal match between forward projection of the ARM and the measured projection images. The Free-Form method localizes markers individually in projection data by a robust Hough transform approach extended from previous work, backprojected to 3D image coordinates based on C-arm geometric calibration. Image-domain point sets were transformed to world coordinates by rigid-body point-based registration. The robustness and registration accuracy of each method was tested in comparison to manual registration across a range of body sites (head, thorax, and abdomen) of interest in CBCT-guided surgery, including cases with interventional tools in the radiographic scene. RESULTS The automatic methods exhibited similar target registration error (TRE) and were comparable or superior to manual registration for placement of the ARM within ∼200 mm of C-arm isocenter. Marker localization in projection data was robust across all anatomical sites, including challenging scenarios involving the presence of interventional tools. The reprojection error of marker localization was independent of the distance of the ARM from isocenter, and the overall TRE was dominated by the configuration of individual fiducials and distance from the target as predicted by theory. The median TRE increased with greater ARM-to-isocenter distance (e.g., for the Free-Form method, TRE increasing from 0.78 mm to 2.04 mm at distances of ∼75 mm and 370 mm, respectively). The median TRE within ∼200 mm distance was consistently lower than that of the manual method (TRE = 0.82 mm). Registration performance was independent of anatomical site (head, thorax, and abdomen). The Free-Form method demonstrated a statistically significant improvement (p = 0.0044) in reproducibility compared to manual registration (0.22 mm versus 0.30 mm, respectively). CONCLUSIONS Automatic image-to-world registration methods demonstrate the potential for improved accuracy, reproducibility, and workflow in CBCT-guided procedures. A Free-Form method was shown to exhibit robustness against anatomical site, with comparable or improved TRE compared to manual registration. It was also comparable or superior in performance to a Known-Model method in which the ARM configuration is specified as a predefined tool, thereby allowing configuration of fiducials on the fly or attachment to the patient.
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Affiliation(s)
- H Dang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21202, USA
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Wittmann W, Wenger T, Loewe E, Lueth TC. Official measurement protocol and accuracy results for an optical surgical navigation system (NPU). ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:1237-40. [PMID: 22254540 DOI: 10.1109/iembs.2011.6090291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Image-guided surgical navigation is on the rise in many different areas of modern medicine and is already an established standard in some disciplines like ear nose and throat (ENT) or maxillofacial surgery. When evaluating surgical navigation systems the absolute accuracy of the device is of major concern to the surgeon. The following work presents two different ways of measuring the accuracy of surgical navigation systems using the example of the KARL STORZ Navigation Panel Unit (NPU). According to these protocols the FDA approval of the NPU navigation system was prepared. In a first series of experiments the accuracy under realistic surgical conditions is evaluated with a phantom of a human head, which is manufactured in rapid-prototyping processes. In another series of experiments a custom registration board is used, which provides means to evaluate the accuracy under optimal conditions and also allows further measurements regarding the registration error, that are not possible with the phantom. In the experiments an accuracy of 1.44 mm ± 0.18 mm was measured in the surgical setup and 0.63 mm ± 0.07 mm under ideal conditions.
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Affiliation(s)
- Wolfgang Wittmann
- Ergosurg GmbH Ismaning, Institute of Micro Technology and Medical Device Technology, Technische Universitaet Muenchen, Garching, Germany.
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Wenger T, Nowatschin S, Wittmann W, Hurka F, Strauss G, Lueth TC. Design and accuracy evaluation of a new navigated drill system for computer assisted ENT-surgery. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2012; 2011:1233-6. [PMID: 22254539 DOI: 10.1109/iembs.2011.6090290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this article a new navigated drill system for computer assisted ear, nose and throat (ENT) surgery is presented. The navigated drill and the microscope probe are part of a surgical navigation system for ENT-surgery. In particular, the accuracy of the new navigated drill is compared to an existing navigated drill experimentally under conditions close to the surgical workflow. For the technical accuracy experiment, the new navigated drill in combination with the new microscope probe and a particular navigated measurement board have been integrated, together with the current navigated drill, in a navigation system by a special navigation software with measuring function, based on a standard ENT navigation software. The developed navigated measurement board provided the implementation of reproducible experiments and the direct accuracy comparison of the two navigated instruments under the same conditions. Thereby, N = 15 accuracy experiments are performed with both navigated drill systems with three possible tracker positions. The distance between the planned and the touched points were calculated and compared. The average distances from the planned points to the touched points with the new navigated drill is in the left tracker position 1.10 mm, in the middle tracker position 1.14 mm and in the right tracker position 1.59 mm. In comparison to the existing drill, the new navigated drill, measured with each tracker position, is 0.62 mm more accurate.
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Galloway RL, Herrell SD, Miga MI. Image-Guided Abdominal Surgery and Therapy Delivery. JOURNAL OF HEALTHCARE ENGINEERING 2012; 3:203-228. [PMID: 25077012 PMCID: PMC4112601 DOI: 10.1260/2040-2295.3.2.203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 07/01/2011] [Indexed: 01/31/2023]
Abstract
Image-Guided Surgery has become the standard of care in intracranial neurosurgery providing more exact resections while minimizing damage to healthy tissue. Moving that process to abdominal organs presents additional challenges in the form of image segmentation, image to physical space registration, organ motion and deformation. In this paper, we present methodologies and results for addressing these challenges in two specific organs: the liver and the kidney.
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Affiliation(s)
- Robert L. Galloway
- Department of Biomedical Engineering
- Department of Neurosurgery
- Department of Surgery
| | | | - Michael I. Miga
- Department of Biomedical Engineering
- Department of Neurosurgery
- Department of Radiology and Radiological Sciences Vanderbilt University
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Reaungamornrat S, Otake Y, Uneri A, Schafer S, Mirota DJ, Nithiananthan S, Stayman JW, Kleinszig G, Khanna AJ, Taylor RH, Siewerdsen JH. An on-board surgical tracking and video augmentation system for C-arm image guidance. Int J Comput Assist Radiol Surg 2012; 7:647-65. [PMID: 22539008 DOI: 10.1007/s11548-012-0682-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 03/20/2012] [Indexed: 11/27/2022]
Abstract
PURPOSE Conventional tracker configurations for surgical navigation carry a variety of limitations, including limited geometric accuracy, line-of-sight obstruction, and mismatch of the view angle with the surgeon's-eye view. This paper presents the development and characterization of a novel tracker configuration (referred to as "Tracker-on-C") intended to address such limitations by incorporating the tracker directly on the gantry of a mobile C-arm for fluoroscopy and cone-beam CT (CBCT). METHODS A video-based tracker (MicronTracker, Claron Technology Inc., Toronto, ON, Canada) was mounted on the gantry of a prototype mobile isocentric C-arm next to the flat-panel detector. To maintain registration within a dynamically moving reference frame (due to rotation of the C-arm), a reference marker consisting of 6 faces (referred to as a "hex-face marker") was developed to give visibility across the full range of C-arm rotation. Three primary functionalities were investigated: surgical tracking, generation of digitally reconstructed radiographs (DRRs) from the perspective of a tracked tool or the current C-arm angle, and augmentation of the tracker video scene with image, DRR, and planning data. Target registration error (TRE) was measured in comparison with the same tracker implemented in a conventional in-room configuration. Graphics processing unit (GPU)-accelerated DRRs were generated in real time as an assistant to C-arm positioning (i.e., positioning the C-arm such that target anatomy is in the field-of-view (FOV)), radiographic search (i.e., a virtual X-ray projection preview of target anatomy without X-ray exposure), and localization (i.e., visualizing the location of the surgical target or planning data). Video augmentation included superimposing tracker data, the X-ray FOV, DRRs, planning data, preoperative images, and/or intraoperative CBCT onto the video scene. Geometric accuracy was quantitatively evaluated in each case, and qualitative assessment of clinical feasibility was analyzed by an experienced and fellowship-trained orthopedic spine surgeon within a clinically realistic surgical setup of the Tracker-on-C. RESULTS The Tracker-on-C configuration demonstrated improved TRE (0.87 ± 0.25) mm in comparison with a conventional in-room tracker setup (1.92 ± 0.71) mm (p < 0.0001) attributed primarily to improved depth resolution of the stereoscopic camera placed closer to the surgical field. The hex-face reference marker maintained registration across the 180° C-arm orbit (TRE = 0.70 ± 0.32 mm). DRRs generated from the perspective of the C-arm X-ray detector demonstrated sub- mm accuracy (0.37 ± 0.20 mm) in correspondence with the real X-ray image. Planning data and DRRs overlaid on the video scene exhibited accuracy of (0.59 ± 0.38) pixels and (0.66 ± 0.36) pixels, respectively. Preclinical assessment suggested potential utility of the Tracker-on-C in a spectrum of interventions, including improved line of sight, an assistant to C-arm positioning, and faster target localization, while reducing X-ray exposure time. CONCLUSIONS The proposed tracker configuration demonstrated sub- mm TRE from the dynamic reference frame of a rotational C-arm through the use of the multi-face reference marker. Real-time DRRs and video augmentation from a natural perspective over the operating table assisted C-arm setup, simplified radiographic search and localization, and reduced fluoroscopy time. Incorporation of the proposed tracker configuration with C-arm CBCT guidance has the potential to simplify intraoperative registration, improve geometric accuracy, enhance visualization, and reduce radiation exposure.
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Affiliation(s)
- S Reaungamornrat
- Department of Biomedical Engineering, Johns Hopkins University, Traylor Building, Room #726, 720 Rutland Avenue, Baltimore, MD 21205-2109, USA.
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Kang SH, Kim MK, Kim JH, Park HK, Park W. Marker-free registration for the accurate integration of CT images and the subject's anatomy during navigation surgery of the maxillary sinus. Dentomaxillofac Radiol 2012; 41:679-85. [PMID: 22499127 DOI: 10.1259/dmfr/21358271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study compared three marker-free registration methods that are applicable to a navigation system that can be used for maxillary sinus surgery, and evaluated the associated errors, with the aim of determining which registration method is the most applicable for operations that require accurate navigation. METHODS The CT digital imaging and communications in medicine (DICOM) data of ten maxillary models in DICOM files were converted into stereolithography file format. All of the ten maxillofacial models were scanned three dimensionally using a light-based three-dimensional scanner. The methods applied for registration of the maxillofacial models utilized the tooth cusp, bony landmarks and maxillary sinus anterior wall area. The errors during registration were compared between the groups. RESULTS There were differences between the three registration methods in the zygoma, sinus posterior wall, molar alveolar, premolar alveolar, lateral nasal aperture and the infraorbital areas. The error was smallest using the overlay method for the anterior wall of the maxillary sinus, and the difference was statistically significant. CONCLUSION The navigation error can be minimized by conducting registration using the anterior wall of the maxillary sinus during image-guided surgery of the maxillary sinus.
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Affiliation(s)
- S-H Kang
- Department of Oral and Maxillofacial Surgery, National Health Insurance Corporation Ilsan Hospital, Gyeonggi-do, Republic of Korea
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