1
|
Asadi Z, Asadi M, Kazemipour N, Léger É, Kersten-Oertel M. A decade of progress: bringing mixed reality image-guided surgery systems in the operating room. Comput Assist Surg (Abingdon) 2024; 29:2355897. [PMID: 38794834 DOI: 10.1080/24699322.2024.2355897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024] Open
Abstract
Advancements in mixed reality (MR) have led to innovative approaches in image-guided surgery (IGS). In this paper, we provide a comprehensive analysis of the current state of MR in image-guided procedures across various surgical domains. Using the Data Visualization View (DVV) Taxonomy, we analyze the progress made since a 2013 literature review paper on MR IGS systems. In addition to examining the current surgical domains using MR systems, we explore trends in types of MR hardware used, type of data visualized, visualizations of virtual elements, and interaction methods in use. Our analysis also covers the metrics used to evaluate these systems in the operating room (OR), both qualitative and quantitative assessments, and clinical studies that have demonstrated the potential of MR technologies to enhance surgical workflows and outcomes. We also address current challenges and future directions that would further establish the use of MR in IGS.
Collapse
Affiliation(s)
- Zahra Asadi
- Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada
| | - Mehrdad Asadi
- Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada
| | - Negar Kazemipour
- Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada
| | - Étienne Léger
- Montréal Neurological Institute & Hospital (MNI/H), Montréal, Canada
- McGill University, Montréal, Canada
| | - Marta Kersten-Oertel
- Department of Computer Science and Software Engineering, Concordia University, Montréal, Canada
| |
Collapse
|
2
|
Frisk H, Burström G, Persson O, El-Hajj VG, Coronado L, Hager S, Edström E, Elmi-Terander A. Automatic image registration on intraoperative CBCT compared to Surface Matching registration on preoperative CT for spinal navigation: accuracy and workflow. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03076-4. [PMID: 38378987 DOI: 10.1007/s11548-024-03076-4] [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: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Spinal navigation solutions have been slower to develop compared to cranial ones. To facilitate greater adoption and use of spinal navigation, the relatively cumbersome registration processes need to be improved upon. This study aims to validate a new solution for automatic image registration and compare it to a traditional Surface Matching method. METHOD Adult patients undergoing spinal surgery requiring navigation were enrolled after providing consent. A registration matrix-Universal AIR (= Automatic Image Registration)-was placed in the surgical field and used for automatic registration based on intraoperative 3D imaging. A standard Surface Matching method was used for comparison. Accuracy measurements were obtained by comparing planned and acquired coordinates on the vertebrae. RESULTS Thirty-nine patients with 42 datasets were included. The mean accuracy of Universal AIR registration was 1.20 ± 0.42 mm, while the mean accuracy of Surface Matching registration was 1.94 ± 0.64 mm. Universal AIR registration was non-inferior to Surface Matching registration. Post hoc analysis showed a significantly greater accuracy for Universal AIR registration. In Surface Matching, but not automatic registration, user-related errors such as incorrect identification of the vertebral level were seen. CONCLUSION Automatic image registration for spinal navigation using Universal AIR and intraoperative 3D imaging provided improved accuracy compared to Surface Matching registration. In addition, it minimizes user errors and offers a standardized workflow, making it a reliable registration method for navigated spinal procedures.
Collapse
Affiliation(s)
- Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
| | | | | | | | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden
- Capio Spine Center Stockholm, Löwenströmska Hospital, Upplands-Väsby, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
3
|
Bui T, Ruiz-Cardozo MA, Dave HS, Barot K, Kann MR, Joseph K, Lopez-Alviar S, Trevino G, Brehm S, Yahanda AT, Molina CA. Virtual, Augmented, and Mixed Reality Applications for Surgical Rehearsal, Operative Execution, and Patient Education in Spine Surgery: A Scoping Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:332. [PMID: 38399619 PMCID: PMC10890632 DOI: 10.3390/medicina60020332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Advances in virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies have resulted in their increased application across many medical specialties. VR's main application has been for teaching and preparatory roles, while AR has been mostly used as a surgical adjunct. The objective of this study is to discuss the various applications and prospects for VR, AR, and MR specifically as they relate to spine surgery. Materials and Methods: A systematic review was conducted to examine the current applications of VR, AR, and MR with a focus on spine surgery. A literature search of two electronic databases (PubMed and Scopus) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The study quality was assessed using the MERSQI score for educational research studies, QUACS for cadaveric studies, and the JBI critical appraisal tools for clinical studies. Results: A total of 228 articles were identified in the primary literature review. Following title/abstract screening and full-text review, 46 articles were included in the review. These articles comprised nine studies performed in artificial models, nine cadaveric studies, four clinical case studies, nineteen clinical case series, one clinical case-control study, and four clinical parallel control studies. Teaching applications utilizing holographic overlays are the most intensively studied aspect of AR/VR; the most simulated surgical procedure is pedicle screw placement. Conclusions: VR provides a reproducible and robust medium for surgical training through surgical simulations and for patient education through various platforms. Existing AR/MR platforms enhance the accuracy and precision of spine surgeries and show promise as a surgical adjunct.
Collapse
Affiliation(s)
- Tim Bui
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Miguel A. Ruiz-Cardozo
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Harsh S. Dave
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karma Barot
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael Ryan Kann
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Karan Joseph
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Sofia Lopez-Alviar
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Gabriel Trevino
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Samuel Brehm
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Alexander T. Yahanda
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Camilo A Molina
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| |
Collapse
|
4
|
Azad TD, Warman A, Tracz JA, Hughes LP, Judy BF, Witham TF. Augmented reality in spine surgery - past, present, and future. Spine J 2024; 24:1-13. [PMID: 37660893 DOI: 10.1016/j.spinee.2023.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/29/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND CONTEXT Augmented reality (AR) is increasingly recognized as a valuable tool in spine surgery. Here we provides an overview of the key developments and technological milestones that have laid the foundation for AR applications in this field. We also assess the quality of existing studies on AR systems in spine surgery and explore potential future applications. PURPOSE The purpose of this narrative review is to examine the role of AR in spine surgery. It aims to highlight the evolution of AR technology in this context, evaluate the existing body of research, and outline potential future directions for integrating AR into spine surgery. STUDY DESIGN Narrative review. METHODS We conducted a thorough literature search to identify studies and developments related to AR in spine surgery. Relevant articles, reports, and technological advancements were analyzed to establish the historical context and current state of AR in this field. RESULTS The review identifies significant milestones in the development of AR technology for spine surgery. It discusses the growing body of research and highlights the strengths and weaknesses of existing investigations. Additionally, it presents insights into the potential for AR to enhance spine surgical education and speculates on future applications. CONCLUSIONS Augmented reality has emerged as a promising adjunct in spine surgery, with notable advancements and research efforts. The integration of AR into the spine surgery operating room holds promise, as does its potential to revolutionize surgical education. Future applications of AR in spine surgery may include real-time navigation, enhanced visualization, and improved patient outcomes. Continued development and evaluation of AR technology are essential for its successful implementation in this specialized surgical field.
Collapse
Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Anmol Warman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Jovanna A Tracz
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Liam P Hughes
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Brendan F Judy
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Meyer 7-109, Baltimore, MD 21287, USA.
| |
Collapse
|
5
|
Gharios M, El-Hajj VG, Frisk H, Ohlsson M, Omar A, Edström E, Elmi-Terander A. The use of hybrid operating rooms in neurosurgery, advantages, disadvantages, and future perspectives: a systematic review. Acta Neurochir (Wien) 2023; 165:2343-2358. [PMID: 37584860 PMCID: PMC10477240 DOI: 10.1007/s00701-023-05756-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/08/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND Hybrid operating rooms (hybrid-ORs) combine the functionalities of a conventional surgical theater with the advanced imaging technologies of a radiological suite. Hybrid-ORs are usually equipped with CBCT devices providing both 2D and 3D imaging capability that can be used for both interventional radiology and image guided surgical applications. Across all fields of surgery, the use of hybrid-ORs is gaining in traction, and neurosurgery is no exception. We hence aimed to comprehensively review the use of hybrid-ORs, the associated advantages, and disadvantages specific to the field of neurosurgery. MATERIALS AND METHODS Electronic databases were searched for all studies on hybrid-ORs from inception to May 2022. Findings of matching studies were pooled to strengthen the current body of evidence. RESULTS Seventy-four studies were included in this review. Hybrid-ORs were mainly used in endovascular surgery (n = 41) and spine surgery (n = 33). Navigation systems were the most common additional technology employed along with the CBCT systems in the hybrid-ORs. Reported advantages of hybrid-ORs included immediate assessment of outcomes, reduced surgical revision rate, and the ability to perform combined open and endovascular procedures, among others. Concerns about increased radiation exposure and procedural time were some of the limitations mentioned. CONCLUSION In the field of neurosurgery, the use of hybrid-ORs for different applications is increasing. Hybrid-ORs provide preprocedure, intraprocedure, and end-of-procedure imaging capabilities, thereby increasing surgical precision, and reducing the need for postoperative imaging and correction surgeries. Despite these advantages, radiation exposure to patient and staff is an important concern.
Collapse
Affiliation(s)
- Maria Gharios
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Victor Gabriel El-Hajj
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurosurgery, Karolinska University Hospital, Eugeniavägen 6, 4Th Floor, Solna, 17164, Stockholm, Sweden.
| | - Henrik Frisk
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Marcus Ohlsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Artur Omar
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Functional differences between primary monocyte-derived and THP-1 macrophages and their response to LCPUFAs. PHARMANUTRITION 2022. [DOI: 10.1016/j.phanu.2022.100322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
7
|
Assessing the accuracy of a new 3D2D registration algorithm based on a non-invasive skin marker model for navigated spine surgery. Int J Comput Assist Radiol Surg 2022; 17:1933-1945. [PMID: 35986831 PMCID: PMC9468112 DOI: 10.1007/s11548-022-02733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 08/04/2022] [Indexed: 11/24/2022]
Abstract
Purpose We assessed the accuracy of a new 3D2D registration algorithm to be used for navigated spine surgery and explored anatomical and radiologic parameters affecting the registration accuracy. Compared to existing 3D2D registration algorithms, the algorithm does not need bone-mounted or table-mounted instruments for registration. Neither does the intraoperative imaging device have to be tracked or calibrated. Methods The rigid registration algorithm required imaging data (a pre-existing CT scan (3D) and two angulated fluoroscopic images (2D)) to register positions of vertebrae in 3D and is based on non-invasive skin markers. The algorithm registered five adjacent vertebrae and was tested in the thoracic and lumbar spine from three human cadaveric specimens. The registration accuracy was calculated for each registered vertebra and measured with the target registration error (TRE) in millimeters. We used multivariable analysis to identify parameters independently affecting the algorithm’s accuracy such as the angulation between the two fluoroscopic images (between 40° and 90°), the detector-skin distance, the number of skin markers applied, and waist circumference. Results The algorithm registered 780 vertebrae with a median TRE of 0.51 mm [interquartile range 0.32–0.73 mm] and a maximum TRE of 2.06 mm. The TRE was most affected by the angulation between the two fluoroscopic images obtained (p < 0.001): larger angulations resulted in higher accuracy. The algorithm was more accurate in thoracic vertebrae (p = 0.004) and in the specimen with the smallest waist circumference (p = 0.003). The algorithm registered all five adjacent vertebrae with similar accuracy. Conclusion We studied the accuracy of a new 3D2D registration algorithm based on non-invasive skin markers. The algorithm registered five adjacent vertebrae with similar accuracy in the thoracic and lumbar spine and showed a maximum target registration error of approximately 2 mm. To further evaluate its potential for navigated spine surgery, the algorithm may now be integrated into a complete navigation system. Supplementary Information The online version contains supplementary material available at 10.1007/s11548-022-02733-w.
Collapse
|
8
|
Boaro A, Moscolo F, Feletti A, Polizzi G, Nunes S, Siddi F, Broekman M, Sala F. Visualization, navigation, augmentation. The ever-changing perspective of the neurosurgeon. BRAIN & SPINE 2022; 2:100926. [PMID: 36248169 PMCID: PMC9560703 DOI: 10.1016/j.bas.2022.100926] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/23/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022]
Abstract
Introduction The evolution of neurosurgery coincides with the evolution of visualization and navigation. Augmented reality technologies, with their ability to bring digital information into the real environment, have the potential to provide a new, revolutionary perspective to the neurosurgeon. Research question To provide an overview on the historical and technical aspects of visualization and navigation in neurosurgery, and to provide a systematic review on augmented reality (AR) applications in neurosurgery. Material and methods We provided an overview on the main historical milestones and technical features of visualization and navigation tools in neurosurgery. We systematically searched PubMed and Scopus databases for AR applications in neurosurgery and specifically discussed their relationship with current visualization and navigation systems, as well as main limitations. Results The evolution of visualization in neurosurgery is embodied by four magnification systems: surgical loupes, endoscope, surgical microscope and more recently the exoscope, each presenting independent features in terms of magnification capabilities, eye-hand coordination and the possibility to implement additional functions. In regard to navigation, two independent systems have been developed: the frame-based and the frame-less systems. The most frequent application setting for AR is brain surgery (71.6%), specifically neuro-oncology (36.2%) and microscope-based (29.2%), even though in the majority of cases AR applications presented their own visualization supports (66%). Discussion and conclusions The evolution of visualization and navigation in neurosurgery allowed for the development of more precise instruments; the development and clinical validation of AR applications, have the potential to be the next breakthrough, making surgeries safer, as well as improving surgical experience and reducing costs.
Collapse
Affiliation(s)
- A. Boaro
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - F. Moscolo
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - A. Feletti
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - G.M.V. Polizzi
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - S. Nunes
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| | - F. Siddi
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands
| | - M.L.D. Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Zuid-Holland, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
| | - F. Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy
| |
Collapse
|
9
|
Robertson FC, Sha RM, Amich JM, Essayed WI, Lal A, Lee BH, Calvachi Prieto P, Tokuda J, Weaver JC, Kirollos RW, Chen MW, Gormley WB. Frameless neuronavigation with computer vision and real-time tracking for bedside external ventricular drain placement: a cadaveric study. J Neurosurg 2022; 136:1475-1484. [PMID: 34653985 DOI: 10.3171/2021.5.jns211033] [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: 04/23/2021] [Accepted: 05/18/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A major obstacle to improving bedside neurosurgical procedure safety and accuracy with image guidance technologies is the lack of a rapidly deployable, real-time registration and tracking system for a moving patient. This deficiency explains the persistence of freehand placement of external ventricular drains, which has an inherent risk of inaccurate positioning, multiple passes, tract hemorrhage, and injury to adjacent brain parenchyma. Here, the authors introduce and validate a novel image registration and real-time tracking system for frameless stereotactic neuronavigation and catheter placement in the nonimmobilized patient. METHODS Computer vision technology was used to develop an algorithm that performed near-continuous, automatic, and marker-less image registration. The program fuses a subject's preprocedure CT scans to live 3D camera images (Snap-Surface), and patient movement is incorporated by artificial intelligence-driven recalibration (Real-Track). The surface registration error (SRE) and target registration error (TRE) were calculated for 5 cadaveric heads that underwent serial movements (fast and slow velocity roll, pitch, and yaw motions) and several test conditions, such as surgical draping with limited anatomical exposure and differential subject lighting. Six catheters were placed in each cadaveric head (30 total placements) with a simulated sterile technique. Postprocedure CT scans allowed comparison of planned and actual catheter positions for user error calculation. RESULTS Registration was successful for all 5 cadaveric specimens, with an overall mean (± standard deviation) SRE of 0.429 ± 0.108 mm for the catheter placements. Accuracy of TRE was maintained under 1.2 mm throughout specimen movements of low and high velocities of roll, pitch, and yaw, with the slowest recalibration time of 0.23 seconds. There were no statistically significant differences in SRE when the specimens were draped or fully undraped (p = 0.336). Performing registration in a bright versus a dimly lit environment had no statistically significant effect on SRE (p = 0.742 and 0.859, respectively). For the catheter placements, mean TRE was 0.862 ± 0.322 mm and mean user error (difference between target and actual catheter tip) was 1.674 ± 1.195 mm. CONCLUSIONS This computer vision-based registration system provided real-time tracking of cadaveric heads with a recalibration time of less than one-quarter of a second with submillimetric accuracy and enabled catheter placements with millimetric accuracy. Using this approach to guide bedside ventriculostomy could reduce complications, improve safety, and be extrapolated to other frameless stereotactic applications in awake, nonimmobilized patients.
Collapse
Affiliation(s)
- Faith C Robertson
- 1Department of Neurosurgery, Massachusetts General Hospital, Boston
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston
- 3Harvard Medical School, Boston
| | - Raahil M Sha
- 4Zeta Surgical Inc., Boston
- 5Harvard Innovation Labs, Boston
| | - Jose M Amich
- 4Zeta Surgical Inc., Boston
- 5Harvard Innovation Labs, Boston
| | - Walid Ibn Essayed
- 3Harvard Medical School, Boston
- 6Department of Neurosurgery, Brigham and Women's Hospital, Boston
| | - Avinash Lal
- 4Zeta Surgical Inc., Boston
- 5Harvard Innovation Labs, Boston
| | - Benjamin H Lee
- 4Zeta Surgical Inc., Boston
- 5Harvard Innovation Labs, Boston
| | - Paola Calvachi Prieto
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston
- 3Harvard Medical School, Boston
| | - Junichi Tokuda
- 7Department of Radiology, Brigham and Women's Hospital, Boston
| | - James C Weaver
- 8Harvard John A. Paulson School of Engineering and Applied Sciences, Cambridge, Massachusetts
| | - Ramez W Kirollos
- 9Department of Neurosurgery, National Neuroscience Institute, Singapore; and
- 10Department of Neurosurgery, SingHealth Duke-NUS, National University of Singapore, Singapore
| | - Min Wei Chen
- 9Department of Neurosurgery, National Neuroscience Institute, Singapore; and
| | - William B Gormley
- 2Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston
- 3Harvard Medical School, Boston
- 6Department of Neurosurgery, Brigham and Women's Hospital, Boston
| |
Collapse
|
10
|
Liu Y, Lee MG, Kim JS. Spine Surgery Assisted by Augmented Reality: Where Have We Been? Yonsei Med J 2022; 63:305-316. [PMID: 35352881 PMCID: PMC8965436 DOI: 10.3349/ymj.2022.63.4.305] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/02/2022] [Accepted: 02/09/2022] [Indexed: 11/27/2022] Open
Abstract
This present systematic review examines spine surgery literature supporting augmented reality (AR) technology and summarizes its current status in spinal surgery technology. Database search strategies were retrieved from PubMed, Web of Science, Cochrane Library, Embase, from the earliest records to April 1, 2021. Our review briefly examines the history of AR, and enumerates different device application workflows in a variety of spinal surgeries. We also sort out the pros and cons of current mainstream AR devices and the latest updates. A total of 45 articles are included in our review. The most prevalent surgical applications included are the augmented reality surgical navigation system and head-mounted display. The most popular application of AR is pedicle screw instrumentation in spine surgery, and the primary responsible surgical levels are thoracic and lumbar. AR guidance systems show high potential value in practical clinical applications for the spine. The overall number of cases in AR-related studies is still rare compared to traditional surgical-assisted techniques. These lack long-term clinical efficacy and robust surgical-related statistical data. Changing healthcare laws as well as the increasing prevalence of spinal surgery are generating critical data that determines the value of AR technology.
Collapse
Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min-Gi Lee
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
11
|
Alluri RK, Sivaganesan A, Vaishnav AS, Dupont M, Qureshi SA. Surface Navigation and the Influence of Navigation on MIS Surgery. Global Spine J 2022; 12:19S-26S. [PMID: 35393880 PMCID: PMC8998479 DOI: 10.1177/21925682211028587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Literature review. OBJECTIVES To review the evidence for surface-based navigation in minimally-invasive spine surgery (MIS), provide an outline for its workflow, and present a wide range of MIS case examples in which surface-based navigation may be advantageous. METHODS A comprehensive review of the literature and compilation of findings related to surface-based navigation in MIS was performed. Workflow and case examples utilizing surface-based navigation were described. RESULTS The nascent literature regarding surface-based intraoperative navigation (ION) in spine surgery is encouraging and initial studies have shown that surface-based navigation can allow for accurate pedicle screw placement and decreased operative time, fluoroscopy time, and radiation exposure when compared to traditional fluoroscopic imaging. Surface-based navigation may be particularly useful in MIS cervical and lumbar decompressions and MIS lumbar instrumentation cases. CONCLUSIONS Overall, it is possible that surface-based ION will become a mainstay in the armamentarium of enabling technologies utilized by minimally-invasive spine surgeons, but further studies are needed assessing its accuracy, complications, and cost-effectiveness.
Collapse
Affiliation(s)
| | | | | | | | - Sheeraz A. Qureshi
- Hospital for Special Surgery, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Tatter C, Fletcher-Sandersjöö A, Persson O, Burström G, Edström E, Elmi-Terander A. Fluoroscopy-Assisted C1-C2 Posterior Fixation for Atlantoaxial Instability: A Single-Center Case Series of 78 Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58010114. [PMID: 35056423 PMCID: PMC8779556 DOI: 10.3390/medicina58010114] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/23/2021] [Accepted: 01/10/2022] [Indexed: 04/21/2023]
Abstract
Background and Objectives: Posterior C1-C2 fixation, with trans-articular screws (TAS) or screw-rod-construct (SRC), is the main surgical technique for atlantoaxial instability, and can be performed with a fluoroscopy-assisted free-handed technique or 3D navigation. This study aimed to evaluate complications, radiological and functional outcome in patients treated with a fluoroscopy-assisted technique. Materials and Methods: A single-center consecutive cohort study was conducted of all adult patients who underwent posterior C1-C2 fixation, using TAS or CRS, between 2005-2019. Results: Seventy-eight patients were included, with a median follow-up time of 6.8 years. Trauma was the most common injury mechanism (64%), and cervicalgia the predominant preoperative symptom (88%). TAS was used in 33%, and SRC in 67% of cases. Surgery was associated with a significant reduction in cervicalgia (from 88% to 26%, p < 0.001). The most common complications were vertebral artery injury (n = 2, 2.6%), and screw malposition (n = 5, 6.7%, of which 2 were TAS and 3 were SRC). No patients deteriorated in their functional status following surgery. Conclusions: Fluoroscopy-assisted C1-C2 fixation with TAS or SRC is a safe and effective treatment for atlantoaxial instability, with a low complication rate, few surgical revisions, and pain relief in the majority of the cases.
Collapse
Affiliation(s)
- Charles Tatter
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: ; Tel.: +46-8-517-74-126
| | - Alexander Fletcher-Sandersjöö
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Oscar Persson
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital, 171 64 Stockholm, Sweden; (A.F.-S.); (O.P.); (G.B.); (E.E.); (A.E.-T.)
- Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
14
|
Feasibility and Accuracy of Thoracolumbar Pedicle Screw Placement Using an Augmented Reality Head Mounted Device. SENSORS 2022; 22:s22020522. [PMID: 35062483 PMCID: PMC8779462 DOI: 10.3390/s22020522] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/30/2021] [Accepted: 01/06/2022] [Indexed: 02/06/2023]
Abstract
Background: To investigate the accuracy of augmented reality (AR) navigation using the Magic Leap head mounted device (HMD), pedicle screws were minimally invasively placed in four spine phantoms. Methods: AR navigation provided by a combination of a conventional navigation system integrated with the Magic Leap head mounted device (AR-HMD) was used. Forty-eight screws were planned and inserted into Th11-L4 of the phantoms using the AR-HMD and navigated instruments. Postprocedural CT scans were used to grade the technical (deviation from the plan) and clinical (Gertzbein grade) accuracy of the screws. The time for each screw placement was recorded. Results: The mean deviation between navigation plan and screw position was 1.9 ± 0.7 mm (1.9 [0.3–4.1] mm) at the entry point and 1.4 ± 0.8 mm (1.2 [0.1–3.9] mm) at the screw tip. The angular deviation was 3.0 ± 1.4° (2.7 [0.4–6.2]°) and the mean time for screw placement was 130 ± 55 s (108 [58–437] s). The clinical accuracy was 94% according to the Gertzbein grading scale. Conclusion: The combination of an AR-HMD with a conventional navigation system for accurate minimally invasive screw placement is feasible and can exploit the benefits of AR in the perspective of the surgeon with the reliability of a conventional navigation system.
Collapse
|
15
|
Uddin SA, Hanna G, Ross L, Molina C, Urakov T, Johnson P, Kim T, Drazin D. Augmented Reality in Spinal Surgery: Highlights From Augmented Reality Lectures at the Emerging Technologies Annual Meetings. Cureus 2021; 13:e19165. [PMID: 34873508 PMCID: PMC8631483 DOI: 10.7759/cureus.19165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction Augmented reality (AR) is an advanced technology and emerging field that has been adopted into spine surgery to enhance care and outcomes. AR superimposes a three-dimensional computer-generated image over the normal anatomy of interest in order to facilitate visualization of deep structures without the ability to directly see them. Objective To summarize the latest literature and highlight AR from the annual “Spinal Navigation, Emerging Technologies and Systems Integration” meeting lectures presented by the Seattle Science Foundation (SSF) on the development and use of augmented reality in spinal surgery. Methods We performed a comprehensive literature review from 2016 to 2020 on PubMed to correlate with lectures given at the annual “Emerging Technologies” conferences. After the exclusion of papers that concerned non-spine surgery specialties, a total of 54 papers concerning AR in spinal applications were found. The articles were then categorized by content and focus. Results The 54 papers were divided into six major focused topics: training, proof of concept, feasibility and usability, clinical evaluation, state of technology, and nonsurgical applications. The greatest number of papers were published during 2020. Each paper discussed varied topics such as patient rehabilitation, proof of concept, workflow, applications in neurological and orthopedic spine surgery, and outcomes data. Conclusions The recent literature and SSF lectures on AR provide a solid base and demonstrate the emergence of an advanced technology that offers a platform for an advantageous technique that is superior, in that it allows the operating surgeon to focus directly on the patient rather than a guidance screen.
Collapse
Affiliation(s)
| | - George Hanna
- Neurosurgery, Cedars-Sinai Spine Center, Los Angeles, USA
| | - Lindsey Ross
- Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Camilo Molina
- Neurological Surgery, Washington University School of Medicine, St. Louis, USA
| | - Timur Urakov
- Neurological Surgery, University of Miami, Miami, USA
| | - Patrick Johnson
- Neurological Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Terrence Kim
- Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Doniel Drazin
- Medicine, Pacific Northwest University of Health Sciences, Yakima, USA
| |
Collapse
|
16
|
Augmented Reality (AR) in Orthopedics: Current Applications and Future Directions. Curr Rev Musculoskelet Med 2021; 14:397-405. [PMID: 34751894 DOI: 10.1007/s12178-021-09728-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Imaging technologies (X-ray, CT, MRI, and ultrasound) have revolutionized orthopedic surgery, allowing for the more efficient diagnosis, monitoring, and treatment of musculoskeletal aliments. The current review investigates recent literature surrounding the impact of augmented reality (AR) imaging technologies on orthopedic surgery. In particular, it investigates the impact that AR technologies may have on provider cognitive burden, operative times, occupational radiation exposure, and surgical precision and outcomes. RECENT FINDINGS Many AR technologies have been shown to lower provider cognitive burden and reduce operative time and radiation exposure while improving surgical precision in pre-clinical cadaveric and sawbones models. So far, only a few platforms focusing on pedicle screw placement have been approved by the FDA. These technologies have been implemented clinically with mixed results when compared to traditional free-hand approaches. It remains to be seen if current AR technologies can deliver upon their multitude of promises, and the ability to do so seems contingent upon continued technological progress. Additionally, the impact of these platforms will likely be highly conditional on clinical indication and provider type. It remains unclear if AR will be broadly accepted and utilized or if it will be reserved for niche indications where it adds significant value. One thing is clear, orthopedics' high utilization of pre- and intra-operative imaging, combined with the relative ease of tracking rigid structures like bone as compared to soft tissues, has made it the clear beachhead market for AR technologies in medicine.
Collapse
|
17
|
Sumdani H, Aguilar-Salinas P, Avila MJ, Barber SR, Dumont TM. Utility of Augmented Reality and Virtual Reality in Spine Surgery: A Systematic Review of the Literature. World Neurosurg 2021; 161:e8-e17. [PMID: 34384919 DOI: 10.1016/j.wneu.2021.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Augmented reality, virtual reality, and mixed reality (AR, VR, MR) are emerging technologies that are starting to be translated into clinical practice. There is limited data available about these tools being used in live surgery of the spine. The objective of this paper was to systematically collect, analyze, and interpret the existing data regarding AR, VR, and MR use in spine surgery on live people. METHODS A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). PubMed, PubMed Central, Cochrane Reviews, and Embase databases were searched. Combinations and variations of "augmented reality", "virtual reality", and "spine surgery" in both AND and OR configurations were used to gather relevant articles. References of included articles from the systematic review were also screened for possible inclusion as a part of manual review. Included studies were full text publications written in English that had any spine surgery on live persons with the use of virtual or augmented reality. RESULTS A total of 1566 unique articles were found, and fifteen full-text publications met criteria for this study. The total number of patients from all studies was 241 with a weighted average age of 50.37. Surgical procedures utilizing AR, VR, and/or MR were diverse and spanned from simple discectomies to intradural spinal tumor resection. All patients experienced improvement in their symptoms from clinical presentation. The highest complication rate mentioned in the articles was 6.1% and was for suboptimal pedicle screw placement. There were no complications that led to clinical sequelae. CONCLUSIONS The systematically collected, analyzed, and interpreted data of existing peer-reviewed full text articles showed favorable metrics regarding surgical efficacy, pedicle screw target accuracy, radiation exposure, clinical outcome, and disability and pain in patients with spinal pathology treated with the help of AR, VR, and/or MR.
Collapse
Affiliation(s)
- Hasan Sumdani
- The University of Arizona College of Medicine, 1501 N Campbell Avenue, Room 4303, Tucson, Arizona, 85724-5070
| | - Pedro Aguilar-Salinas
- The University of Arizona College of Medicine, 1501 N Campbell Avenue, Room 4303, Tucson, Arizona, 85724-5070
| | - Mauricio J Avila
- The University of Arizona College of Medicine, 1501 N Campbell Avenue, Room 4303, Tucson, Arizona, 85724-5070
| | - Samuel R Barber
- The University of Arizona College of Medicine, Department of Otolaryngology, 1501 N Campbell Avenue, Tucson, Arizona, 85724-5070
| | - Travis M Dumont
- The University of Arizona College of Medicine, 1501 N Campbell Avenue, Room 4303, Tucson, Arizona, 85724-5070.
| |
Collapse
|
18
|
Bi S, Gu Y, Zou J, Wang L, Zhai C, Gong M. High Precision Optical Tracking System Based on near Infrared Trinocular Stereo Vision. SENSORS 2021; 21:s21072528. [PMID: 33916582 PMCID: PMC8038438 DOI: 10.3390/s21072528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 12/25/2022]
Abstract
A high precision optical tracking system (OTS) based on near infrared (NIR) trinocular stereo vision (TSV) is presented in this paper. Compared with the traditional OTS on the basis of binocular stereo vision (BSV), hardware and software are improved. In the hardware aspect, a NIR TSV platform is built, and a new active tool is designed. Imaging markers of the tool are uniform and complete with large measurement angle (>60°). In the software aspect, the deployment of extra camera brings high computational complexity. To reduce the computational burden, a fast nearest neighbor feature point extraction algorithm (FNNF) is proposed. The proposed method increases the speed of feature points extraction by hundreds of times over the traditional pixel-by-pixel searching method. The modified NIR multi-camera calibration method and 3D reconstruction algorithm further improve the tracking accuracy. Experimental results show that the calibration accuracy of the NIR camera can reach 0.02%, positioning accuracy of markers can reach 0.0240 mm, and dynamic tracking accuracy can reach 0.0938 mm. OTS can be adopted in high-precision dynamic tracking.
Collapse
Affiliation(s)
- Songlin Bi
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230027, China; (S.B.); (J.Z.); (L.W.)
| | - Yonggang Gu
- Experiment Center of Engineering and Material Science, University of Science and Technology of China, Hefei 230027, China; (C.Z.); (M.G.)
- Correspondence:
| | - Jiaqi Zou
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230027, China; (S.B.); (J.Z.); (L.W.)
| | - Lianpo Wang
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei 230027, China; (S.B.); (J.Z.); (L.W.)
| | - Chao Zhai
- Experiment Center of Engineering and Material Science, University of Science and Technology of China, Hefei 230027, China; (C.Z.); (M.G.)
| | - Ming Gong
- Experiment Center of Engineering and Material Science, University of Science and Technology of China, Hefei 230027, China; (C.Z.); (M.G.)
| |
Collapse
|
19
|
Burström G, Persson O, Edström E, Elmi-Terander A. Augmented reality navigation in spine surgery: a systematic review. Acta Neurochir (Wien) 2021; 163:843-852. [PMID: 33506289 PMCID: PMC7886712 DOI: 10.1007/s00701-021-04708-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conventional spinal navigation solutions have been criticized for having a negative impact on time in the operating room and workflow. AR navigation could potentially alleviate some of these concerns while retaining the benefits of navigated spine surgery. The objective of this study is to summarize the current evidence for using augmented reality (AR) navigation in spine surgery. METHODS We performed a systematic review to explore the current evidence for using AR navigation in spine surgery. PubMed and Web of Science were searched from database inception to November 27, 2020, for data on the AR navigation solutions; the reported efficacy of the systems; and their impact on workflow, radiation, and cost-benefit relationships. RESULTS In this systematic review, 28 studies were included in the final analysis. The main findings were superior workflow and non-inferior accuracy when comparing AR to free-hand (FH) or conventional surgical navigation techniques. A limited number of studies indicated decreased use of radiation. There were no studies reporting mortality, morbidity, or cost-benefit relationships. CONCLUSIONS AR provides a meaningful addition to FH surgery and traditional navigation methods for spine surgery. However, the current evidence base is limited and prospective studies on clinical outcomes and cost-benefit relationships are needed.
Collapse
|
20
|
Manni F, Mamprin M, Holthuizen R, Shan C, Burström G, Elmi-Terander A, Edström E, Zinger S, de With PHN. Multi-view 3D skin feature recognition and localization for patient tracking in spinal surgery applications. Biomed Eng Online 2021; 20:6. [PMID: 33413426 PMCID: PMC7792004 DOI: 10.1186/s12938-020-00843-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Minimally invasive spine surgery is dependent on accurate navigation. Computer-assisted navigation is increasingly used in minimally invasive surgery (MIS), but current solutions require the use of reference markers in the surgical field for both patient and instruments tracking. PURPOSE To improve reliability and facilitate clinical workflow, this study proposes a new marker-free tracking framework based on skin feature recognition. METHODS Maximally Stable Extremal Regions (MSER) and Speeded Up Robust Feature (SURF) algorithms are applied for skin feature detection. The proposed tracking framework is based on a multi-camera setup for obtaining multi-view acquisitions of the surgical area. Features can then be accurately detected using MSER and SURF and afterward localized by triangulation. The triangulation error is used for assessing the localization quality in 3D. RESULTS The framework was tested on a cadaver dataset and in eight clinical cases. The detected features for the entire patient datasets were found to have an overall triangulation error of 0.207 mm for MSER and 0.204 mm for SURF. The localization accuracy was compared to a system with conventional markers, serving as a ground truth. An average accuracy of 0.627 and 0.622 mm was achieved for MSER and SURF, respectively. CONCLUSIONS This study demonstrates that skin feature localization for patient tracking in a surgical setting is feasible. The technology shows promising results in terms of detected features and localization accuracy. In the future, the framework may be further improved by exploiting extended feature processing using modern optical imaging techniques for clinical applications where patient tracking is crucial.
Collapse
Affiliation(s)
- Francesca Manni
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Marco Mamprin
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Caifeng Shan
- Shandong University of Science and Technology, Qingdao, China
| | - Gustav Burström
- Department of Neurosurgery, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Adrian Elmi-Terander
- Department of Neurosurgery, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Erik Edström
- Department of Neurosurgery, Karolinska University Hospital and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Svitlana Zinger
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter H N de With
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| |
Collapse
|
21
|
Manni F, Elmi-Terander A, Burström G, Persson O, Edström E, Holthuizen R, Shan C, Zinger S, van der Sommen F, de With PHN. Towards Optical Imaging for Spine Tracking without Markers in Navigated Spine Surgery. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3641. [PMID: 32610555 PMCID: PMC7374436 DOI: 10.3390/s20133641] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/13/2020] [Accepted: 06/22/2020] [Indexed: 12/18/2022]
Abstract
Surgical navigation systems are increasingly used for complex spine procedures to avoid neurovascular injuries and minimize the risk for reoperations. Accurate patient tracking is one of the prerequisites for optimal motion compensation and navigation. Most current optical tracking systems use dynamic reference frames (DRFs) attached to the spine, for patient movement tracking. However, the spine itself is subject to intrinsic movements which can impact the accuracy of the navigation system. In this study, we aimed to detect the actual patient spine features in different image views captured by optical cameras, in an augmented reality surgical navigation (ARSN) system. Using optical images from open spinal surgery cases, acquired by two gray-scale cameras, spinal landmarks were identified and matched in different camera views. A computer vision framework was created for preprocessing of the spine images, detecting and matching local invariant image regions. We compared four feature detection algorithms, Speeded Up Robust Feature (SURF), Maximal Stable Extremal Region (MSER), Features from Accelerated Segment Test (FAST), and Oriented FAST and Rotated BRIEF (ORB) to elucidate the best approach. The framework was validated in 23 patients and the 3D triangulation error of the matched features was < 0 . 5 mm. Thus, the findings indicate that spine feature detection can be used for accurate tracking in navigated surgery.
Collapse
Affiliation(s)
- Francesca Manni
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (S.Z.); (F.v.d.S.); (P.H.N.d.W.)
| | - Adrian Elmi-Terander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 46, Sweden & Department of Neurosurgery, Karolinska University Hospital, SE-171 46 Stockholm, Sweden; (A.E.-T.); (G.B.); (O.P.); (E.E.)
| | - Gustav Burström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 46, Sweden & Department of Neurosurgery, Karolinska University Hospital, SE-171 46 Stockholm, Sweden; (A.E.-T.); (G.B.); (O.P.); (E.E.)
| | - Oscar Persson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 46, Sweden & Department of Neurosurgery, Karolinska University Hospital, SE-171 46 Stockholm, Sweden; (A.E.-T.); (G.B.); (O.P.); (E.E.)
| | - Erik Edström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm SE-171 46, Sweden & Department of Neurosurgery, Karolinska University Hospital, SE-171 46 Stockholm, Sweden; (A.E.-T.); (G.B.); (O.P.); (E.E.)
| | | | - Caifeng Shan
- Philips Research, High Tech Campus 36, 5656 AE Eindhoven, The Netherlands;
| | - Svitlana Zinger
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (S.Z.); (F.v.d.S.); (P.H.N.d.W.)
| | - Fons van der Sommen
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (S.Z.); (F.v.d.S.); (P.H.N.d.W.)
| | - Peter H. N. de With
- Department of Electrical Engineering, Eindhoven University of Technology, 5600 MB Eindhoven, The Netherlands; (S.Z.); (F.v.d.S.); (P.H.N.d.W.)
| |
Collapse
|