Optimal display conditions for quantitative analysis of stereoscopic cerebral angiograms

Image-guidance for surgical procedures

Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.

Skeletonization of volumetric angiograms for display

The display of three-dimensional angiograms can benefit from the knowledge of quantitative shape features such as tangent and curvature of the centerline of vessels. These can be obtained from a curve-like skeleton representation. If connectivity and topology are preserved, and if geometrical constraints such as smoothness and centeredness are satisfied, it is possible to estimate length, orientation, curvature, and torsion. It is also required that no part of the original object be left unrepresented. An efficient method for the identification of such shape components is developed. First, a suitable representation is obtained using a voxel coding approach to yield connected and labeled unit-thick paths. The desired features are estimated from a smoothed version of the skeleton produced by a moving average filter. The computational cost is linear, of the order of N(object), the total number of object voxels contained in the binary volumetric data. The method is also shown to be robust to boundary noise. Examples are discussed.

Image-guided surgery: from X-rays to virtual reality

Since the discovery of X-rays, medical imaging has played a major role in the guidance of surgical procedures. While medical imaging began with simple X-ray plates to indicate the presence of foreign objects within the human body, the advent of the computer has been a major factor in the recent development of this field. Imaging techniques have grown greatly in their sophistication and can now provide the surgeon with high quality three-dimensional images depicting not only the normal anatomy and pathology, but also vascularity and function. One key factor in the advances in Image-Guided Surgery (IGS) is the ability not only to register images derived from the various imaging modalities amongst themselves, but also to register them to the patient. The other crucial aspect of IGS is the ability to track instruments in real time during the procedure, and to portray them as part of a realistic model of the operative volume. Stereoscopic and virtual-reality techniques can usefully enhance the visualization process. IGS nevertheless relies heavily on the assumption that the images acquired prior to surgery, and upon which the surgical guidance is based, accurately represent the morphology of the tissue during the surgical procedure. In many instances this assumption is invalid, and intra-operative real-time imaging, using interventional MRI, Ultrasound, and electrophysiological recordings are often employed to overcome this limitation. Although now in extensive clinical use, IGS is often currently perceived as an intrusion into the operating room. It must evolve towards becoming a routine surgical tool, but this will only happen if natural and intuitive human interfaces are developed for these systems.

Modeling and optimization of rotational C-arm stereoscopic X-ray angiography

Stereoscopy can be an effective method for obtaining three-dimensional (3-D) spatial information from two-dimensional (2-D) projection X-ray images, without the need for tomographic reconstruction. This much-needed information is missed in many X-ray diagnostic and interventional procedures, such as the treatment of vascular aneurysms. Fast C-arm X-ray systems can obtain multiple angle sequences of stereoscopic image pairs from a single contrast injection and a single breath hold. To advance this solution, we developed a model of stereo angiography, performed perception experiments and related results to optimal acquisition. The model described horizontal disparity for the C-arm geometry that agreed very well with measurements from a geometric phantom. The perceptual accommodation-convergence conflict and geometry limited the effective stereoscopic field of view (SFOV). For a typical large image intensifier system, it was 28 cm x 31 cm at the center of rotation (COR). In the model, blurring from finite focal-spot size and C-arm motion reduced depth resolution on the digital display. Near the COR, the predicted depth resolution was 3-11 mm for a viewing angle of 7 degrees , which agreed favorably with results from recently published studies. The model also described how acquisition parameters affected spatial warping of curves of equal apparent depth. Pincushioning and the difference between the acquisition and display geometry were found to introduce additional distortions to stereo displays. Preference studies on X-ray angiograms indicated that the ideal viewing angle should be small (1-2 degrees), which agreed with some previously published work. Perceptual studies indicated that stereo angiograms should have high artery contrast and that digital processing to increase contrast improved stereopsis. Digital subtraction angiograms, with different motion errors between the left and right-eye views, gave artifacts that confused stereopsis. The addition of background to subtracted images reduced this effect and provided other features for improved depth perception. Using the modeling results and typical clinical angiography requirements, we recommend acquisition protocols and engineering specifications that are achievable on current high-end systems.