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Supanich M, Siewerdsen J, Fahrig R, Farahani K, Gang GJ, Helm P, Jans J, Jones K, Koenig T, Kuhls-Gilcrist A, Lin M, Riddell C, Ritschl L, Schafer S, Schueler B, Silver M, Timmer J, Trousset Y, Zhang J. AAPM Task Group Report 238: 3D C-arms with volumetric imaging capability. Med Phys 2023; 50:e904-e945. [PMID: 36710257 DOI: 10.1002/mp.16245] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 12/21/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023] Open
Abstract
This report reviews the image acquisition and reconstruction characteristics of C-arm Cone Beam Computed Tomography (C-arm CBCT) systems and provides guidance on quality control of C-arm systems with this volumetric imaging capability. The concepts of 3D image reconstruction, geometric calibration, image quality, and dosimetry covered in this report are also pertinent to CBCT for Image-Guided Radiation Therapy (IGRT). However, IGRT systems introduce a number of additional considerations, such as geometric alignment of the imaging at treatment isocenter, which are beyond the scope of the charge to the task group and the report. Section 1 provides an introduction to C-arm CBCT systems and reviews a variety of clinical applications. Section 2 briefly presents nomenclature specific or unique to these systems. A short review of C-arm fluoroscopy quality control (QC) in relation to 3D C-arm imaging is given in Section 3. Section 4 discusses system calibration, including geometric calibration and uniformity calibration. A review of the unique approaches and challenges to 3D reconstruction of data sets acquired by C-arm CBCT systems is give in Section 5. Sections 6 and 7 go in greater depth to address the performance assessment of C-arm CBCT units. First, Section 6 describes testing approaches and phantoms that may be used to evaluate image quality (spatial resolution and image noise and artifacts) and identifies several factors that affect image quality. Section 7 describes both free-in-air and in-phantom approaches to evaluating radiation dose indices. The methodologies described for assessing image quality and radiation dose may be used for annual constancy assessment and comparisons among different systems to help medical physicists determine when a system is not operating as expected. Baseline measurements taken either at installation or after a full preventative maintenance service call can also provide valuable data to help determine whether the performance of the system is acceptable. Collecting image quality and radiation dose data on existing phantoms used for CT image quality and radiation dose assessment, or on newly developed phantoms, will inform the development of performance criteria and standards. Phantom images are also useful for identifying and evaluating artifacts. In particular, comparing baseline data with those from current phantom images can reveal the need for system calibration before image artifacts are detected in clinical practice. Examples of artifacts are provided in Sections 4, 5, and 6.
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Affiliation(s)
- Mark Supanich
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Pat Helm
- Medtronic Inc., Minneapolis, Minnesota, USA
| | | | - Kyle Jones
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | | | - MingDe Lin
- Yale University, New Haven, Connecticut, USA
| | | | | | | | | | - Mike Silver
- Canon Medical Systems USA, Long Beach, California, USA
| | | | | | - Jie Zhang
- University of Kentucky, Lexington, Kentucky
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2
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Lui JT, Dahm V, Chen JM, Lin VY, Irish JC, Le TN, Chan HHL. Using augmented reality to guide bone conduction device implantation. Sci Rep 2023; 13:7182. [PMID: 37137995 PMCID: PMC10156678 DOI: 10.1038/s41598-023-33523-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
Exact placement of bone conduction implants requires avoidance of critical structures. Existing guidance technologies for intraoperative placement have lacked widespread adoption given accessibility challenges and significant cognitive loading. The purpose of this study is to examine the application of augmented reality (AR) guided surgery on accuracy, duration, and ease on bone conduction implantation. Five surgeons surgically implanted two different types of conduction implants on cadaveric specimens with and without AR projection. Pre- and postoperative computer tomography scans were superimposed to calculate centre-to-centre distances and angular accuracies. Wilcoxon signed-rank testing was used to compare centre-to-centre (C-C) and angular accuracies between the control and experimental arms. Additionally, projection accuracy was derived from the distance between the bony fiducials and the projected fiducials using image guidance coordinates. Both operative time (4.3 ± 1.2 min. vs. 6.6 ± 3.5 min., p = 0.030) and centre-to-centre distances surgery (1.9 ± 1.6 mm vs. 9.0 ± 5.3 mm, p < 0.001) were significantly less in augmented reality guided surgery. The difference in angular accuracy, however, was not significantly different. The overall average distance between the bony fiducial markings and the AR projected fiducials was 1.7 ± 0.6 mm. With direct intraoperative reference, AR-guided surgery enhances bone conduction implant placement while reduces operative time when compared to conventional surgical planning.
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Affiliation(s)
- Justin T Lui
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Valerie Dahm
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Joseph M Chen
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Vincent Y Lin
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
- Guided Therapeutics (GTx) Program, Techna Research Institute, University Health Network, Toronto, Canada
| | - Trung N Le
- Department of Otolaryngology-Head & Neck Surgery, Temerty School of Medicine, University of Toronto, Toronto, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Research Institute, University Health Network, Toronto, Canada.
- Techna Institute for the Advancement of Technology for Health, University Health Network, 100 College Street, Room 7-207, MaRS Building, Princess Margaret Cancer Research Tower, 7th Floor (STTARR), Toronto, ON, M5G 1P5, Canada.
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3
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Sritharan R, Arya R, Abdelrahman A, Parmar S, Sharp I, Breeze J. Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes. Br J Oral Maxillofac Surg 2023; 61:315-319. [PMID: 37088595 DOI: 10.1016/j.bjoms.2023.03.010] [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] [Received: 10/12/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified. Those developing complications including RTT were determined. All postoperative CT scans (including those without complication or RTT) were re-analysed with the clinicians blinded to the outcomes to determine the positive predictive value (PPV) and negative predictive value (NPV) of requiring RTT to alter plate position intraoperatively based on CT scan alone. In all, there were eight episodes of unplanned return to theatre, resulting in an overall RTT rate of 8/119 (6.7%). When only analysing patients treated for orbital fractures this RTT rises to 8/40 (20%). Of those eight patients who had a postoperative CT and required RTT, this could have been predicted in 7/8 (87.5%). A total of 16/44 (36.4%) patients that did not have RTT would have additionally been recommended to have the plate position altered based on CT alone. Based upon those that had a CT, the PPV of CT alone being able to predict those requiring RTT was 40.6% and the NPV 96.2%. Our results would suggest intraoperative CT would likely have prevented eight patients requiring RTT in two years and could have improved outcomes in 16 cases. In preventing RTT as well as potentially improving the outcomes of a further 16 cases in maxillofacial surgery, the purchase of an intraoperative CT scanner could yield net savings of £75534-£114990 over two years.
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Affiliation(s)
- R Sritharan
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
| | - R Arya
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - A Abdelrahman
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - S Parmar
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - I Sharp
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - J Breeze
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
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4
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Karius A, Szkitsak J, Boronikolas V, Fietkau R, Bert C. Quality assurance and long-term stability of a novel 3-in-1 X-ray system for brachytherapy. J Appl Clin Med Phys 2022; 23:e13727. [PMID: 35848090 PMCID: PMC9512339 DOI: 10.1002/acm2.13727] [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: 03/09/2022] [Revised: 05/20/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose A novel, mobile 3‐in‐1 X‐ray system featuring radiography, fluoroscopy, and cone‐beam computed tomography (CBCT) has been launched for brachytherapy recently. Currently, there is no quality assurance (QA) procedure explicitly applicable to this system equipped with innovative technologies such as dynamic jaws and motorized lasers. We developed a dedicated QA procedure and, based on its performance for a duration of 6 months, provide an assessment of the device's stability over time. Methods With the developed QA procedure, we assessed the system's planar and CBCT‐imaging performance by investigating geometric accuracy, CT‐number stability, contrast‐noise‐ratio, uniformity, spatial resolution, low‐contrast detectability, dynamic range, and X‐ray exposure using dedicated phantoms. Furthermore, we evaluated geometric stability by using the flexmap‐approach and investigated the device's laser‐ and jaw‐positioning accuracy with an in‐house test phantom. CBCT‐ and planar‐imaging protocols for pelvis, breast, and abdomen imaging were examined. Results Planar‐ and CBCT‐imaging performances were widely stable with a geometric accuracy ≤1 mm, CT‐number stability of up to 46 HU, and uniformity variations of up to 48 HU over time. For planar imaging, low‐contrast detectability and dynamic range exceeded current recommendations. Although geometric stability was considered tolerable, partly substantial positioning inaccuracies of up to more than 120 mm and −13 mm were obtained for lasers and jaws, respectively. X‐ray exposure showed small variations of ≤0.56 μGy and ≤0.76 mGy for planar‐ and CBCT‐imaging, respectively. The conductance of the QA procedure allowed a smooth evaluation of the system's overall performance. Conclusion We developed a QA workflow for a novel 3‐in‐1 X‐ray system allowing to assess the device's imaging and hardware performance. The system showed in general a reasonable imaging performance and stability over time, whereas improvements regarding laser and jaw accuracy are strictly required.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vasilios Boronikolas
- Abteilung für medizinische Physik, Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland.,Partnerstandort Freiburg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Freiburg im Breisgau, Deutschland.,Partnerstandort Freiburg, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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5
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Sheth NM, Uneri A, Helm PA, Zbijewski W, Siewerdsen JH. Technical assessment of 2D and 3D imaging performance of an IGZO-based flat-panel X-ray detector. Med Phys 2022; 49:3053-3066. [PMID: 35363391 PMCID: PMC10153656 DOI: 10.1002/mp.15605] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Indirect detection flat-panel detectors (FPDs) consisting of hydrogenated amorphous silicon (a-Si:H) thin-film transistors (TFTs) are a prevalent technology for digital x-ray imaging. However, their performance is challenged in applications requiring low exposure levels, high spatial resolution, and high frame rate. Emerging FPD designs using metal oxide TFTs may offer potential performance improvements compared to FPDs based on a-Si:H TFTs. PURPOSE This work investigates the imaging performance of a new indium gallium zinc oxide (IGZO) TFT-based detector in 2D fluoroscopy and 3D cone-beam CT (CBCT). METHODS The new FPD consists of a sensor array combining IGZO TFTs with a-Si:H photodiodes and a 0.7-mm thick CsI:Tl scintillator. The FPD was implemented on an x-ray imaging bench with system geometry emulating intraoperative CBCT. A conventional FPD with a-Si:H TFTs and a 0.6-mm thick CsI:Tl scintillator was similarly implemented as a basis of comparison. 2D imaging performance was characterized in terms of electronic noise, sensitivity, linearity, lag, spatial resolution (modulation transfer function, MTF), image noise (noise-power spectrum, NPS), and detective quantum efficiency (DQE) with entrance air kerma (EAK) ranging from 0.3 to 1.2 μGy. 3D imaging performance was evaluated in terms of the 3D MTF and noise-equivalent quanta (NEQ), soft-tissue contrast-to-noise ratio (CNR), and image quality evident in anthropomorphic phantoms for a range of anatomical sites and dose, with weighted air kerma, K w ${K_w}$ , ranging from 0.8 to 4.9 mGy. RESULTS The 2D imaging performance of the IGZO-based FPD exhibited up to ∼1.7× lower electronic noise than the a-Si:H FPD at matched pixel pitch. Furthermore, the IGZO FPD exhibited ∼27% increase in mid-frequency DQE (1 mm-1 ) at matched pixel size and dose (EAK ≈ 1.0 μGy) and ∼11% increase after adjusting for differences in scintillator thickness. 2D spatial resolution was limited by the scintillator for each FPD. The IGZO-based FPD demonstrated improved 3D NEQ at all spatial frequencies in both head (≥25% increase for all dose levels) and body (≥10% increase for K w ${K_w}$ ≤2 mGy) imaging scenarios. These characteristics translated to improved low-contrast visualization in anthropomorphic phantoms, demonstrating ≥10% improvement in CNR and extension of the low-dose range for which the detector is input-quantum limited. CONCLUSION The IGZO-based FPD demonstrated improvements in electronic noise, image lag, and NEQ that translated to measurable improvements in 2D and 3D imaging performance compared to a conventional FPD based on a-Si:H TFTs. The improvements are most beneficial for 2D or 3D imaging scenarios involving low-dose and/or high-frame rate.
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Affiliation(s)
- Niral Milan Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ali Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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6
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Han M, Kim HJ, Choi JW, Park D, Han JG. Diagnostic usefulness of cone‐beam computed tomography versus multi‐detector computed tomography for sinonasal structure evaluation. Laryngoscope Investig Otolaryngol 2022; 7:662-670. [PMID: 35734052 PMCID: PMC9195011 DOI: 10.1002/lio2.792] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
Objective Cone‐beam computed tomography (CBCT) is a promising imaging modality for sinonasal evaluation, with advantages of relatively low radiation dose, low cost, and quick outpatient imaging. Our study aimed to compare the diagnostic performance and image quality of CBCT with those of multi‐detector computed tomography (MDCT) with different slice thickness. Methods We retrospectively reviewed 60 consecutive patients who had undergone both CBCT and MDCT. MDCT images was reconstructed with 1 and 3 mm slice thickness. The quantitative image quality parameters (image noise, signal‐to‐noise ratio [SNR], and contrast‐to noise ratio [CNR] were calculated and compared between the two imaging modalities. Two observers (ENT surgeon and neuroradiologist) evaluated the presence of seven sinonasal anatomic variations in each patient and interobserver agreements were analyzed. The diagnostic performance of CBCT (0.3 mm) and MDCT (3 mm) was assessed and compared with that of high resolution MDCT (1 mm), which is considered as the gold standard. Results The image noise was significantly higher and SNR and CNR values were lower in the CBCT (0.3 mm) group than in the MDCT groups (1 and 3 mm). The diagnostic performance of CBCT (0.3 mm) was similar to that of MDCT (1 mm) and superior to that of MDCT (3 mm). The highest interobserver agreement was for high resolution MDCT (1 mm), followed by CBCT (0.3 mm), and MDCT (3 mm). Conclusion Considering its low radiation dose, low cost, and ease of clinical access, CBCT may be a useful imaging modality for as first line sinonasal evaluation and repeated follow up. Study design: Retrospective study in a tertiary referral university center. Level of evidence: NA.
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Affiliation(s)
- Miran Han
- Department of Radiology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
- Department of Radiology Graduate School of Kangwon National University Chuncheon Republic of Korea
| | - Hyun Jun Kim
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Jin Wook Choi
- Department of Radiology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Do‐Yang Park
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
| | - Jang Gyu Han
- Department of Otolaryngology Ajou University Hospital, Ajou University School of Medicine Suwon Republic of Korea
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7
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Karius A, Strnad V, Lotter M, Kreppner S, Bert C. First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy. Strahlenther Onkol 2022; 198:573-581. [PMID: 35278094 PMCID: PMC9165284 DOI: 10.1007/s00066-022-01912-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
Abstract
Background and purpose On-site cone-beam computed tomography (CBCT) has gained in importance in adaptive brachytherapy during recent years. Besides treatment planning, there is increased need particularly for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide. We present the first clinical images and experiences. Materials and methods The novel CBCT system is constructed of a 121 cm diameter ring gantry, and features a 43.2 × 43.2 cm2 flat-panel detector, wireless remote-control via tablet-PC, and battery-powered maneuverability. Within the first months of clinical operation, we performed CBCT-based treatment QA for a total of 26 patients (8 with breast, 16 with cervix, and 2 with vaginal cancer). CBCT scans were analyzed regarding potential movements of implanted applicators in-situ during the brachytherapy course. Results With the presented device, treatment QA was feasible for the majority of patients. The CBCT scans of breast patients showed sufficient contrast between implanted catheters and tissue. For gynecologic patients, a distinct visualization of applicators was achieved in general. However, reasonable differentiations of organic soft tissues were not feasible. Conclusion The CBCT system allowed basic treatment QA measures for breast and gynecologic patients. For image-guidance during interventional brachytherapy procedures, the current image quality is not adequate. Substantial performance enhancements are required for intraoperative image-guidance.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany. .,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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8
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Karius A, Karolczak M, Strnad V, Bert C. Technical evaluation of the cone-beam computed tomography imaging performance of a novel, mobile, gantry-based X-ray system for brachytherapy. J Appl Clin Med Phys 2021; 23:e13501. [PMID: 34905285 PMCID: PMC8833290 DOI: 10.1002/acm2.13501] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose A novel, mobile cone‐beam computed tomography (CBCT) system for image‐guided adaptive brachytherapy was recently deployed at our hospital as worldwide first site. Prior to the device's clinical operation, a profound characterization of its imaging performance was conducted. This was essential to optimize both the imaging workflow and image quality for achieving the best possible clinical outcomes. We present the results of our investigations. Methods The novel CBCT‐system features a ring gantry with 121 cm clearance as well as a 43.2 × 43.2 cm2 flat‐panel detector, and is controlled via a tablet‐personal computer (PC). For evaluating its imaging performance, the geometric reproducibility as well as imaging fidelity, computed tomography (CT)‐number accuracy, uniformity, contrast‐noise‐ratio (CNR), noise characteristics, and spatial resolution as fundamental image quality parameters were assessed. As dose metric the weighted cone‐beam dose index (CBDIw) was measured. Image quality was evaluated using standard quality assurance (QA) as well as anthropomorphic upper torso and breast phantoms. Both in‐house and manufacturer protocols for abdomen, pelvis, and breast imaging were examined. Results Using the in‐house protocols, the QA phantom scans showed altogether a high image quality, with high CT‐number accuracy (R2 > 0.97) and uniformity (<12 Hounsfield Unit (HU) cupping), reasonable noise and imaging fidelity, and good CNR at bone–tissue transitions of up to 28:1. Spatial resolution was strongly limited by geometric instabilities of the device. The breast phantom scans fulfilled clinical requirements, whereas the abdomen and pelvis scans showed severe artifacts, particularly at air/bone–tissue transitions. Conclusion With the novel CBCT‐system, achieving a high image quality appears possible in principle. However, adaptations of the standard protocols, performance enhancements in image reconstruction referring to artifact reductions, as well as the extinction of geometric instabilities are imperative.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Marek Karolczak
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Henkestraße 91, Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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9
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Taboni S, Ferrari M, Daly MJ, Chan HHL, Eu D, Gualtieri T, Jethwa AR, Sahovaler A, Sewell A, Hasan W, Berania I, Qiu J, de Almeida J, Nicolai P, Gilbert RW, Irish JC. Navigation-Guided Transnasal Endoscopic Delineation of the Posterior Margin for Maxillary Sinus Cancers: A Preclinical Study. Front Oncol 2021; 11:747227. [PMID: 34858824 PMCID: PMC8632239 DOI: 10.3389/fonc.2021.747227] [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: 07/25/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background The resection of advanced maxillary sinus cancers can be challenging due to the anatomical proximity to surrounding critical anatomical structures. Transnasal endoscopy can effectively aid the delineation of the posterior margin of resection. Implementation with 3D-rendered surgical navigation with virtual endoscopy (3D-SNVE) may represent a step forward. This study aimed to demonstrate and quantify the benefits of this technology. Material and Method Four maxillary tumor models with critical posterior extension were created in four artificial skulls (Sawbones®). Images were acquired with cone-beam computed tomography and the tumor and carotid were contoured. Eight head and neck surgeons were recruited for the simulations. Surgeons delineated the posterior margin of resection through a transnasal approach and avoided the carotid while establishing an adequate resection margin with respect to tumor extirpation. Three simulations were performed: 1) unguided: based on a pre-simulation study of cross-sectional imaging; 2) tumor-guided: guided by real-time tool tracking with 3D tumor and carotid rendering; 3) carotid-guided: tumor-guided with a 2-mm alert cloud surrounding the carotid. Distances of the planes from the carotid and tumor were classified as follows and the points of the plane were classified accordingly: “red”: through the carotid artery; “orange”: <2 mm from the carotid; “yellow”: >2 mm from the carotid and within the tumor or <5 mm from the tumor; “green”: >2 mm from the carotid and 5–10 mm from the tumor; and “blue”: >2 mm from the carotid and >10 mm from the tumor. The three techniques (unguided, tumor-guided, and carotid-guided) were compared. Results 3D-SNVE for the transnasal delineation of the posterior margin in maxillary tumor models significantly improved the rate of margin-negative clearance around the tumor and reduced damage to the carotid artery. “Green” cuts occurred in 52.4% in the unguided setting versus 62.1% and 64.9% in the tumor- and carotid-guided settings, respectively (p < 0.0001). “Red” cuts occurred 6.7% of the time in the unguided setting versus 0.9% and 1.0% in the tumor- and carotid-guided settings, respectively (p < 0.0001). Conclusions This preclinical study has demonstrated that 3D-SNVE provides a substantial improvement of the posterior margin delineation in terms of safety and oncological adequacy. Translation into the clinical setting, with a meticulous assessment of the oncological outcomes, will be the proposed next step.
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Affiliation(s)
- Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Artificial Intelligence in Medicine and Innovation in Clinical Research and Methodology (PhD Program), Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,University Health Network (UHN) Guided Therapeutics (GTx) Program International Scholar, Toronto, ON, Canada.,Technology for Health (PhD Program), Department of Information Engineering, University of Brescia, Brescia, Italy
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia-"ASST Spedali Civili di Brescia", Brescia, Italy
| | - Ashok R Jethwa
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Head & Neck Surgery, University College London Hospital, London, United Kingdom
| | - Andrew Sewell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Wael Hasan
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Ilyes Berania
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua-"Azienda Ospedaliera di Padova", Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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10
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Sahovaler A, Chan HHL, Gualtieri T, Daly M, Ferrari M, Vannelli C, Eu D, Manojlovic-Kolarski M, Orzell S, Taboni S, de Almeida JR, Goldstein DP, Deganello A, Nicolai P, Gilbert RW, Irish JC. Augmented Reality and Intraoperative Navigation in Sinonasal Malignancies: A Preclinical Study. Front Oncol 2021; 11:723509. [PMID: 34790568 PMCID: PMC8591179 DOI: 10.3389/fonc.2021.723509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
Objective To report the first use of a novel projected augmented reality (AR) system in open sinonasal tumor resections in preclinical models and to compare the AR approach with an advanced intraoperative navigation (IN) system. Methods Four tumor models were created. Five head and neck surgeons participated in the study performing virtual osteotomies. Unguided, AR, IN, and AR + IN simulations were performed. Statistical comparisons between approaches were obtained. Intratumoral cut rate was the main outcome. The groups were also compared in terms of percentage of intratumoral, close, adequate, and excessive distances from the tumor. Information on a wearable gaze tracker headset and NASA Task Load Index questionnaire results were analyzed as well. Results A total of 335 cuts were simulated. Intratumoral cuts were observed in 20.7%, 9.4%, 1.2,% and 0% of the unguided, AR, IN, and AR + IN simulations, respectively (p < 0.0001). The AR was superior than the unguided approach in univariate and multivariate models. The percentage of time looking at the screen during the procedures was 55.5% for the unguided approaches and 0%, 78.5%, and 61.8% in AR, IN, and AR + IN, respectively (p < 0.001). The combined approach significantly reduced the screen time compared with the IN procedure alone. Conclusion We reported the use of a novel AR system for oncological resections in open sinonasal approaches, with improved margin delineation compared with unguided techniques. AR improved the gaze-toggling drawback of IN. Further refinements of the AR system are needed before translating our experience to clinical practice.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Tommaso Gualtieri
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Michael Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Marco Ferrari
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Claire Vannelli
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Donovan Eu
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Mirko Manojlovic-Kolarski
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Susannah Orzell
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Stefano Taboni
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy.,Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia-ASST "Spedali Civili di Brescia, Brescia, Italy
| | - Piero Nicolai
- Section of Otorhinolaryngology-Head and Neck Surgery, University of Padua-Azienda Ospedaliera di Padova, Padua, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, ON, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, ON, Canada
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11
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Muhanna N, Douglas CM, Chan HHL, Daly MJ, Townson JL, Ferrari M, Eu D, Akens M, Chen J, Zheng G, Irish JC. Rabbit VX2 head and neck squamous cell models for translational head and neck theranostic technology development. Clin Transl Med 2021; 11:e550. [PMID: 34709737 PMCID: PMC8506636 DOI: 10.1002/ctm2.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Nidal Muhanna
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Catriona M Douglas
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada
| | - Jason L Townson
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada
| | - Marco Ferrari
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Unit of Otorhinolaryngology-Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Donovan Eu
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Margarete Akens
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada
| | - Juan Chen
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada
| | - Gang Zheng
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada
| | - Jonathan C Irish
- Guided Therapeutics (GTx) Program, Princess Margaret Cancer Centre/University Health Network, TECHNA Institute, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, Ontario, Canada
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12
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Moon S, Choi S, Jang H, Shin M, Roh Y, Baek J. Geometry calibration and image reconstruction for carbon-nanotube-based multisource and multidetector CT. Phys Med Biol 2021; 66. [PMID: 34289459 DOI: 10.1088/1361-6560/ac16c1] [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] [Received: 03/22/2021] [Accepted: 07/21/2021] [Indexed: 11/12/2022]
Abstract
Conventional intraoperative computed tomography (CT) has a long scan time, degrading the image quality. Its large size limits the position of a surgeon during surgery. Therefore, this study proposes a CT system comprising of eight carbon-nanotube (CNT)-based x-ray sources and 16 detector modules to solve these limitations. Gantry only requires 45° of rotation to acquire the whole projection, reducing the scan time to 1/8 compared to the full rotation. Moreover, the volume and scan time of the system can be significantly reduced using CNT sources with a small volume and short pulse width and placing a heavy and large high-voltage generator outside the gantry. We divided the proposed system into eight subsystems and sequentially devised a geometry calibration method for each subsystem. Accordingly, a calibration phantom consisting of four polytetrafluoroethylene beads, each with 15 mm diameter, was designed. The geometry calibration parameters were estimated by minimizing the difference between the measured bead projection and the forward projection of the formulated subsystem. By reflecting the estimated geometry calibration parameters, the projection data were obtained via rebinning to be used in the filtered-backprojection reconstruction. The proposed calibration and reconstruction methods were validated by computer simulations and real experiments. Additionally, the accuracy of the geometry calibration method was examined by computer simulation. Furthermore, we validated the improved quality of the reconstructed image through the mean-squared error (MSE), structure similarity (SSIM), and visual inspections for both the simulated and experimental data. The results show that the calibrated images, reconstructed by reflecting the calibration results, have smaller MSE and higher SSIM values than the uncalibrated images. The calibrated images were observed to have fewer artifacts than the uncalibrated images in visual inspection, demonstrating that the proposed calibration and reconstruction methods effectively reduce artifacts caused by geometry misalignments.
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Affiliation(s)
- Seunghyuk Moon
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Seungwon Choi
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Hanjoo Jang
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
| | - Minsik Shin
- KohYoung Technology, Yongin, Republic Of Korea
| | | | - Jongduk Baek
- School of Integrated Technology, Yonsei University, Incheon, Republic Of Korea
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13
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Bessen SY, Wu X, Sramek MT, Shi Y, Pastel D, Halter R, Paydarfar JA. Image-guided surgery in otolaryngology: A review of current applications and future directions in head and neck surgery. Head Neck 2021; 43:2534-2553. [PMID: 34032338 DOI: 10.1002/hed.26743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/20/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023] Open
Abstract
Image-guided surgery (IGS) has become a widely adopted technology in otolaryngology. Since its introduction nearly three decades ago, IGS technology has developed rapidly and improved real-time intraoperative visualization for a diverse array of clinical indications. As usability, accessibility, and clinical experiences with IGS increase, its potential applications as an adjunct in many surgical procedures continue to expand. Here, we describe the basic components of IGS and review both the current state and future directions of IGS in otolaryngology, with attention to current challenges to its application in surgery of the nonrigid upper aerodigestive tract.
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Affiliation(s)
- Sarah Y Bessen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Xiaotian Wu
- Massachussetts General Hospital, Boston, Massachusetts, USA
| | - Michael T Sramek
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Yuan Shi
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
| | - David Pastel
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Ryan Halter
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA
| | - Joseph A Paydarfar
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Thayer School of Engineering at Dartmouth, Hanover, New Hampshire, USA.,Department of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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14
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Chen T, Liu G, Mu Y, Xu WH, Guo YT, Guo J, Chen YD. Application of cardiac computed tomographic imaging and fluoroscopy fusion for guiding left atrial appendage occlusion. Int J Cardiol 2021; 331:289-295. [PMID: 33529659 DOI: 10.1016/j.ijcard.2021.01.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Evaluate the value of 3D computed tomography (CT) and CT-integrating fluoroscopy for procedural guidance during WATCHMAN implantation. METHODS This observational study compared the clinical and procedural parameters for LAAO with and without fusion imaging. Forty-one pairs of patients-matched by procedure month and with or without the use of the image fusion system-were enrolled. Using the image fusion Advanced Workstation 4.6 software (GE Healthcare), we identified the 3D cardiac anatomy and safe zones for septal punch. The LAA orifice anatomy outlines were then projected onto the real-time fluoroscopy image during the procedure to guide all the steps of LAAO. RESULTS The use of image fusion significantly reduced the procedural time, compared to the time required for the control group (44.73 ± 20.03 min vs. 63.73 ± 26.10 min, respectively; P < 0.001). When compared to the standard procedure, the use of image fusion significantly reduced both the total radiation dose (448.80 ± 556.35 mGy vs. 798.42 ± 616.34 mGy; P = 0.004) and dose area product (DAP) (38.03 ± 47.15 Gy∙cm2 vs. 67.66 ± 52.23 Gy∙cm2, P = 0.004). Corresponding to the radiation dose, the contrast volume was also reduced (67.32 ± 18.65 vs. 90.98 ± 25.03 ml; P = 0.0004). During short-term follow-up at 6 months, there was only one femoral hematoma and incomplete LAA sealing (>3 mm) in either group. CONCLUSIONS Automated real-time integration of cardiac CT and fluoroscopy is feasible, safe, and applicable in LAAO. It may significantly reduce the radiation exposure, procedure duration, and volume of contrast media. Following these results, the potential of merging reconstructed 3D CT scans with real-time coronary angiography should be fully exploited in LAAO.
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Affiliation(s)
- Tao Chen
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China.
| | - Ge Liu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Yang Mu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Wei-Hao Xu
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Yu-Tao Guo
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
| | - Jun Guo
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China.
| | - Yun-Dai Chen
- Department of Cardiovascular, Chinese PLA General Hospital, Beijing 100853, China
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15
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Muhanna N, Eu D, Chan HH, Daly M, Fricke IB, Douglas CM, Townson JL, Zheng J, Allen C, Jaffray DA, Irish JC. Assessment of a liposomal CT/optical contrast agent for image-guided head and neck surgery. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 32:102327. [PMID: 33220507 DOI: 10.1016/j.nano.2020.102327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 10/22/2022]
Abstract
This study evaluates a long-acting liposomal fluorescence / CT dual-modality contrast agent (CF800) in head and neck cancer to enhance intraoperative tumor demarcation with fluorescence imaging and cone-beam computed tomography (CBCT). CF800 was administered to 12 buccal cancer-bearing rabbits. Imaging was acquired at regular time points to quantify time-dependent contrast enhancement. Surgery was performed 5-7 days after, with intraoperative near-infrared fluorescence endoscopy and CBCT, followed by histological and ex-vivo fluorescence assessment. Tumor enhancement on CT was significant at 24, 96 and 120 hours. Volumetric analysis of tumor segmentation showed high correlation between CBCT and micro-CT. Fluorescence signal was apparent in both ex-vivo and in-vivo imaging. Histological correlation showed [100%] specificity for primary tumor. Sensitivity and specificity of CF800 in detecting nodal involvement require further investigation.CF800 is long acting and has dual function for CT and fluorescence contrast, making it an excellent candidate for image-guided surgery.
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Affiliation(s)
- Nidal Muhanna
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada.; Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada.; Department of Otolaryngology-Head and Neck Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Donovan Eu
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada.; Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Harley Hl Chan
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada
| | - Michael Daly
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada
| | - Inga B Fricke
- University Health Network, TECHNA Institute, Toronto, ON, Canada
| | - Catriona M Douglas
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada.; Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jason L Townson
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada
| | - Jinzi Zheng
- University Health Network, TECHNA Institute, Toronto, ON, Canada
| | - Christine Allen
- University of Toronto, Pharmaceutical Sciences, Toronto, ON, Canada
| | - David A Jaffray
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada.; University of Toronto, Departments of Radiation Oncology and Medical Biophysics, Toronto, ON, Canada
| | - Jonathan C Irish
- Princess Margaret Cancer Centre and University Health Network, TECHNA Institute, Guided Therapeutic (GTx) Program, Toronto, ON, Canada.; Department of Otolaryngology-Head and Neck Surgery-Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, University of Toronto, Toronto, ON, Canada..
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16
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Gaêta-Araujo H, Alzoubi T, Vasconcelos KDF, Orhan K, Pauwels R, Casselman JW, Jacobs R. Cone beam computed tomography in dentomaxillofacial radiology: a two-decade overview. Dentomaxillofac Radiol 2020; 49:20200145. [PMID: 32501720 DOI: 10.1259/dmfr.20200145] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES The aim of this study was to evaluate and summarise features of currently and formerly available cone beam CT (CBCT) devices from 1996 to 2019. Additionally, a recommendation for standardised reporting of CBCT characteristics was provided. METHODS AND MATERIALS Information about the features of all available CBCT devices was obtained from the manufacturers' available data. Moreover, site visits to newly developed CBCT machines' manufacturers were performed in order to obtain relevant information. RESULTS A total of 279 CBCT models from 47 manufacturers located in 12 countries (Brazil, China, Denmark, Finland, France, Germany, Italy, Japan, Republic of Korea, Slovakia, Thailand, and USA) could be listed. Overall, wide variations in CBCT features and technical specifications were identified. CONCLUSIONS CBCT in dentomaxillofacial radiology is a generic term applicable to a broad range of CBCT machines and features. Experimental outcomes and literature statements regarding radiation doses, imaging performance and diagnostic applicability of dental CBCT cannot be simply transferred from one CBCT model to another considering a wide variation in technical characteristics and clinical diagnostic performance. The information tabulated in the present study will be later provided on the International Association of DentoMaxilloFacial Radiology website (www.iadmfr.one).
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Affiliation(s)
- Hugo Gaêta-Araujo
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, Sao Paulo, Brazil
| | - Tamara Alzoubi
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Karla de Faria Vasconcelos
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Kaan Orhan
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of DentoMaxillofacial Radiology, Ankara University, Faculty of Dentistry, Ankara, Turkey
| | - Ruben Pauwels
- Medical Physics & Quality Assessment Department of Imaging & Pathology, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium.,Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | | | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, Faculty of Medicine, University of Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
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17
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Wu P, Sisniega A, Stayman JW, Zbijewski W, Foos D, Wang X, Khanna N, Aygun N, Stevens RD, Siewerdsen JH. Cone-beam CT for imaging of the head/brain: Development and assessment of scanner prototype and reconstruction algorithms. Med Phys 2020; 47:2392-2407. [PMID: 32145076 PMCID: PMC7343627 DOI: 10.1002/mp.14124] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/06/2020] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Our aim was to develop a high-quality, mobile cone-beam computed tomography (CBCT) scanner for point-of-care detection and monitoring of low-contrast, soft-tissue abnormalities in the head/brain, such as acute intracranial hemorrhage (ICH). This work presents an integrated framework of hardware and algorithmic advances for improving soft-tissue contrast resolution and evaluation of its technical performance with human subjects. METHODS Four configurations of a CBCT scanner prototype were designed and implemented to investigate key aspects of hardware (including system geometry, antiscatter grid, bowtie filter) and technique protocols. An integrated software pipeline (c.f., a serial cascade of algorithms) was developed for artifact correction (image lag, glare, beam hardening and x-ray scatter), motion compensation, and three-dimensional image (3D) reconstruction [penalized weighted least squares (PWLS), with a hardware-specific statistical noise model]. The PWLS method was extended in this work to accommodate multiple, independently moving regions with different resolution (to address both motion compensation and image truncation). Imaging performance was evaluated quantitatively and qualitatively with 41 human subjects in the neurosciences critical care unit (NCCU) at our institution. RESULTS The progression of four scanner configurations exhibited systematic improvement in the quality of raw data by variations in system geometry (source-detector distance), antiscatter grid, and bowtie filter. Quantitative assessment of CBCT images in 41 subjects demonstrated: ~70% reduction in image nonuniformity with artifact correction methods (lag, glare, beam hardening, and scatter); ~40% reduction in motion-induced streak artifacts via the multi-motion compensation method; and ~15% improvement in soft-tissue contrast-to-noise ratio (CNR) for PWLS compared to filtered backprojection (FBP) at matched resolution. Each of these components was important to improve contrast resolution for point-of-care cranial imaging. CONCLUSIONS This work presents the first application of a high-quality, point-of-care CBCT system for imaging of the head/ brain in a neurological critical care setting. Hardware configuration iterations and an integrated software pipeline for artifacts correction and PWLS reconstruction mitigated artifacts and noise to achieve image quality that could be valuable for point-of-care detection and monitoring of a variety of intracranial abnormalities, including ICH and hydrocephalus.
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Affiliation(s)
- P Wu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - J W Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - D Foos
- Carestream Health, Rochester, NY, 14608, USA
| | - X Wang
- Carestream Health, Rochester, NY, 14608, USA
| | - N Khanna
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - N Aygun
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - R D Stevens
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Neurology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, 21205, USA
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18
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Muhanna N, Douglas CM, Daly MJ, Chan HHL, Weersink R, Townson J, Monteiro E, Yu E, Weimer E, Kucharczyk W, Jaffray DA, Irish JC, de Almeida JR. Evaluating an Image-Guided Operating Room with Cone Beam CT for Skull Base Surgery. J Neurol Surg B Skull Base 2020; 82:e306-e314. [PMID: 34306954 DOI: 10.1055/s-0040-1701211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022] Open
Abstract
Importance Skull base surgery requires precise preoperative assessment and intraoperative management of the patient. Surgical navigation is routinely used for complex skull base cases; however, the image guidance is commonly based on preoperative scans alone. Objective The primary objective of this study was to assess the image quality of intraoperative cone-beam computed tomography (CBCT) within anatomical landmarks used in sinus and skull base surgery. The secondary objective was to assess the registration error of a surgical navigation system based on intraoperative CBCT. Design Present study is a retrospective case series of image quality after intraoperative cone beam CT. Setting The study was conducted at Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto. Participants A total of 46 intraoperative scans (34 patients, 21 skull base, 13 head and neck) were studied. Main Outcome and Measures Thirty anatomical landmarks (vascular, soft tissue, and bony) within the sinuses and anterior skull base were evaluated for general image quality characteristics: (1) bony detail visualization; (2) soft-tissue visualization; (3) vascular visualization; and (4) freedom from artifacts (e.g., metal). Levels of intravenous (IV) contrast enhancement were quantified in Hounsfield's units (HU). Standard paired-point registration between imaging and tracker coordinates was performed using 6 to 8 skin fiducial markers and the corresponding fiducial registration error (FRE) was measured. Results Median score for bony detail on CBCT was 5, remaining at 5 after administration of IV contrast. Median soft-tissue score was 2 for both pre- and postcontrast. Median vascular score was 1 precontrast and 3 postcontrast. Median score for artifacts on CBCT were 2 for both pre-and postcontrast, and metal objects were noted to be the most significant source of artifact. Intraoperative CBCT allowed preresection images and immediate postresection images to be available to the skull base surgeon. There was a significant improvement in mean (standard deviation [SD]) CT intensity in the left carotid artery postcontrast 334 HU (67 HU) ( p < 10 -10 ). The mean FRE was 1.8 mm (0.45 mm). Conclusion Intraoperative CBCT in complex skull base procedures provides high-resolution bony detail allowing immediate assessment of complex resections. The use of IV contrast with CBCT improves the visualization of vasculature. Image-guidance based on CBCT yields registration errors consistent with standard techniques.
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Affiliation(s)
- Nidal Muhanna
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center-Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Catriona M Douglas
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jason Townson
- TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada
| | - Eugene Yu
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Emilie Weimer
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - David A Jaffray
- Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology, Head and Neck Surgery, University of Toronto, Toronto, Canada.,Department of Surgical Oncology, Toronto General Hospital and Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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19
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Sheth NM, De Silva T, Uneri A, Ketcha M, Han R, Vijayan R, Osgood GM, Siewerdsen JH. A mobile isocentric C‐arm for intraoperative cone‐beam CT: Technical assessment of dose and 3D imaging performance. Med Phys 2020; 47:958-974. [DOI: 10.1002/mp.13983] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/09/2019] [Accepted: 12/13/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- N. M. Sheth
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - T. De Silva
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - A. Uneri
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - M. Ketcha
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - R. Han
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - R. Vijayan
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
| | - G. M. Osgood
- Department of Orthopaedic Surgery Johns Hopkins Medical Institutions Baltimore MD USA
| | - J. H. Siewerdsen
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD USA
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20
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Siewerdsen JH, Uneri A, Hernandez AM, Burkett GW, Boone JM. Cone‐beam CT dose and imaging performance evaluation with a modular, multipurpose phantom. Med Phys 2019; 47:467-479. [DOI: 10.1002/mp.13952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- J. H. Siewerdsen
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD 21205USA
| | - A. Uneri
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD 21205USA
| | - A. M. Hernandez
- Department of Radiology University of California – Davis Sacramento CA 95817USA
| | - G. W. Burkett
- Department of Radiology University of California – Davis Sacramento CA 95817USA
| | - J. M. Boone
- Department of Radiology University of California – Davis Sacramento CA 95817USA
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21
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Nateghifard K, Low D, Awofala L, Srikanthan D, Kuthubutheen J, Daly M, Chan H, Irish J, Chen J, Lin V, Le TN. Cone beam CT for perioperative imaging in hearing preservation Cochlear implantation - a human cadaveric study. J Otolaryngol Head Neck Surg 2019; 48:65. [PMID: 31753027 PMCID: PMC6873551 DOI: 10.1186/s40463-019-0388-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background Knowledge of the cochlear implant array’s precise position is important because of the correlation between electrode position and speech understanding. Several groups have provided recent image processing evidence to determine scalar translocation, angular insertion depth, and cochlear duct length (CDL); all of which are being used for patient-specific programming. Cone beam computed tomography (CBCT) is increasingly used in otology due to its superior resolution and low radiation dose. Our objectives are as followed:
Validate CBCT by measuring cochlear metrics, including basal turn diameter (A-value) and lateral wall cochlear duct length at different angular intervals and comparing it against microcomputed CT (uCT). Explore the relationship between measured lateral wall cochlear duct length at different angular intervals and insertion depth among 3 different length electrodes using CBCT.
Methods The study was performed using fixed human cadaveric temporal bones in a tertiary academic centre. Ten temporal bones were subjected to the standard facial recess approach for cochlear implantation and imaged by CBCT followed by uCT. Measurements were performed on a three-dimensional reconstructed model of the cochlea. Sequential insertion of 3 electrodes (Med-El Flex24, 28 and Soft) was then performed in 5 bones and reimaged by CBCT. Statistical analysis was performed using Pearson’s correlation. Results There was good agreement between CBCT and uCT for cochlear metrics, validating the precision of CBCT against the current gold standard uCT in imaging. The A-value recorded by both modalities showed a high degree of linear correlation and did not differ by more than 0.23 mm in absolute values. For the measurement of lateral wall CDL at various points along the cochlea, there was a good correlation between both modalities at 360 deg and 720 deg (r = 0.85, p < 0.01 and r = 0.79, p < 0.01). The Flex24 electrode displayed consistent insertion depth across different bones. Conclusions CBCT reliably performs cochlear metrics and measures electrode insertion depth. The low radiation dose, fast acquisition time, diminished metallic artifacts and portability of CBCT make it a valid option for imaging in cochlear implant surgery.
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Affiliation(s)
- Kayvan Nateghifard
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - David Low
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - Lola Awofala
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - Dilakshan Srikanthan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - Jafri Kuthubutheen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada.,University of Western Australia, School of Surgery, Perth, Australia
| | - Michael Daly
- Guided Therapeutics (GTx) Program, TECHNA Research Institute, University of Toronto, University Health Network, Toronto, Canada
| | - Harley Chan
- Guided Therapeutics (GTx) Program, TECHNA Research Institute, University of Toronto, University Health Network, Toronto, Canada
| | - Jonathan Irish
- Guided Therapeutics (GTx) Program, TECHNA Research Institute, University of Toronto, University Health Network, Toronto, Canada.,Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Canada
| | - Joseph Chen
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - Vincent Lin
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada
| | - Trung Ngoc Le
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Room M1, Toronto, 102, Canada.
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22
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Daly MJ, Chan H, Muhanna N, Akens MK, Wilson BC, Irish JC, Jaffray DA. Intraoperative cone-beam CT spatial priors for diffuse optical fluorescence tomography. ACTA ACUST UNITED AC 2019; 64:215007. [DOI: 10.1088/1361-6560/ab4917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Ferrari M, Daly MJ, Douglas CM, Chan HHL, Qiu J, Deganello A, Taboni S, Thomas CM, Sahovaler A, Jethwa AR, Hasan W, Nicolai P, Gilbert RW, Irish JC. Navigation-guided osteotomies improve margin delineation in tumors involving the sinonasal area: A preclinical study. Oral Oncol 2019; 99:104463. [PMID: 31683173 DOI: 10.1016/j.oraloncology.2019.104463] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/16/2019] [Accepted: 10/22/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To demonstrate and quantify, in a preclinical setting, the benefit of three-dimensional (3D) navigation guidance for margin delineation during ablative open surgery for advanced sinonasal cancer. MATERIALS AND METHODS Seven tumor models were created. 3D images were acquired with cone beam computed tomography, and 3D tumor segmentations were contoured. Eight surgeons with variable experience were recruited for the simulation of osteotomies. Three simulations were performed: 1) Unguided, 2) Guided using real-time tool tracking with 3D tumor segmentation (tumor-guided), and 3) Guided by 3D visualization of both the tumor and 1-cm margin segmentations (margin-guided). Analysis of cutting planes was performed and distance from the tumor surface was classified as follows: "intratumoral" when 0 mm or negative, "close" when greater than 0 mm and less than or equal to 5 mm, "adequate" when greater than 5 mm and less than or equal to 15 mm, and "excessive" over 15 mm. The three techniques (unguided, tumor-guided, margin-guided) were statistically compared. RESULTS The use of 3D navigation for margin delineation significantly improved control of margins: unguided cuts had 18.1% intratumoral cuts compared to 0% intratumoral cuts with 3D navigation (p < 0.0001). CONCLUSION This preclinical study has demonstrated the significant benefit of navigation-guided osteotomies for sinonasal tumors. Translation into the clinical setting - with rigorous assessment of oncological outcomes - would be the proposed next step.
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Affiliation(s)
- Marco Ferrari
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Stefano Taboni
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Carissa M Thomas
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Ashok R Jethwa
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Wael Hasan
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Piero Nicolai
- Unit of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Ralph W Gilbert
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre/University Health Network, Toronto, Ontario, Canada; Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.
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24
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Muhanna N, Douglas CM, Daly MJ, Chan HHL, Weersink R, Qiu J, Townson J, de Almeida JR, Goldstein D, Gilbert R, Yu E, Kucharczyk W, Jaffray DA, Irish JC. The image-guided operating room-Utility and impact on surgeon's performance in the head and neck surgery. Head Neck 2019; 41:3372-3382. [PMID: 31287216 DOI: 10.1002/hed.25864] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/17/2019] [Accepted: 06/18/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The image-guided operating room (OR) is an emerging standard for dealing with complex cases in many surgical disciplines including neurosurgery, thoracic surgery, maxillofacial trauma, and orthopedic surgery. Its use in head and neck oncological surgery is not well established. The primary aim of this study was to assess the image quality of cone-beam CT (CBCT) under real clinical conditions. The secondary aim was to assess the effect on surgical performance and decision making. METHODS Intraoperative 3D imaging was performed using a CBCT capable C-Arm mounted on a multi-axis robot (Siemens Zeego) in the image-guided OR. All patients had immediate preoperative imaging taken with further intraoperative imaging performed as required. Ten initial patients, comprising 28 intraoperative scans, were used for questionnaire-based image reviews conducted with experienced head and neck clinicians. Scans were assessed for aspects of both image quality and clinical utility, on separate 5-point Likert scales (1-5). RESULTS The median rating for bony detail was 4 out of 5. Vascular detail was increased (P < 10-8 ) from 1 to 3 with the use of IV contrast (region of interest CT# was 284 HU [SD, 47 HU]). Images were rated as 4 for freedom from artifact. Soft tissue definition was 2, with no significant improvement (P = .2) with the addition of IV iodinated contrast. Surgeons rated the greatest clinical utility (4) for the CBCT when assessing postreconstruction imaging of a complex case. CONCLUSIONS The image quality of CBCT in the image-guided OR is good for bony detail and complex oncological reconstructions in the head and neck setting but probably has limited benefit for intraoperative soft tissue delineation. Future studies must also focus on clinical outcomes to help demonstrate the value of the image-guided OR.
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Affiliation(s)
- Nidal Muhanna
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology, Head and Neck and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center - Tel Aviv University, Tel Aviv, Israel.,Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Catriona M Douglas
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael J Daly
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Jason Townson
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Eugene Yu
- Toronto Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Toronto Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - David A Jaffray
- Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada.,Department of Medical Physics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Toronto Joint Department of Medical Imaging, University Health Network/Mt. Sinai Hospital, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.,Guided Therapeutics (GTx) Program, TECHNA Institute, University Health Network, Toronto, Ontario, Canada
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25
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Daly MJ, Wilson BC, Irish JC, Jaffray DA. Navigated non-contact fluorescence tomography. ACTA ACUST UNITED AC 2019; 64:135021. [DOI: 10.1088/1361-6560/ab1f33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abd El Aziz TT, El Fiky L, Shalaby MH, Essam A. Radiological evaluation of inner ear trauma after cochlear implant surgery by cone beam CT(CBCT). Eur Arch Otorhinolaryngol 2019; 276:2697-2703. [PMID: 31214825 DOI: 10.1007/s00405-019-05507-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Cochlear implantation (CI) has been extended to involve younger age group with higher incidence of residual hearing which increases the need of minimizing surgical inner ear trauma. Radiological evaluation for electrode position has been studied yet without assessment of inner ear trauma, our objective is radiological evaluation of post cochlear implantation inner ear trauma MATERIAL AND METHODS: 20 patients with CI for pre lingual SNHL were included in this study. Cone beam CT (CBCT) was used for evaluation of electrode position and assessment of inner ear trauma. A Neuroradiologist and an implant surgeon analyzed the relation of inserted electrode to the intra-cochlear structures, with introduction of novel radiological grading for inner ear trauma. RESULTS The mean major cochlear diameter was 8.9 mm, the mean angular depth of insertion was 406.9944 (SD = 165.0559). Ten patients were with no cochlear trauma (grade 0), three patients were grade 1, two patients were grade 2 and five patients were grade 3 inner ear trauma. CONCLUSION Radiological evaluation for electrode position should extend to involve assessment of inner ear trauma using relation of the implant to cochlear internal structures which could be performed by CBCT with high resolution and least metallic artifacts.
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Affiliation(s)
| | - Lobna El Fiky
- Otorhinolaryngology Department, Ain Shams University, Cairo, Egypt
| | | | - Ahmed Essam
- Otorhinolaryngology Department, Ain Shams University, Cairo, Egypt
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27
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Hasan W, Daly MJ, Chan HHL, Qiu J, Irish JC. Intraoperative cone‐beam CT‐guided osteotomy navigation in mandible and maxilla surgery. Laryngoscope 2019; 130:1166-1172. [DOI: 10.1002/lary.28082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/08/2019] [Accepted: 05/08/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Wael Hasan
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical OncologyUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Michael J. Daly
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Harley H. L Chan
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
| | - Jonathan C. Irish
- Guided Therapeutics (GTx) Program, TECHNA InstituteUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
- Department of Otolaryngology–Head & Neck Surgery/Surgical OncologyUniversity of Toronto, Princess Margaret Cancer Centre Toronto Ontario Canada
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Capostagno S, Stayman JW, Jacobson M, Ehtiati T, Weiss CR, Siewerdsen JH. Task-driven source-detector trajectories in cone-beam computed tomography: II. Application to neuroradiology. J Med Imaging (Bellingham) 2019; 6:025004. [PMID: 31093518 DOI: 10.1117/1.jmi.6.2.025004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/04/2019] [Indexed: 11/14/2022] Open
Abstract
We apply the methodology detailed in "Task-driven source-detector trajectories in cone-beam computed tomography: I. Theory and methods" by Stayman et al. for task-driven optimization of source-detector orbits in cone-beam computed tomography (CBCT) to scenarios emulating imaging tasks in interventional neuroradiology. The task-driven imaging framework is used to optimize the CBCT source-detector trajectory by maximizing the detectability index, d ' . The approach was applied to simulated cases of endovascular embolization of an aneurysm and arteriovenous malformation and was translated to real data first using a CBCT test bench followed by implementation on an interventional robotic C-arm. Task-driven trajectories were found to generally favor higher fidelity (i.e., less noisy) views, with an average increase in d ' ranging from 7% to 28%. Visually, this resulted in improved conspicuity of particular stimuli by reducing the noise and altering the noise correlation to a form distinct from the spatial frequencies associated with the imaging task. The improvements in detectability and the demonstration of the task-driven workflow using a real interventional imaging system show the potential of the task-driven imaging framework to improve imaging performance on motorized, multiaxis C-arms in neuroradiology.
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Affiliation(s)
- Sarah Capostagno
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - J Webster Stayman
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Matthew Jacobson
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Tina Ehtiati
- Siemens Medical Solutions USA, Inc., Imaging and Therapy Systems, Hoffman Estates, Illinois, United States
| | - Clifford R Weiss
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, Maryland, United States
| | - Jeffrey H Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States.,Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, Maryland, United States
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Stayman JW, Capostagno S, Gang GJ, Siewerdsen JH. Task-driven source-detector trajectories in cone-beam computed tomography: I. Theory and methods. J Med Imaging (Bellingham) 2019; 6:025002. [PMID: 31065569 PMCID: PMC6497008 DOI: 10.1117/1.jmi.6.2.025002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/29/2019] [Indexed: 11/14/2022] Open
Abstract
We develop a mathematical framework for the design of orbital trajectories that are optimal to a particular imaging task (or tasks) in advanced cone-beam computed tomography systems that have the capability of general source-detector positioning. The framework allows various parameterizations of the orbit as well as constraints based on imaging system capabilities. To accommodate nonstandard system geometries, a model-based iterative reconstruction method is applied. Such algorithms generally complicate the assessment and prediction of reconstructed image properties; however, we leverage efficient implementations of analytical predictors of local noise and spatial resolution that incorporate dependencies of the reconstruction algorithm on patient anatomy, x-ray technique, and geometry. These image property predictors serve as inputs to a task-based performance metric defined by detectability index, which is optimized with respect to the orbital parameters of data acquisition. We investigate the framework of the task-driven trajectory design in several examples to examine the dependence of optimal source-detector trajectories on the imaging task (or tasks), including location and spatial-frequency dependence. A variety of multitask objectives are also investigated, and the advantages to imaging performance are quantified in simulation studies.
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Affiliation(s)
- J. Webster Stayman
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Sarah Capostagno
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Grace J. Gang
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
| | - Jeffrey H. Siewerdsen
- Johns Hopkins University, Department of Biomedical Engineering, Baltimore, Maryland, United States
- Johns Hopkins University, Department of Radiology and Radiological Science, Baltimore, Maryland, United States
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30
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Paydarfar JA, Wu X, Halter RJ. Initial experience with image-guided surgical navigation in transoral surgery. Head Neck 2018; 41:E1-E10. [PMID: 30556235 DOI: 10.1002/hed.25380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/08/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Surgical navigation using image guidance may improve the safety and efficacy of transoral surgery (TOS); however, preoperative imaging cannot be accurately registered to the intraoperative state due to deformations resulting from placement of the laryngoscope or retractor. This proof of concept study explores feasibility and registration accuracy of surgical navigation for TOS by utilizing intraoperative imaging. METHODS Four patients undergoing TOS were recruited. Suspension laryngoscopy was performed with a CT-compatible laryngoscope. An intraoperative contrast enhanced CT scan was obtained and registered to fiducials placed on the neck, face, and laryngoscope. RESULTS All patients were successfully scanned and registered. Registration accuracy within the pharynx and larynx was 1 mm or less. Target registration was confirmed by localizing endoscopic and surface structures to the CT images. Successful tracking was performed in all 4 patients. CONCLUSION For surgical navigation during TOS, although a high level of registration accuracy can be achieved by utilizing intraoperative imaging, significant limitations of the existing technology have been identified. These limitations, as well as areas for future investigation, are discussed.
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Affiliation(s)
- Joseph A Paydarfar
- Section of Otolaryngology, Audiology, and Maxillofacial Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Lebanon, New Hampshire
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Xiaotian Wu
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
| | - Ryan J Halter
- Thayer School of Engineering at Dartmouth, Hanover, New Hampshire
- Dartmouth College Geisel School of Medicine, Department of Surgery, Hanover, New Hampshire
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31
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Wu P, Stayman JW, Sisniega A, Zbijewski W, Foos D, Wang X, Aygun N, Stevens R, Siewerdsen JH. Statistical weights for model-based reconstruction in cone-beam CT with electronic noise and dual-gain detector readout. ACTA ACUST UNITED AC 2018; 63:245018. [DOI: 10.1088/1361-6560/aaf0b4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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32
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Xia D, Chang YB, Manak J, Siddiqui AH, Zhang Z, Chen B, Sidky EY, Pan X. Reduction of Angularly-Varying-Data Truncation in C-Arm CBCT Imaging. SENSING AND IMAGING 2018; 19:14. [PMID: 30319317 PMCID: PMC6181237 DOI: 10.1007/s11220-018-0198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/02/2018] [Indexed: 05/07/2023]
Abstract
C-arm cone-beam computed tomography (CBCT) has been used increasingly as an imaging tool for yielding 3D anatomical information about the subjects in surgical and interventional procedures. In the clinical applications, the limited field-of-view (FOV) of C-arm CBCT can lead to significant data truncation, resulting in image artifacts that can obscure low contrast tumor embedded within soft-tissue background, thus limiting the utility of C-arm CBCT. The truncation issue can become serious as most of the surgical and interventional procedures would involve devices and tubes that are placed outside the FOV of C-arm CBCT and thus can engender angularly-varying-data truncation. Existing methods may not be adequately applicable to dealing with the angularly-varying truncation. In this work, we seek to reduce truncation artifacts by tailoring optimization-based reconstruction directly from truncated data, without performing pre-reconstruction data compensation, collected from physical phantoms and human subjects. The reconstruction problem is formulated as a constrained optimization program in which a data-derivative-ℓ2-norm fidelity is included for effectively suppressing image artifacts caused by the angularly-varying-data truncation, and the generic Chambolle-Pock algorithm is tailored to solve the optimization program. The results of the study suggest that an appropriately designed optimization-based reconstruction can be exploited for yielding images with reduced artifacts caused by angularly-varying-data truncation.
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Affiliation(s)
- Dan Xia
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA
| | - Yu-Bing Chang
- Canon Medical Research Institute USA, Inc., Vernon Hills, IL 60061, USA
| | - Joe Manak
- Canon Medical Research Institute USA, Inc., Vernon Hills, IL 60061, USA
| | - Adnan H Siddiqui
- University at Buffalo Neurosurgery, Inc., Baffulo, NY 14203, USA
| | - Zheng Zhang
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA
| | - Buxin Chen
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA
| | - Emil Y Sidky
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA
| | - Xiaochuan Pan
- Department of Radiology, The University of Chicago, Chicago, IL 60637, USA
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33
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Sheth NM, Zbijewski W, Jacobson MW, Abiola G, Kleinszig G, Vogt S, Soellradl S, Bialkowski J, Anderson WS, Weiss CR, Osgood GM, Siewerdsen JH. Mobile C-Arm with a CMOS detector: Technical assessment of fluoroscopy and Cone-Beam CT imaging performance. Med Phys 2018; 45:5420-5436. [PMID: 30339271 DOI: 10.1002/mp.13244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/08/2018] [Accepted: 10/11/2018] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Indirect-detection CMOS flat-panel detectors (FPDs) offer fine pixel pitch, fast readout, and low electronic noise in comparison to current a-Si:H FPDs. This work investigates the extent to which these potential advantages affect imaging performance in mobile C-arm fluoroscopy and cone-beam CT (CBCT). METHODS FPDs based on CMOS (Xineos 3030HS, 0.151 mm pixel pitch) or a-Si:H (PaxScan 3030X, 0.194 mm pixel pitch) sensors were outfitted on equivalent mobile C-arms for fluoroscopy and CBCT. Technical assessment of 2D and 3D imaging performance included measurement of electronic noise, gain, lag, modulation transfer function (MTF), noise-power spectrum (NPS), detective quantum efficiency (DQE), and noise-equivalent quanta (NEQ) in fluoroscopy (with entrance air kerma ranging 5-800 nGy per frame) and cone-beam CT (with weighted CT dose index, CTDIw , ranging 0.08-1 mGy). Image quality was evaluated by clinicians in vascular, orthopaedic, and neurological surgery in realistic interventional scenarios with cadaver subjects emulating a variety of 2D and 3D imaging tasks. RESULTS The CMOS FPD exhibited ~2-3× lower electronic noise and ~7× lower image lag than the a-Si:H FPD. The 2D (projection) DQE was superior for CMOS at ≤50 nGy per frame, especially at high spatial frequencies (~2% improvement at 0.5 mm-1 and ≥50% improvement at 2.3 mm-1 ) and was somewhat inferior at moderate-high doses (up to 18% lower DQE for CMOS at 0.5 mm-1 ). For smooth CBCT reconstructions (low-frequency imaging tasks), CMOS exhibited ~10%-20% higher NEQ (at 0.1-0.5 mm-1 ) at the lowest dose levels (CTDIw ≤0.1 mGy), while the a-Si:H system yielded slightly (~5%) improved NEQ (at 0.1-0.5 lp/mm) at higher dose levels (CTDIw ≥0.6 mGy). For sharp CBCT reconstructions (high-frequency imaging tasks), NEQ was ~32% higher above 1 mm-1 for the CMOS system at mid-high-dose levels and ≥75% higher at the lowest dose levels (CTDIw ≤0.1 mGy). Observer assessment of 2D and 3D cadaver images corroborated the objective metrics with respect to a variety of pertinent interventional imaging tasks. CONCLUSION Measurements of image noise, spatial resolution, DQE, and NEQ indicate improved low-dose performance for the CMOS-based system, particularly at lower doses and higher spatial frequencies. Assessment in realistic imaging scenarios confirmed improved visibility of fine details in low-dose fluoroscopy and CBCT. The results quantitate the extent to which CMOS detectors improve mobile C-arm imaging performance, especially in 2D and 3D imaging scenarios involving high-resolution tasks and low-dose conditions.
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Affiliation(s)
- Niral M Sheth
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Matthew W Jacobson
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Godwin Abiola
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | | | | | | | - William S Anderson
- Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Clifford R Weiss
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Greg M Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Uneri A, Zhang X, Yi T, Stayman JW, Helm PA, Theodore N, Siewerdsen JH. Image quality and dose characteristics for an O-arm intraoperative imaging system with model-based image reconstruction. Med Phys 2018; 45:4857-4868. [PMID: 30180274 DOI: 10.1002/mp.13167] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/13/2018] [Accepted: 08/16/2018] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the imaging performance and radiation dose characteristics of the O-arm CBCT imaging system (Medtronic Inc., Littleton MA) and demonstrate the potential for improved image quality and reduced dose via model-based image reconstruction (MBIR). METHODS Two main studies were performed to investigate previously unreported characteristics of the O-arm system. First is an investigation of dose and 3D image quality achieved with filtered back-projection (FBP) - including enhancements in geometric calibration, handling of lateral truncation and detector saturation, and incorporation of an isotropic apodization filter. Second is implementation of an MBIR algorithm based on Huber-penalized likelihood estimation (PLH) and investigation of image quality improvement at reduced dose. Each study involved measurements in quantitative phantoms as a basis for analysis of contrast-to-noise ratio and spatial resolution as well as imaging of a human cadaver to test the findings under realistic imaging conditions. RESULTS View-dependent calibration of system geometry improved the accuracy of reconstruction as quantified by the full-width at half maximum of the point-spread function - from 0.80 to 0.65 mm - and yielded subtle but perceptible improvement in high-contrast detail of bone (e.g., temporal bone). Standard technique protocols for the head and body imparted absorbed dose of 16 and 18 mGy, respectively. For low-to-medium contrast (<100 HU) imaging at fixed spatial resolution (1.3 mm edge-spread function) and fixed dose (6.7 mGy), PLH improved CNR over FBP by +48% in the head and +35% in the body. Evaluation at different dose levels demonstrated 30% increase in CNR at 62% of the dose in the head and 90% increase in CNR at 50% dose in the body. CONCLUSIONS A variety of improvements in FBP implementation (geometric calibration, truncation and saturation effects, and isotropic apodization) offer the potential for improved image quality and reduced radiation dose on the O-arm system. Further gains are possible with MBIR, including improved soft-tissue visualization, low-dose imaging protocols, and extension to methods that naturally incorporate prior information of patient anatomy and/or surgical instrumentation.
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Affiliation(s)
- A Uneri
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - X Zhang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - T Yi
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - J W Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - P A Helm
- Medtronic Inc., Littleton, MA, 01460, USA
| | - N Theodore
- Department of Neurosurgery, Johns Hopkins Medical Institute, Baltimore, MD, 21287, USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, 21205, USA.,Department of Neurosurgery, Johns Hopkins Medical Institute, Baltimore, MD, 21287, USA
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Abella M, de Molina C, Ballesteros N, García-Santos A, Martínez Á, García I, Desco M. Enabling tomography with low-cost C-arm systems. PLoS One 2018; 13:e0203817. [PMID: 30212543 PMCID: PMC6136768 DOI: 10.1371/journal.pone.0203817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 08/28/2018] [Indexed: 11/19/2022] Open
Abstract
In scenarios where the use of a Computed Tomography (CT) is difficult, such as during surgery or in the ICU, the use of a C-arm system to generate tomographic information could contribute with interesting additional clinical information. Recent days are seeing the development of the so-called cone-beam CT (CBCT) based on advanced motorized isocentric C-arm systems. To be able to make use of more basic C-arm systems, apart from the geometric non-idealities common to any CBCT, we need to address other difficulties. First, the trajectory of the source-detector pair may differ from a circular path and the system may suffer mechanical strains that modify the relative positions of the source and detector for different projection angles. Second, and more importantly, the exact position of the source and detector elements may not be repeatable for consecutive rotations due to low mechanical precision, thus preventing an accurate geometrical calibration of the system. Finally, the limitation of the angular span and the difficulty of obtaining a high number of projections pose a great challenge to the image reconstruction. In this work, we present a novel method to adapt a standard C-arm, originally designed for planar imaging, to be used as a tomograph. The key parts of the new acquisition protocol are (1) a geometrical calibration method to compensate mechanical inaccuracies that prevent an accurate repetition of source-detector position between acquisitions, and (2) an advanced image reconstruction method able to deal with limited angle data, sparse projections and non-circular trajectories. Both methods exploit surface information from the patient, which can be obtained using a 3D surface scanner. The proposed method was evaluated with two real C-arm systems, based on an image intensifier and a flat panel detector respectively, showing the feasibility of the proposal.
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Affiliation(s)
- Monica Abella
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro Nacional Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- * E-mail:
| | - Claudia de Molina
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Nerea Ballesteros
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Alba García-Santos
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Álvaro Martínez
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Inés García
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro Nacional Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
- Centro de investigación en red en salud mental (CIBERSAM), Madrid, Spain
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Lee CY, Chan H, Ujiie H, Fujino K, Kinoshita T, Irish JC, Yasufuku K. Novel Thoracoscopic Navigation System With Augmented Real-Time Image Guidance for Chest Wall Tumors. Ann Thorac Surg 2018; 106:1468-1475. [PMID: 30120940 DOI: 10.1016/j.athoracsur.2018.06.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/24/2018] [Accepted: 06/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND We developed a thoracoscopic surgical navigation system with real-time augmented image guidance to assess the potential benefits for minimally invasive resection of chest wall tumors. The accuracy of localization of tumor and resection margin and the effect on task workload and confidence were evaluated in a chest wall tumor phantom. METHODS After scanning a realistic tumor phantom by cone-beam computed tomography and registering the data into the system, three-dimensional contoured tumor and resection margin was displayed. Fifteen surgeons were asked to localize the tumor margin and surgical margins with the thoracoscope alone. The same procedure was performed with the surgical navigation system activated, and results were compared between each attempt. A questionnaire and National Aeronautics and Space Administration Task Load Index were completed after. RESULTS The surgical navigation system significantly reduced localization error for the medial (p = 0.002) and superior tumor margin (p < 0.001), which was difficult to visualize by thoracoscopy alone. All surgical resection margins were improved circumferentially, including margins that were readily visible by thoracoscopy. National Aeronautics and Space Administration Task Load Index response scores showed a statistically significant reduction in workload in all subscales. There was a more than 50% mean reduction in workload for performance (10.1 vs 4.4, p = 0.001) and frustration (13.0 vs 5.4, p = 0.001). CONCLUSIONS This study showed that the thoracoscopic surgical navigation system providing augmented image guidance decreased tumor localization error for regions difficult to visualize thoracoscopically and also reduced surgical margin error circumferentially, regardless of thoracoscopic visibility. This system also reduced workload and increased surgeon's confidence in localizing challenging chest wall tumors.
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Affiliation(s)
- Chang Young Lee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Harley Chan
- Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada
| | - Hideki Ujiie
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kosuke Fujino
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tomonari Kinoshita
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada; Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada; Princess Margaret Cancer Centre and Guided Therapeutics Program-TECHNA Institute, University Health Network, Toronto, Ontario, Canada.
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37
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Fresse-Warin K, Plessis J, Benelhadj H, Guérin P. Impact of fused computed tomography and fluoroscopy in the catheterization laboratory. Arch Cardiovasc Dis 2018; 111:449-455. [DOI: 10.1016/j.acvd.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/11/2018] [Accepted: 03/12/2018] [Indexed: 12/31/2022]
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38
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Sternheim A, Kashigar A, Daly M, Chan H, Qiu J, Weersink R, Jaffray D, Irish JC, Ferguson PC, Wunder JS. Cone-Beam Computed Tomography-Guided Navigation in Complex Osteotomies Improves Accuracy at All Competence Levels: A Study Assessing Accuracy and Reproducibility of Joint-Sparing Bone Cuts. J Bone Joint Surg Am 2018; 100:e67. [PMID: 29762285 DOI: 10.2106/jbjs.16.01304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The objective of this study was to assess the accuracy and reproducibility of a novel cone-beam computed tomography (CBCT)-guided navigation system designed for osteotomies with joint-sparing bone cuts. METHODS Eighteen surgeons participated in this study. First, 3 expert tumor surgeons resected bone tumors in 3 Sawbones tumor models identical to actual patient scenarios. They first performed these osteotomies without navigation and then performed them using a navigation system and 3-dimensional (3D) planning tools based on CBCT imaging. The 2 sets of measurements were compared using image-based measurements from post-resection CBCT. Next, 15 residents, fellows, and orthopaedic staff surgeons were instructed on the use of the system, and their navigated resections were compared with navigated resections performed by the 3 expert tumor surgeons. RESULTS One hundred and twenty-six navigated cuts done by the orthopaedic oncologists were compared with 126 non-navigated cuts by the same surgeons. The cuts violated the tumor in 22% (6) of the 27 non-navigated resections compared with none of the 27 navigated resections. The navigated cuts were significantly more accurate in terms of entry point, pitch, and roll (p < 0.001). The variation among the 3 surgeons when they used navigation was <0.6 mm for the entry cut and, on average, 1.5° for pitch and roll. All 18 surgeons then completed a total of 144 navigated cuts. The level of experience did not result in a significant difference among groups with regard to cut accuracy. Two cuts went into the tumor. The mean distance from the planned bone cuts to the actual entry points into bone was 1.5 mm (standard deviation [SD] = 1.4 mm) for all users. The mean difference in pitch and roll between the planned and actual cuts was 3.5° (SD = 2.8°) and 3.7° (SD = 3.2°) for all users. CONCLUSIONS Even in expert hands, navigated cuts were significantly more accurate than non-navigated cuts. When the osteotomies were aided by navigation, their accuracy did not differ according to the level of professional experience. CBCT-based metrics enable intraoperative assessments of cut accuracy and reconstruction planning. CLINICAL RELEVANCE CBCT-guided navigated osteotomies can improve accuracy regardless of surgeon experience and decrease the variability among different surgeons.
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Affiliation(s)
- Amir Sternheim
- National Unit of Orthopaedic Oncology, Tel Aviv Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aidin Kashigar
- Division of Orthopaedic Surgery, Queen's University, Kingston, Ontario, Canada
| | - Michael Daly
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley Chan
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert Weersink
- Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - David Jaffray
- Techna Institute, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Physics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Ontario Cancer Institute, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Techna Institute, University Health Network, Toronto, Ontario, Canada.,Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jay S Wunder
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada
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Talbott JF, Cooke DL, Mabray MC, Larson PS, Amans MR, Hetts SW, Wilson MW, Moore T, Salegio EA. Accuracy of image-guided percutaneous injection into a phantom spinal cord utilizing flat panel detector CT with MR fusion and integrated navigational software. J Neurointerv Surg 2018; 10:e37. [PMID: 29666181 DOI: 10.1136/neurintsurg-2018-013878] [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: 02/23/2018] [Revised: 03/22/2018] [Accepted: 03/25/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To evaluate the accuracy of percutaneous fluoroscopic injection into the spinal cord of a spine phantom utilizing integrated navigational guidance from fused flat panel detector CT (FDCT) and MR datasets. Conventional and convection-enhanced delivery (CED) techniques were evaluated. MATERIALS AND METHODS FDCT and MR datasets of a swine thoracic spine phantom were co-registered using an integrated guidance system and surface to spinal cord target trajectory planning was performed on the fused images. Under real-time fluoroscopic guidance with pre-planned trajectory overlay, spinal cord targets were accessed via a coaxial technique. Final needle tip position was compared with a pre-determined target on 10 independent passes. In a subset of cases, contrast was injected into the central spinal cord with a 25G spinal needle or customized 200 µm inner diameter step design cannula for CED. RESULTS Average needle tip deviation from target measured 0.92±0.5 mm in the transverse, 0.47±0.4 mm in the anterior-posterior, and 1.67±1.2 mm in the craniocaudal dimension for an absolute distance error of 2.12±1.12 mm. CED resulted in elliptical intramedullary diffusion of contrast compared with primary reflux observed with standard needle injection. CONCLUSIONS These phantom feasibility data demonstrate a minimally invasive percutaneous approach for targeted injection into the spinal cord utilizing real-time fluoroscopy aided by overlay trajectories derived from fused MRI and FDCT data sets with a target error of 2.1 mm. Intramedullary diffusion of injectate in the spinal cord is facilitated with CED compared with standard injection technique. Pre-clinical studies in large animal models are warranted.
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Affiliation(s)
- Jason F Talbott
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA.,Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Marc C Mabray
- Department of Radiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Terilyn Moore
- Department of Radiology and Biomedical Imaging, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Ernesto A Salegio
- Department of Neurological Surgery, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA
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Thompson JG, van der Sterren W, Bakhutashvili I, van der Bom IM, Radaelli AG, Karanian JW, Esparza-Trujillo J, Woods DL, Lewis AL, Wood BJ, Pritchard WF. Distribution and Detection of Radiopaque Beads after Hepatic Transarterial Embolization in Swine: Cone-Beam CT versus MicroCT. J Vasc Interv Radiol 2018; 29:568-574. [PMID: 29500000 PMCID: PMC5869084 DOI: 10.1016/j.jvir.2017.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/28/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine the true distribution of radiopaque beads (ROBs) after hepatic embolization in swine as imaged by micro-computed tomography (microCT) compared with in vivo cone-beam computerized tomography (CT) imaged at different kVp settings. MATERIALS AND METHODS Swine (n = 3) underwent hepatic transarterial embolization (n = 6) with the use of 70-150-μm ROBs under fluoroscopic guidance. After stasis, in vivo cone-beam CT was performed at 120, 100, and 80 kVp. The animal was euthanized, the liver resected, and microCT with 17 μm resolution performed on embolized tissue samples. The resulting cone-beam CT and microCT data were segmented and registered. Total vessel length, minimum volume-enclosing ellipsoid (MVEE), and number of independent volumes were measured. Maximum-intensity projections (MIPs) were generated for each cone-beam CT. RESULTS Metrics for all cone-beam CT segmentations differed significantly from microCT segmentations. Segmentations at 80 kVp presented significantly greater vessel length, MVEE, and number of independent volumes compared with 100 kVp and 120 kVp. In addition, 100 kVp segmentations presented significantly greater vessel length than 120 kVp. MIPs presented greater visualization than cone-beam CT segmentations and improved as kVp decreased. CONCLUSIONS The full ROB distribution was more extensive than was apparent on cone-beam CT. Quantitative measures of embolic distribution demonstrated significantly better correlation with microCT with decreasing kVp. Similarly, qualitative analysis of MIPs showed improved visualization of beads with decreasing kVp. These findings demonstrate the clinical value of 80 kVp and 100 kVp protocols in the imaging of radiopaque embolizations compared with 120 kVp. However, considerations on X-ray penetration and dose may favor use of 100 kVp imaging over 80 kVp.
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Affiliation(s)
- John G Thompson
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Ivane Bakhutashvili
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Alessandro G Radaelli
- Image-Guided Therapy Systems, Image-Guided Interventions, Philips, Best, The Netherlands
| | - John W Karanian
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - Juan Esparza-Trujillo
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - David L Woods
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | | | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD 20892.
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41
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Fotouhi J, Fuerst B, Unberath M, Reichenstein S, Lee SC, Johnson AA, Osgood GM, Armand M, Navab N. Automatic intraoperative stitching of nonoverlapping cone-beam CT acquisitions. Med Phys 2018; 45:2463-2475. [PMID: 29569728 DOI: 10.1002/mp.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Cone-beam computed tomography (CBCT) is one of the primary imaging modalities in radiation therapy, dentistry, and orthopedic interventions. While CBCT provides crucial intraoperative information, it is bounded by a limited imaging volume, resulting in reduced effectiveness. This paper introduces an approach allowing real-time intraoperative stitching of overlapping and nonoverlapping CBCT volumes to enable 3D measurements on large anatomical structures. METHODS A CBCT-capable mobile C-arm is augmented with a red-green-blue-depth (RGBD) camera. An offline cocalibration of the two imaging modalities results in coregistered video, infrared, and x-ray views of the surgical scene. Then, automatic stitching of multiple small, nonoverlapping CBCT volumes is possible by recovering the relative motion of the C-arm with respect to the patient based on the camera observations. We propose three methods to recover the relative pose: RGB-based tracking of visual markers that are placed near the surgical site, RGBD-based simultaneous localization and mapping (SLAM) of the surgical scene which incorporates both color and depth information for pose estimation, and surface tracking of the patient using only depth data provided by the RGBD sensor. RESULTS On an animal cadaver, we show stitching errors as low as 0.33, 0.91, and 1.72 mm when the visual marker, RGBD SLAM, and surface data are used for tracking, respectively. CONCLUSIONS The proposed method overcomes one of the major limitations of CBCT C-arm systems by integrating vision-based tracking and expanding the imaging volume without any intraoperative use of calibration grids or external tracking systems. We believe this solution to be most appropriate for 3D intraoperative verification of several orthopedic procedures.
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Affiliation(s)
- Javad Fotouhi
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
| | - Bernhard Fuerst
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
| | - Mathias Unberath
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan Reichenstein
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
| | - Sing Chun Lee
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA
| | - Alex A Johnson
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Greg M Osgood
- Department of Orthopaedic Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Mehran Armand
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA.,Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA
| | - Nassir Navab
- Computer Aided Medical Procedures, Johns Hopkins University, Baltimore, MD, USA.,Computer Aided Medical Procedures, Technical University of Munich, Munich, Germany
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Orth RC, Wallace MJ, Kuo MD. C-arm cone-beam CT: general principles and technical considerations for use in interventional radiology. J Vasc Interv Radiol 2018; 20:S538-44. [PMID: 19560038 DOI: 10.1016/j.jvir.2009.04.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Revised: 02/11/2008] [Accepted: 02/11/2008] [Indexed: 11/30/2022] Open
Abstract
Digital flat-panel detector cone-beam computed tomography (CBCT) has recently been adapted for use with C-arm systems. This configuration provides projection radiography, fluoroscopy, digital subtraction angiography, and volumetric computed tomography (CT) capabilities in a single patient setup, within the interventional suite. Such capabilities allow the interventionalist to perform intraprocedural volumetric imaging without the need for patient transportation. Proper use of this new technology requires an understanding of both its capabilities and limitations. This article provides an overview of C-arm CBCT with particular attention to trade-offs between C-arm CBCT systems and conventional multi-detector CT.
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Affiliation(s)
- Robert C Orth
- Department of Radiology, University of California San Diego Medical Center, 200 W Arbor Dr, San Diego, CA 92103, USA
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43
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Ma AK, Daly M, Qiu J, Chan HHL, Goldstein DP, Irish JC, de Almeida JR. Intraoperative image guidance in transoral robotic surgery: A pilot study. Head Neck 2017; 39:1976-1983. [DOI: 10.1002/hed.24805] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/25/2017] [Accepted: 02/28/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
- Andrew K. Ma
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology; University of Toronto; Toronto Ontario Canada
| | - Michael Daly
- Guided Therapeutics (GTx) Program, Techna Institute; University Health Network; Toronto Ontario Canada
| | - Jimmy Qiu
- Guided Therapeutics (GTx) Program, Techna Institute; University Health Network; Toronto Ontario Canada
| | - Harley H. L. Chan
- Guided Therapeutics (GTx) Program, Techna Institute; University Health Network; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology; University of Toronto; Toronto Ontario Canada
| | - Jonathan C. Irish
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology; University of Toronto; Toronto Ontario Canada
- Guided Therapeutics (GTx) Program, Techna Institute; University Health Network; Toronto Ontario Canada
| | - John R. de Almeida
- Department of Otolaryngology - Head and Neck Surgery/Surgical Oncology; University of Toronto; Toronto Ontario Canada
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44
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Leon S. Assessment of volumetric absorbed dose for mobile fluoroscopic 3D image acquisition. J Appl Clin Med Phys 2017; 18:230-236. [PMID: 28585724 PMCID: PMC5874898 DOI: 10.1002/acm2.12108] [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: 01/13/2017] [Revised: 04/20/2017] [Accepted: 04/21/2017] [Indexed: 11/21/2022] Open
Abstract
Mobile fluoroscopy (c‐arm) units offering 3D image reconstruction are becoming more common in surgical settings. Although these images are “CT‐like” and sometimes replace the postoperative CT, the acquisition is technically very different from a traditional CT acquisition. Dose assessment is complicated by a large beam width, automatic exposure rate control, and a rotation of less than 360°. The purpose of this work was to explore the impact of these factors on the volumetric dose calculation and to provide practical recommendations for clinical physicists assessing dose from these units using commonly available equipment. CTDIW was calculated using the IAEA method for dosimetry of wide beams and compared to scans of the 32‐cm CTDI phantom using the full beam width and a 20‐mm collimated beam width. The impact of the partial rotation on the CTDIW calculation was assessed by acquiring measurements at four and twelve positions on the phantom periphery. For the system tested, the CTDIW was calculated to be 16.1 mGy using the IAEA method with default clinical protocol. Results showed that measuring CTDIW with the full beam width or a collimated beam width alone resulted in CTDI values of 19.0 mGy and 19.5 mGy, respectively. Using four peripheral measurements instead of 12 resulted in a difference of 4% for a collimated beam and 6% for an open beam. Variations in positioning on the order of a few centimeters resulted in a variation of only 4% with an open beam. The excellent reproducibility of the measurements using the full beam width suggests that this simple method is adequate for year‐to‐year comparisons. In contrast, the IAEA method is difficult to employ, particularly with 180° acquisitions. Use of peripheral measurements in excess of the usual four is time‐consuming and not necessary for most applications obtained with the geometry specific to this system.
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Affiliation(s)
- Stephanie Leon
- Department of Radiology, University of Florida, Gainesville, FL, USA
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45
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Current techniques and outcomes in hysteroscopic sterilization: current evidence, considerations, and complications with hysteroscopic sterilization micro inserts. Curr Opin Obstet Gynecol 2017; 29:218-224. [PMID: 28537948 DOI: 10.1097/gco.0000000000000369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW To describe the current data regarding effectiveness, complications, postoperative evaluation, and surgical interventions associated with Essure hysteroscopic sterilization. RECENT FINDINGS Hysteroscopic sterilization is a commonly performed procedure that is offered as a well tolerated, effective, outpatient method of permanent sterilization. Over the past several years, concerns have been raised regarding correct placement and postoperative complications. This has led to statements by both the Food and Drug Administration (FDA) in October, 2016 and American Association of Gynecologic Laparoscopists in February, 2017, as a significant portion of women seek removal of these devices. A current black-box warning issued by the FDA in 2016 recommends discussion of 'the probabilities of rates or events' of adverse outcomes associated with Essure placement. SUMMARY Although hysteroscopic sterilization is usually a safe, effective option for permanent contraception, new evidence regarding complications has emphasized the need for proper education and counseling. Appropriate patient selection and knowledge of potential complications is paramount to ensuring patients, and medical providers are well informed and have realistic expectations regarding potential placement and postoperative issues.
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46
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Anterior Impingement Syndrome of the Ankle Caused by Osteoid Osteoma in the Talar Neck Treated with Arthroscopy and 3D C-Arm-Based Imaging. Case Rep Orthop 2017; 2017:2171627. [PMID: 28458936 PMCID: PMC5387828 DOI: 10.1155/2017/2171627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 03/23/2017] [Indexed: 01/07/2023] Open
Abstract
Osteoid osteoma in periarticular lesions tends to have an unusual presentation that likely leads to a delayed or missed diagnosis compared with a typical osteoid osteoma in the metaphysis or diaphysis of the long bone. In cases that are unresponsive to conservative treatment, surgical interventions including en bloc resection, computed tomography-guided percutaneous treatment, and arthroscopic resection have been performed; however, these methods frequently result in inadequate tumor resection and recurrence. Here we present a case of a 16-year-old girl with osteoid osteoma in the talar neck presenting as anterior impingement syndrome due to marked synovitis in the ankle joint which was successfully treated without complications by arthroscopic synovectomy and tumor resection followed by intraoperative 3D C-arm-based imaging confirming complete tumor lesion removal. Her pain was relieved immediately after the surgery, and there was no recurrence at 12 months of follow-up. This is the first case report of the surgical treatment of the osteoid osteoma in the talar neck with the combination methods of arthroscopy and 3D C-arm-based imaging.
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Robinson S, Robertson FC, Dasenbrock HH, O'Brien CP, Berde C, Padua H. Image-guided intrathecal baclofen pump catheter implantation: a technical note and case series. J Neurosurg Spine 2017; 26:621-627. [DOI: 10.3171/2016.8.spine16263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEMedically refractory spasticity and dystonia are often alleviated with intrathecal baclofen (ITB) administration through an indwelling catheter inserted in the lumbar spine. In patients with cerebral palsy, however, there is a high incidence of concomitant neuromuscular scoliosis. ITB placement may be technically challenging in those who have severe spinal deformity or who have undergone prior instrumented thoracolumbar fusion. Although prior reports have described drilling through the lumbar fusion mass with a high-speed bur, as well as IT catheter implantation at the foramen magnum or cervical spine, these approaches have notable limitations. To the authors' knowledge, this is the first report of ITB placement using cone beam CT (CBCT) image guidance to facilitate percutaneous IT catheterization.METHODSData were prospectively collected on patients treated between November 2012 and June 2014. In the interventional radiology suite, general anesthesia was induced and the patient was positioned prone. Imaging was performed to identify the optimal trajectory. Percutaneous puncture was performed at an entry site with image-guided placement of a sheathed needle. CBCT provided real-time 2D projections and 3D reconstructions for detailed volumetric imaging. A biopsy drill was passed through the sheath, and subsequently a Tuohy needle was advanced intrathecally. The catheter was threaded cephalad under fluoroscopic visualization. After tip localization and CSF flow were confirmed, the stylet was replaced, the external catheter tubing was wrapped sterilely in a dressing, and the patient was transported to the operating room. After lateral decubitus positioning of the patient, the IT catheter was exposed and connected to the distal abdominal tubing with typical pump placement.RESULTSOf 15 patients with Gross Motor Function Classification System Levels IV and V cerebral palsy and instrumented thoracolumbar fusion, 8 had predominantly spasticity, and 7 had mixed spasticity and dystonia. The mean age of patients was 20.1 years (range 13–27 years). Nine patients underwent initial catheter and pump placement, and 6 underwent catheter replacement. The procedure was technically successful, with accurate spinal catheter placement in all patients. The median hospital stay was 4 days (IQR 3–5 days). One patient had an early postoperative urinary tract infection. With a mean follow-up of 25.8 months (median 26, range 18–38 months), no CSF leakage or catheter failure occurred. One late infection due to Pseudomonas aeruginosa (requiring pump explantation) occurred at 4 months, probably secondary to recurrent urinary tract infections.CONCLUSIONSImage-guided CBCT navigation resulted in accurate percutaneous placement of the IT catheter for ITB pumps in patients with prior instrumented thoracolumbar fusion. The multimodality approach is an alternate technique that may be used for IT catheter insertion in patients with complex lumbar spine anatomy, extending the potential to provide safe, durable ITB therapy in this population.
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Affiliation(s)
| | | | - Hormuzdiyar H. Dasenbrock
- 2Harvard Medical School
- 3Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts; and
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Tabanfar R, Qiu J, Chan H, Aflatouni N, Weersink R, Hasan W, Irish JC. Real-time continuous image-guided surgery: Preclinical investigation in glossectomy. Laryngoscope 2017; 127:E347-E353. [PMID: 28349585 DOI: 10.1002/lary.26585] [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: 11/15/2016] [Revised: 02/04/2017] [Accepted: 02/20/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To develop, validate, and study the efficacy of an intraoperative real-time continuous image-guided surgery (RTC-IGS) system for glossectomy. STUDY DESIGN Prospective study. METHODS We created a RTC-IGS system and surgical simulator for glossectomy, enabling definition of a surgical target preoperatively, real-time cautery tracking, and display of a surgical plan intraoperatively. System performance was evaluated by a group of otolaryngology residents, fellows, medical students, and staff under a reproducible setting by using realistic tongue phantoms. Evaluators were grouped into a senior and a junior group based on surgical experience, and guided and unguided tumor resections were performed. National Aeronautics and Space Administration Task Load Index (NASA-TLX) scores and a Likert scale were used to measure workloads and impressions of the system, respectively. Efficacy was studied by comparing surgical accuracy, time, collateral damage, and workload between RTC-IGS and non-navigated resections. RESULTS The senior group performed more accurately (80.9% ± 3.7% vs. 75.2% ± 5.5%, P = .28), required less time (5.0 ± 1.3 minutes vs. 7.3 ± 1.2 minutes, P = .17), and experienced lower workload (43 ± 2.0 vs. 64.4 ± 1.3 NASA-TLX score, P = .08), suggesting a trend of construct validity. Impressions were favorable, with participants reporting the system is a valuable practice tool (4.0/5 ± 0.3) and increases confidence (3.9/5 ± 0.4). Use of RTC-IGS improved both groups' accuracy, with the junior group improving from 64.4% ± 5.4% to 75.2% ± 5.5% (P = .01) and the senior group improving from 76.1% ± 4.5% to 80.9% ± 3.7% (P = .16). CONCLUSIONS We created an RTC-IGS system and surgical simulator and demonstrated a trend of construct validity. Our navigated simulator allows junior trainees to practice glossectomies outside the operating room. In all evaluators, navigation assistance resulted in increased surgical accuracy. LEVEL OF EVIDENCE NA Laryngoscope, 127:E347-E353, 2017.
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Affiliation(s)
- Reza Tabanfar
- Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Jimmy Qiu
- Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Harley Chan
- Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Niousha Aflatouni
- Institute of Biomaterials and Biomedical Engineering University of Toronto, Toronto, Ontario, Canada
| | - Robert Weersink
- Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.,Department of Radiation Oncology University of Toronto, Toronto, Ontario, Canada
| | - Wael Hasan
- University Health Network, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Guided Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada.,University Health Network, Toronto, Ontario, Canada.,Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
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Xu J, Sisniega A, Zbijewski W, Dang H, Stayman JW, Mow M, Wang X, Foos DH, Koliatsos VE, Aygun N, Siewerdsen JH. Technical assessment of a prototype cone-beam CT system for imaging of acute intracranial hemorrhage. Med Phys 2017; 43:5745. [PMID: 27782694 DOI: 10.1118/1.4963220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE A cone-beam CT scanner has been developed for detection and monitoring of traumatic brain injury and acute intracranial hemorrhage (ICH) at the point of care. This work presents a technical assessment of imaging performance and dose for the scanner in phantom and cadaver studies as a prerequisite to clinical translation. METHODS The scanner incorporates a compact, rotating-anode x-ray source and a flat-panel detector (43 × 43 cm2) on a mobile U-arm gantry with source-axis distance = 550 mm and source-detector distance = 1000 mm. Central and peripheral doses were measured in 16 cm diameter CTDI phantoms using a 0.6 cm3 Farmer ionization chamber for various scan techniques and as a function of longitudinal position, including out of field. Spatial resolution, contrast, noise, and image uniformity were assessed in quantitative and anthropomorphic head phantoms. Two reconstruction protocols were evaluated, including filtered backprojection (FBP) for high-resolution bone imaging and penalized weighted least squares (PWLS) reconstruction for low-contrast soft tissue (ICH) visualization. A fresh cadaver was imaged with and without simulated ICH using the scanner as well as a diagnostic multidetector CT (MDCT) scanner using a standard head protocol. Images were interpreted by a fellowship-trained neuroradiologist for imaging tasks of ICH detection, gray-white-CSF differentiation, detection of midline shift, and fracture detection. RESULTS The nominal scan protocol involved 720 projections acquired over a 360° orbit at 100 kV and 216 mAs, giving a dose (weighted CTDI) of 22.8 mGy (∼1.2 mSv effective dose). Out-of-field dose decreased to <10% within 6 cm of the field edge (approximate to the thyroid position). Image uniformity demonstrated <1% variation between the edge of the field (near the cranium) and center of the image. The high-resolution FBP reconstruction protocol showed ∼0.9 mm point spread function (PSF) full-width at half-maximum (FWHM). The smooth PWLS reconstruction protocol yielded ∼1.2 mm PSF FWHM and contrast-to-noise ratio exceeding 5.7 in ∼50 HU spherical ICH, resulting in conspicuous depiction of ICH down to ∼2 mm (the smallest diameter investigated). Cadaver images demonstrated good differentiation of brain and CSF (sufficient, but inferior to MDCT, recognizing that the CBCT dose was one-third that of MDCT), excellent visualization of cranial sutures and fracture (potentially superior to MDCT), clear detection of midline shift, and conspicuous detection of ICH. CONCLUSIONS Technical assessment of the prototype demonstrates dose characteristics and imaging performance consistent with point-of-care detection and monitoring of head injury-most notably, conspicuous detection of ICH-and supports translation of the system to clinical studies.
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Affiliation(s)
- Jennifer Xu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Wojciech Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Hao Dang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - J Webster Stayman
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | - Michael Mow
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205
| | | | | | | | - Nafi Aygun
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland 21205; Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland 21205; Department of Computer Science, Johns Hopkins University, Baltimore, Maryland 21205; Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland 21205; and Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland 21205
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Xia D, Langan DA, Solomon SB, Zhang Z, Chen B, Lai H, Sidky EY, Pan X. Optimization-based image reconstruction with artifact reduction in C-arm CBCT. Phys Med Biol 2016; 61:7300-7333. [PMID: 27694700 PMCID: PMC5109550 DOI: 10.1088/0031-9155/61/20/7300] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
We investigate an optimization-based reconstruction, with an emphasis on image-artifact reduction, from data collected in C-arm cone-beam computed tomography (CBCT) employed in image-guided interventional procedures. In the study, an image to be reconstructed is formulated as a solution to a convex optimization program in which a weighted data divergence is minimized subject to a constraint on the image total variation (TV); a data-derivative fidelity is introduced in the program specifically for effectively suppressing dominant, low-frequency data artifact caused by, e.g. data truncation; and the Chambolle-Pock (CP) algorithm is tailored to reconstruct an image through solving the program. Like any other reconstructions, the optimization-based reconstruction considered depends upon numerous parameters. We elucidate the parameters, illustrate their determination, and demonstrate their impact on the reconstruction. The optimization-based reconstruction, when applied to data collected from swine and patient subjects, yields images with visibly reduced artifacts in contrast to the reference reconstruction, and it also appears to exhibit a high degree of robustness against distinctively different anatomies of imaged subjects and scanning conditions of clinical significance. Knowledge and insights gained in the study may be exploited for aiding in the design of practical reconstructions of truly clinical-application utility.
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Affiliation(s)
- Dan Xia
- Department of Radiology, The University of Chicago, Chicago, IL, USA
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