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Brekken R, Hofstad EF, Solberg OV, Tangen GA, Leira HO, Gruionu L, Langø T. Accuracy of instrument tip position using fiber optic shape sensing for navigated bronchoscopy. Med Eng Phys 2024; 125:104116. [PMID: 38508792 DOI: 10.1016/j.medengphy.2024.104116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/21/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
The purpose of this study was to evaluate the accuracy of a method for estimating the tip position of a fiber optic shape-sensing (FOSS) integrated instrument being inserted through a bronchoscope. A modified guidewire with a multicore optical fiber was inserted into the working channel of a custom-made catheter with three electromagnetic (EM) sensors. The displacement between the instruments was manually set, and a point-based method was applied to match the position of the EM sensors to corresponding points on the shape. The accuracy was evaluated in a realistic bronchial model. An additional EM sensor was used to sample the tip of the guidewire, and the absolute deviation between this position and the estimated tip position was calculated. For small displacements between the tip of the FOSS integrated tool and the catheter, the median deviation in estimated tip position was ≤5 mm. For larger displacements, deviations exceeding 10 mm were observed. The deviations increased when the shape sensor had sharp curvatures relative to more straight shapes. The method works well for clinically relevant displacements of a biopsy tool from the bronchoscope tip, and when the path to the lesion has limited curvatures. However, improvements must be made to our configuration before pursuing further clinical testing.
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Affiliation(s)
- Reidar Brekken
- SINTEF Digital, Department of Health Research, Trondheim, Norway; Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway.
| | - Erlend Fagertun Hofstad
- SINTEF Digital, Department of Health Research, Trondheim, Norway; Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
| | - Ole Vegard Solberg
- SINTEF Digital, Department of Health Research, Trondheim, Norway; Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
| | - Geir Arne Tangen
- SINTEF Digital, Department of Health Research, Trondheim, Norway; Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway; Department of Thoracic Medicine, St Olavs Hospital, Trondheim, Norway
| | - Lucian Gruionu
- Faculty of Mechanics, University of Craiova, Craiova, Romania
| | - Thomas Langø
- SINTEF Digital, Department of Health Research, Trondheim, Norway; Norwegian National Research Centre for Minimally Invasive and Image-guided Diagnostics and Therapy, St. Olavs Hospital, Trondheim, Norway
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Kildahl-Andersen A, Hofstad EF, Peters K, Van Beek G, Sorger H, Amundsen T, Langø T, Leira HO. A novel clip-on device for electromagnetic tracking in endobronchial ultrasound bronchoscopy. MINIM INVASIV THER 2022; 31:1041-1049. [DOI: 10.1080/13645706.2022.2091937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Arne Kildahl-Andersen
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | | | | | - Hanne Sorger
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
| | - Tore Amundsen
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Langø
- Department of Health Research, SINTEF Digital, Trondheim, Norway
- Department of Research, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Våpenstad C, Fagertun Hofstad E, Eivind Bernstein T, Aadahl P, Johnsen G, Mårvik R. Optimal timing of assessment tasks depending on experience level of surgical trainees. MINIM INVASIV THER 2019; 29:161-169. [DOI: 10.1080/13645706.2019.1612441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Health Research, SINTEF Digital AS, Trondheim, Norway
| | | | - Tor Eivind Bernstein
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Petter Aadahl
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Gjermund Johnsen
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Jaeger HA, Trauzettel F, Nardelli P, Daverieux F, Hofstad EF, Leira HO, Kennedy MP, Langø T, Cantillon-Murphy P. Peripheral tumour targeting using open-source virtual bronchoscopy with electromagnetic tracking: a multi-user pre-clinical study. MINIM INVASIV THER 2018; 28:363-372. [PMID: 30428748 DOI: 10.1080/13645706.2018.1544911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: The goal was to demonstrate the utility of open-source tracking and visualisation tools in the targeting of lung cancer.Material and methods: The study demonstrates the first deployment of the Anser electromagnetic (EM) tracking system with the CustusX image-guided interventional research platform to navigate using an endobronchial catheter to injected tumour targets. Live animal investigations validated the deployment and targeting of peripheral tumour models using an innovative tumour marking routine.Results: Novel tumour model deployment was successfully achieved at all eight target sites across two live animal investigations without pneumothorax. Virtual bronchoscopy with tracking successfully guided the tracked catheter to 2-12 mm from the target tumour site. Deployment of a novel marker was achieved at all eight sites providing a reliable measure of targeting accuracy. Targeting accuracy within 10 mm was achieved in 7/8 sites and in all cases, the virtual target distance at marker deployment was within the range subsequently measured with x-ray.Conclusions: Endobronchial targeting of peripheral airway targets is feasible using existing open-source technology. Notwithstanding the shortcomings of current commercial platforms, technological improvements in EM tracking and registration accuracy fostered by open-source technology may provide the impetus for widespread clinical uptake of electromagnetic navigation in bronchoscopy.
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Affiliation(s)
- Herman Alexander Jaeger
- School of Engineering, University College Cork, Cork, Ireland.,IHU Strasbourg - Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Fabian Trauzettel
- School of Engineering, University College Cork, Cork, Ireland.,IHU Strasbourg - Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | - Pietro Nardelli
- Applied Chest Imaging Laboratory, Harvard Medical School, Boston, MA, USA
| | - Federico Daverieux
- IHU Strasbourg - Institut de Chirurgie Guidée par l'Image, Strasbourg, France
| | | | - Håkon O Leira
- St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Thomas Langø
- Medical Technology Research Group, SINTEF AS, Trondheim, Norway.,St. Olavs Hospital, Trondheim, Norway
| | - Pádraig Cantillon-Murphy
- School of Engineering, University College Cork, Cork, Ireland.,IHU Strasbourg - Institut de Chirurgie Guidée par l'Image, Strasbourg, France.,Tyndall National Institute, Dyke Parade, Cork, Ireland
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Reynisson PJ, Leira HO, Langø T, Tangen GA, Hatlen P, Amundsen T, Hofstad EF. Pulmonologist evaluation on new CT visualization for guidance to lung lesions during bronchoscopy. MINIM INVASIV THER 2018; 28:22-28. [PMID: 29703098 DOI: 10.1080/13645706.2018.1465436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Endoluminal visualization in virtual and video bronchoscopy lacks information about the surrounding structures, and the traditional 2 D axial, coronal and sagittal CT views can be difficult to interpret. To address this challenge, we previously introduced a novel visualization technique, Anchored to Centerline Curved Surface, for navigated bronchoscopy. The current study compares the ACCuSurf to the standard ACS CT views as planning and guiding tools in a phantom study. MATERIAL AND METHODS Bronchoscope operators navigated in physical phantom guided by virtual realistic image data constructed by fusion of CT dataset of phantom and anonymized patient CT data. We marked four different target positions within the virtual image data and gave 12 pulmonologists the task to navigate, with either ACCuSurf or ACS as guidance, to the corresponding targets in the physical phantom. RESULTS Using ACCuSurf reduced the planning time and increased the grade of successful navigation significantly compared to ACS. CONCLUSION The phantom setup with virtual patient image data proved realistic according to the pulmonologists. ACCuSurf proved superior to ACS regarding planning time and navigation success grading. Improvements on visualisation or display techniques may consequently improve both planning and navigated bronchoscopy and thus contribute to more precise lung diagnostics.
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Affiliation(s)
- Pall Jens Reynisson
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Håkon Olav Leira
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,b Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
| | - Thomas Langø
- c Department of Medical Technology , SINTEF Technology and Society , Trondheim , Norway
| | - Geir Arne Tangen
- c Department of Medical Technology , SINTEF Technology and Society , Trondheim , Norway
| | - Peter Hatlen
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,b Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
| | - Tore Amundsen
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,b Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
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Pham KD, Havre RF, Langø T, Hofstad EF, Tangen GA, Mårvik R, Pham T, Gilja OH, Hatlebakk JG, Viste A. Navigated retrograde endoscopic myotomy (REM) for the treatment of therapy-resistant achalasia. Neurogastroenterol Motil 2018; 30:e13252. [PMID: 29144018 DOI: 10.1111/nmo.13252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM. We aim to evaluate the feasibility and safety of REM and usefulness of the navigation during REM. METHOD A 42-year-old male with type III achalasia who was treated with laparoscopic myotomy with fundoplication, multiple pneumatic balloon dilations, Botox injections and anterior POEM of the middle and distal esophagus without symptomatic effect. Repeated high-resolution- manometry (HRM) revealed occluding contractions of high amplitude around and above the aortic arch. A probe-based real-time electromagnetic navigation platform was used to facilitate real-time anatomical orientation and to evaluate myotomy position and length during REM. RESULTS The navigation system aided in identifying the major structures of the mediastinum, and position and length of the myotomy. Twelve weeks after REM, the Eckardt score fell from seven at baseline seven to two. We also observed improvement with reduction of the pressure at the level of previous spasms in the proximal esophagus from 124 mmHg to 8 mmHg on HRM. CONCLUSION REM makes the proximal esophagus accessible for endoscopic myotomy. Potential indication for REM is motility disorders in the proximal esophagus and therapy failure after POEM.
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Affiliation(s)
- K D Pham
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R F Havre
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - T Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway
| | - E F Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - G A Tangen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - R Mårvik
- Norwegian National Advisory Unit on Advanced Laparoscopic Surgery, St. Olav Hospital, Trondheim, Norway
| | - T Pham
- Department of Surgery, Haukeland University Hospital, Bergen, Norway
| | - O H Gilja
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - J G Hatlebakk
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - A Viste
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Surgery, Haukeland University Hospital, Bergen, Norway
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Hofstad EF, Sorger H, Bakeng JBL, Gruionu L, Leira HO, Amundsen T, Langø T. Intraoperative localized constrained registration in navigated bronchoscopy. Med Phys 2017; 44:4204-4212. [DOI: 10.1002/mp.12361] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Hanne Sorger
- Department of Thoracic Medicine St. Olav's Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology (NTNU) Trondheim Norway
| | | | - Lucian Gruionu
- Department of Automotive Transportation and Industrial Engineering Faculty of Mechanics University of Craiova Craiova Romania
| | - Håkon Olav Leira
- Department of Thoracic Medicine St. Olav's Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology (NTNU) Trondheim Norway
| | - Tore Amundsen
- Department of Thoracic Medicine St. Olav's Hospital Trondheim Norway
- Department of Circulation and Medical Imaging Faculty of Medicine Norwegian University of Science and Technology (NTNU) Trondheim Norway
| | - Thomas Langø
- Department of Medical Technology SINTEF Technology and Society Trondheim Norway
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Reynisson PJ, Hofstad EF, Leira HO, Askeland C, Langø T, Sorger H, Lindseth F, Amundsen T, Hernes TAN. A new visualization method for navigated bronchoscopy. MINIM INVASIV THER 2017; 27:119-126. [PMID: 28554242 DOI: 10.1080/13645706.2017.1327870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In flexible endoscopy techniques, such as bronchoscopy, there is often a challenge visualizing the path from start to target based on preoperative data and accessing these during the procedure. An example of this is visualizing only the inside of central airways in bronchoscopy. Virtual bronchoscopy (VB) does not meet the pulmonologist's need to detect, define and sample the frequent targets outside the bronchial wall. Our aim was to develop and study a new visualization technique for navigated bronchoscopy. MATERIAL AND METHODS We extracted the shortest possible path from the top of the trachea to the target along the airway centerline and a corresponding auxiliary route in the opposite lung. A surface structure between the centerlines was developed and displayed. The new technique was tested on non-selective CT data from eight patients using artificial lung targets. RESULTS The new display technique anchored to centerline curved surface (ACCuSurf) made it easy to detect and interpret anatomical features, targets and neighboring anatomy outside the airways, in all eight patients. CONCLUSIONS ACCuSurf can simplify planning and performing navigated bronchoscopy, meets the challenge of improving orientation and register the direction of the moving endoscope, thus creating an optimal visualization for navigated bronchoscopy.
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Affiliation(s)
- Pall Jens Reynisson
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | | | - Håkon Olav Leira
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,c Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
| | - Christian Askeland
- b Department of Medical Technology , SINTEF Technology and Society , Trondheim , Norway
| | - Thomas Langø
- b Department of Medical Technology , SINTEF Technology and Society , Trondheim , Norway
| | - Hanne Sorger
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,c Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
| | - Frank Lindseth
- b Department of Medical Technology , SINTEF Technology and Society , Trondheim , Norway.,d Department Computer and Information Science , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
| | - Tore Amundsen
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,c Department Thoracic Medicine , St. Olavs Hospital , Trondheim , Norway
| | - Toril Anita Nagelhus Hernes
- a Department of Circulation and Medical Imaging, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,e Department of Research , St. Olavs Hospital , Trondheim , Norway
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Våpenstad C, Hofstad EF, Bø LE, Kuhry E, Johnsen G, Mårvik R, Langø T, Hernes TN. Lack of transfer of skills after virtual reality simulator training with haptic feedback. MINIM INVASIV THER 2017; 26:346-354. [DOI: 10.1080/13645706.2017.1319866] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Cecilie Våpenstad
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Central Norway Regional Health Authority, Trondheim, Norway
- The Norwegian National Advisory Unit for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Erlend Fagertun Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lars Eirik Bø
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Central Norway Regional Health Authority, Trondheim, Norway
- The Norwegian National Advisory Unit for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Esther Kuhry
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gjermund Johnsen
- The Norwegian National Advisory Unit for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Advisory Unit for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Gastrointestinal Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Toril Nagelhus Hernes
- Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Sorger H, Hofstad EF, Amundsen T, Langø T, Bakeng JBL, Leira HO. A multimodal image guiding system for Navigated Ultrasound Bronchoscopy (EBUS): A human feasibility study. PLoS One 2017; 12:e0171841. [PMID: 28182758 PMCID: PMC5300184 DOI: 10.1371/journal.pone.0171841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/26/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is the endoscopic method of choice for confirming lung cancer metastasis to mediastinal lymph nodes. Precision is crucial for correct staging and clinical decision-making. Navigation and multimodal imaging can potentially improve EBUS-TBNA efficiency. AIMS To demonstrate the feasibility of a multimodal image guiding system using electromagnetic navigation for ultrasound bronchoschopy in humans. METHODS Four patients referred for lung cancer diagnosis and staging with EBUS-TBNA were enrolled in the study. Target lymph nodes were predefined from the preoperative computed tomography (CT) images. A prototype convex probe ultrasound bronchoscope with an attached sensor for position tracking was used for EBUS-TBNA. Electromagnetic tracking of the ultrasound bronchoscope and ultrasound images allowed fusion of preoperative CT and intraoperative ultrasound in the navigation software. Navigated EBUS-TBNA was used to guide target lymph node localization and sampling. Navigation system accuracy was calculated, measured by the deviation between lymph node position in ultrasound and CT in three planes. Procedure time, diagnostic yield and adverse events were recorded. RESULTS Preoperative CT and real-time ultrasound images were successfully fused and displayed in the navigation software during the procedures. Overall navigation accuracy (11 measurements) was 10.0 ± 3.8 mm, maximum 17.6 mm, minimum 4.5 mm. An adequate sample was obtained in 6/6 (100%) of targeted lymph nodes. No adverse events were registered. CONCLUSIONS Electromagnetic navigated EBUS-TBNA was feasible, safe and easy in this human pilot study. The clinical usefulness was clearly demonstrated. Fusion of real-time ultrasound, preoperative CT and electromagnetic navigational bronchoscopy provided a controlled guiding to level of target, intraoperative overview and procedure documentation.
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Affiliation(s)
- Hanne Sorger
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Medicine, Levanger Hospital, North-Trøndelag Health Trust, Norway
| | - Erlend Fagertun Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Tore Amundsen
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Janne Beate Lervik Bakeng
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- Norwegian National Advisory Unit for Ultrasound and image-guided therapy, St. Olavs Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Thoracic Medicine, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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11
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Hofstad EF, Våpenstad C, Bø LE, Langø T, Kuhry E, Mårvik R. Psychomotor skills assessment by motion analysis in minimally invasive surgery on an animal organ. MINIM INVASIV THER 2017. [DOI: 10.1080/13645706.2017.1284131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Erlend Fagertun Hofstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Cecilie Våpenstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lars Eirik Bø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
| | - Esther Kuhry
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Mårvik
- The Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital-Trondheim University Hospital, Trondheim, Norway
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- National Center for Advanced Laparoscopic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Reynisson PJ, Scali M, Smistad E, Hofstad EF, Leira HO, Lindseth F, Nagelhus Hernes TA, Amundsen T, Sorger H, Langø T. Airway Segmentation and Centerline Extraction from Thoracic CT - Comparison of a New Method to State of the Art Commercialized Methods. PLoS One 2015; 10:e0144282. [PMID: 26657513 PMCID: PMC4676651 DOI: 10.1371/journal.pone.0144282] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/15/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Our motivation is increased bronchoscopic diagnostic yield and optimized preparation, for navigated bronchoscopy. In navigated bronchoscopy, virtual 3D airway visualization is often used to guide a bronchoscopic tool to peripheral lesions, synchronized with the real time video bronchoscopy. Visualization during navigated bronchoscopy, the segmentation time and methods, differs. Time consumption and logistics are two essential aspects that need to be optimized when integrating such technologies in the interventional room. We compared three different approaches to obtain airway centerlines and surface. METHOD CT lung dataset of 17 patients were processed in Mimics (Materialize, Leuven, Belgium), which provides a Basic module and a Pulmonology module (beta version) (MPM), OsiriX (Pixmeo, Geneva, Switzerland) and our Tube Segmentation Framework (TSF) method. Both MPM and TSF were evaluated with reference segmentation. Automatic and manual settings allowed us to segment the airways and obtain 3D models as well as the centrelines in all datasets. We compared the different procedures by user interactions such as number of clicks needed to process the data and quantitative measures concerning the quality of the segmentation and centrelines such as total length of the branches, number of branches, number of generations, and volume of the 3D model. RESULTS The TSF method was the most automatic, while the Mimics Pulmonology Module (MPM) and the Mimics Basic Module (MBM) resulted in the highest number of branches. MPM is the software which demands the least number of clicks to process the data. We found that the freely available OsiriX was less accurate compared to the other methods regarding segmentation results. However, the TSF method provided results fastest regarding number of clicks. The MPM was able to find the highest number of branches and generations. On the other hand, the TSF is fully automatic and it provides the user with both segmentation of the airways and the centerlines. Reference segmentation comparison averages and standard deviations for MPM and TSF correspond to literature. CONCLUSION The TSF is able to segment the airways and extract the centerlines in one single step. The number of branches found is lower for the TSF method than in Mimics. OsiriX demands the highest number of clicks to process the data, the segmentation is often sparse and extracting the centerline requires the use of another software system. Two of the software systems performed satisfactory with respect to be used in preprocessing CT images for navigated bronchoscopy, i.e. the TSF method and the MPM. According to reference segmentation both TSF and MPM are comparable with other segmentation methods. The level of automaticity and the resulting high number of branches plus the fact that both centerline and the surface of the airways were extracted, are requirements we considered particularly important. The in house method has the advantage of being an integrated part of a navigation platform for bronchoscopy, whilst the other methods can be considered preprocessing tools to a navigation system.
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Affiliation(s)
- Pall Jens Reynisson
- Dept. Circulation and medical imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Marta Scali
- Bio-Mechanical Engineering, Faculty of Mechanical Engineering, Delft University of Technology, Delft, Netherlands
| | - Erik Smistad
- Dept. Computer and Information Science, NTNU, Trondheim, Norway
| | | | - Håkon Olav Leira
- Dept. Circulation and medical imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Dept. Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Frank Lindseth
- Dept. Computer and Information Science, NTNU, Trondheim, Norway.,Dept. Medical Technology, SINTEF, Trondheim, Norway
| | - Toril Anita Nagelhus Hernes
- Dept. Circulation and medical imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tore Amundsen
- Dept. Circulation and medical imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Dept. Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Hanne Sorger
- Dept. Circulation and medical imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Dept. Thoracic Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Thomas Langø
- Dept. Medical Technology, SINTEF, Trondheim, Norway
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13
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Sorger H, Hofstad EF, Amundsen T, Langø T, Leira HO. A novel platform for electromagnetic navigated ultrasound bronchoscopy (EBUS). Int J Comput Assist Radiol Surg 2015; 11:1431-43. [PMID: 26615428 PMCID: PMC4958402 DOI: 10.1007/s11548-015-1326-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/06/2015] [Indexed: 12/25/2022]
Abstract
Purpose Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of mediastinal lymph nodes is essential for lung cancer staging and distinction between curative and palliative treatment. Precise sampling is crucial. Navigation and multimodal imaging may improve the efficiency of EBUS-TBNA. We demonstrate a novel EBUS-TBNA navigation system in a dedicated airway phantom. Methods Using a convex probe EBUS bronchoscope (CP-EBUS) with an integrated sensor for electromagnetic (EM) position tracking, we performed navigated CP-EBUS in a phantom. Preoperative computed tomography (CT) and real-time ultrasound (US) images were integrated into a navigation platform for EM navigated bronchoscopy. The coordinates of targets in CT and US volumes were registered in the navigation system, and the position deviation was calculated. Results The system visualized all tumor models and displayed their fused CT and US images in correct positions in the navigation system. Navigating the EBUS bronchoscope was fast and easy. Mean error observed between US and CT positions for 11 target lesions (37 measurements) was \documentclass[12pt]{minimal}
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\begin{document}$$2.8\pm 1.0$$\end{document}2.8±1.0 mm, maximum error was 5.9 mm. Conclusion The feasibility of our novel navigated CP-EBUS system was successfully demonstrated. An EBUS navigation system is needed to meet future requirements of precise mediastinal lymph node mapping, and provides new opportunities for procedure documentation in EBUS-TBNA.
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Affiliation(s)
- Hanne Sorger
- Department of Thoracic Medicine, St. Olavs Hospital, Postboks 3250, Sluppen, 7006, Trondheim, Norway. .,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), AHL-senteret, Prinsesse Kristinas gate 3, Trondheim, Norway. .,Department of Medicine, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
| | | | - Tore Amundsen
- Department of Thoracic Medicine, St. Olavs Hospital, Postboks 3250, Sluppen, 7006, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), AHL-senteret, Prinsesse Kristinas gate 3, Trondheim, Norway
| | - Thomas Langø
- Department Medical Technology, SINTEF, Technology and Society, Trondheim, Norway
| | - Håkon Olav Leira
- Department of Thoracic Medicine, St. Olavs Hospital, Postboks 3250, Sluppen, 7006, Trondheim, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), AHL-senteret, Prinsesse Kristinas gate 3, Trondheim, Norway
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14
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Askeland C, Solberg OV, Bakeng JBL, Reinertsen I, Tangen GA, Hofstad EF, Iversen DH, Våpenstad C, Selbekk T, Langø T, Hernes TAN, Olav Leira H, Unsgård G, Lindseth F. CustusX: an open-source research platform for image-guided therapy. Int J Comput Assist Radiol Surg 2015; 11:505-19. [PMID: 26410841 PMCID: PMC4819973 DOI: 10.1007/s11548-015-1292-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/31/2015] [Indexed: 12/14/2022]
Abstract
Purpose CustusX is an image-guided therapy (IGT) research platform dedicated to intraoperative navigation and ultrasound imaging. In this paper, we present CustusX as a robust, accurate, and extensible platform with full access to data and algorithms and show examples of application in technological and clinical IGT research. Methods CustusX has been developed continuously for more than 15 years based on requirements from clinical and technological researchers within the framework of a well-defined software quality process. The platform was designed as a layered architecture with plugins based on the CTK/OSGi framework, a superbuild that manages dependencies and features supporting the IGT workflow. We describe the use of the system in several different clinical settings and characterize major aspects of the system such as accuracy, frame rate, and latency. Results The validation experiments show a navigation system accuracy of \documentclass[12pt]{minimal}
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\begin{document}$$<$$\end{document}<1.1 mm, a frame rate of 20 fps, and latency of 285 ms for a typical setup. The current platform is extensible, user-friendly and has a streamlined architecture and quality process. CustusX has successfully been used for IGT research in neurosurgery, laparoscopic surgery, vascular surgery, and bronchoscopy. Conclusions CustusX is now a mature research platform for intraoperative navigation and ultrasound imaging and is ready for use by the IGT research community. CustusX is open-source and freely available at http://www.custusx.org.
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Affiliation(s)
- Christian Askeland
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway. .,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
| | - Ole Vegard Solberg
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | | | - Ingerid Reinertsen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | - Geir Arne Tangen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway
| | | | - Daniel Høyer Iversen
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Cecilie Våpenstad
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tormod Selbekk
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Thomas Langø
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Toril A Nagelhus Hernes
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Håkon Olav Leira
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Geirmund Unsgård
- Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
| | - Frank Lindseth
- Department of Medical Technology, SINTEF Technology and Society, Trondheim, Norway.,Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Norwegian National Advisory Unit on Ultrasound and Image-Guided Therapy, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway
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Bø LE, Hofstad EF, Lindseth F, Hernes TAN. Versatile robotic probe calibration for position tracking in ultrasound imaging. Phys Med Biol 2015; 60:3499-513. [DOI: 10.1088/0031-9155/60/9/3499] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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16
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Vijayan S, Klein S, Hofstad EF, Lindseth F, Ystgaard B, Langø T. Motion tracking in the liver: Validation of a method based on 4D ultrasound using a nonrigid registration technique. Med Phys 2014; 41:082903. [DOI: 10.1118/1.4890091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Vijayan S, Reinertsen I, Hofstad EF, Rethy A, Hernes TAN, Langø T. Liver deformation in an animal model due to pneumoperitoneum assessed by a vessel-based deformable registration. MINIM INVASIV THER 2014; 23:279-86. [PMID: 24848136 DOI: 10.3109/13645706.2014.914955] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE Surgical navigation based on preoperative images partly overcomes some of the drawbacks of minimally invasive interventions - reduction of free sight, lack of dexterity and tactile feedback. The usefulness of preoperative images is limited in laparoscopic liver surgery, as the liver shifts due to respiration, induction of pneumoperitoneum and surgical manipulation. In this study, we evaluated the shift and deformation in an animal liver caused by respiration and pneumopertioneum using intraoperative cone beam CT. MATERIAL AND METHODS 3D cone beam CT scans were acquired with arterial contrast. The centerlines of the segmented vessels were extracted from the images taken at different respiration and pressure settings. A non-rigid registration method was used to measure the shift and deformation. The mean Euclidean distance between the annotated landmarks was used for evaluation. RESULTS A shift and deformation of 44.6 mm on average was introduced due to the combined effect of respiration and pneumoperitoneum. On average 91% of the deformations caused by the respiration and pneumoperitoneum were recovered. CONCLUSION The results can contribute to the use of intraoperative imaging to correct for anatomic shift so that preoperative data can be used with greater confidence and accuracy during guidance of laparoscopic liver procedures.
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Affiliation(s)
- Sinara Vijayan
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU) , Trondheim , Norway
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Hofstad EF, Sorger H, Leira HO, Amundsen T, Langø T. Automatic registration of CT images to patient during the initial phase of bronchoscopy: A clinical pilot study. Med Phys 2014; 41:041903. [DOI: 10.1118/1.4866884] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Våpenstad C, Hofstad EF, Bø LE, Chmarra MK, Kuhry E, Johnsen G, Mårvik R, Langø T. Limitations of haptic feedback devices on construct validity of the LapSim® virtual reality simulator. Surg Endosc 2012; 27:1386-96. [DOI: 10.1007/s00464-012-2621-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/21/2012] [Indexed: 01/22/2023]
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Hofstad EF, Våpenstad C, Chmarra MK, Langø T, Kuhry E, Mårvik R. A study of psychomotor skills in minimally invasive surgery: what differentiates expert and nonexpert performance. Surg Endosc 2012; 27:854-63. [DOI: 10.1007/s00464-012-2524-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
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Zijlmans M, Langø T, Hofstad EF, Van Swol CFP, Rethy A. Navigated laparoscopy – liver shift and deformation due to pneumoperitoneum in an animal model. MINIM INVASIV THER 2012; 21:241-8. [DOI: 10.3109/13645706.2012.665805] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Bø LE, Leira HO, Tangen GA, Hofstad EF, Amundsen T, Langø T. Accuracy of electromagnetic tracking with a prototype field generator in an interventional OR setting. Med Phys 2011; 39:399-406. [DOI: 10.1118/1.3666768] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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