The Feasibility and Accuracy of Holographic Navigation with Laser Crosshair Simulator Registration on a Mixed-Reality Display

Addressing conventional neurosurgical navigation systems' high costs and complexity, this study explores the feasibility and accuracy of a simplified, cost-effective mixed reality navigation (MRN) system based on a laser crosshair simulator (LCS). A new automatic registration method was developed, featuring coplanar laser emitters and a recognizable target pattern. The workflow was integrated into Microsoft's HoloLens-2 for practical application. The study assessed the system's precision by utilizing life-sized 3D-printed head phantoms based on computed tomography (CT) or magnetic resonance imaging (MRI) data from 19 patients (female/male: 7/12, average age: 54.4 ± 18.5 years) with intracranial lesions. Six to seven CT/MRI-visible scalp markers were used as reference points per case. The LCS-MRN's accuracy was evaluated through landmark-based and lesion-based analyses, using metrics such as target registration error (TRE) and Dice similarity coefficient (DSC). The system demonstrated immersive capabilities for observing intracranial structures across all cases. Analysis of 124 landmarks showed a TRE of 3.0 ± 0.5 mm, consistent across various surgical positions. The DSC of 0.83 ± 0.12 correlated significantly with lesion volume (Spearman rho = 0.813, p < 0.001). Therefore, the LCS-MRN system is a viable tool for neurosurgical planning, highlighting its low user dependency, cost-efficiency, and accuracy, with prospects for future clinical application enhancements.

Feasibility of Customized Thermoplastic Patient-Specific Helmet Bolus for Scalp Irradiation Using Volumetric-Modulated Arc Therapy Planning

Introduction: In this study, we sought to develop a thermoplastic patient-specific helmet bolus that could deliver a uniform therapeutic dose to the target and minimize the dose to the normal brain during whole-scalp treatment with a humanoid head phantom. Methods: The bolus material was a commercial thermoplastic used for patient immobilization, and the holes in the netting were filled with melted paraffin. We compared volumetric-modulated arc therapy treatment plans with and without the bolus for quantitative dose distribution analysis. We analyzed the dose distribution in the region of interest to compare dose differences between target and normal organs. For quantitative analysis of treatment dose, OSLD chips were attached at the vertex (VX), posterior occipital (PO), right (RT), and left temporal (LT) locations. Results: The average dose in the clinical target volume was 6553.8 cGy (99.3%) with bolus and 5874 cGy (89%) without bolus, differing by more than 10% from the prescribed dose (6600 cGy) to the scalp target. For the normal brain, it was 3747.8 cGy (56.8%) with bolus and 5484.6 cGy (83.1%) without bolus. These results show that while the dose to the treatment target decreased, the average dose to the normal brain, which is mostly inside the treatment target, increased by more than 25%. With the bolus, the OSLD measured dose was 102.5 ± 1.2% for VX and 101.5 ± 1.9%, 95.9 ± 1.9%, and 81.8 ± 2.1% for PO, RT, and LT, respectively. In addition, the average dose in the treatment plan was 102%, 101%, 93.6%, and 80.7% for VX, PO, RT, and LT. When no bolus was administered, 59.6 ± 2.4%, 112.6 ± 1.8%, 47.1 ± 1.6%, and 53.1 ± 2.3% were assessed as OSLD doses for VX, PO, RT, and LT, respectively. Conclusion: This study proposed a method to fabricate patient-specific boluses that are highly reproducible, accessible, and easy to fabricate for radiotherapy to the entire scalp and can effectively spare normal tissue while delivering sufficient surface dose.

A Novel Registration Method for a Mixed Reality Navigation System Based on a Laser Crosshair Simulator: A Technical Note

Mixed Reality Navigation (MRN) is pivotal in augmented reality-assisted intelligent neurosurgical interventions. However, existing MRN registration methods face challenges in concurrently achieving low user dependency, high accuracy, and clinical applicability. This study proposes and evaluates a novel registration method based on a laser crosshair simulator, evaluating its feasibility and accuracy. A novel registration method employing a laser crosshair simulator was introduced, designed to replicate the scanner frame's position on the patient. The system autonomously calculates the transformation, mapping coordinates from the tracking space to the reference image space. A mathematical model and workflow for registration were designed, and a Universal Windows Platform (UWP) application was developed on HoloLens-2. Finally, a head phantom was used to measure the system's target registration error (TRE). The proposed method was successfully implemented, obviating the need for user interactions with virtual objects during the registration process. Regarding accuracy, the average deviation was 3.7 ± 1.7 mm. This method shows encouraging results in efficiency and intuitiveness and marks a valuable advancement in low-cost, easy-to-use MRN systems. The potential for enhancing accuracy and adaptability in intervention procedures positions this approach as promising for improving surgical outcomes.

Validating Poly(3,4-ethylene dioxythiophene) Polystyrene Sulfonate-Based Textile Electroencephalography Electrodes by a Textile-Based Head Phantom

It is important to go through a validation process when developing new electroencephalography (EEG) electrodes, but it is impossible to keep the human mind constant, making the process difficult. It is also very difficult to identify noise and signals as the input signal is unknown. In this work, we have validated textile-based EEG electrodes constructed from a poly(3,4-ethylene dioxythiophene) polystyrene sulfonate:/polydimethylsiloxane coated cotton fabric using a textile-based head phantom. The performance of the textile-based electrode has also been compared against a commercial dry electrode. The textile electrodes collected a signal to a smaller skin-to-electrode impedance (-18.9%) and a higher signal-to-noise ratio (+3.45%) than Ag/AgCl dry electrodes. From an EEGLAB, it was observed that the inter-trial coherence and event-related spectral perturbation graphs of the textile-based electrodes were identical to the Ag/AgCl electrodes. Thus, these textile-based electrodes can be a potential alternative to monitor brain activity.

A Long-Lasting Textile-Based Anatomically Realistic Head Phantom for Validation of EEG Electrodes

During the development of new electroencephalography electrodes, it is important to surpass the validation process. However, maintaining the human mind in a constant state is impossible which in turn makes the validation process very difficult. Besides, it is also extremely difficult to identify noise and signals as the input signals are not known. For that reason, many researchers have developed head phantoms predominantly from ballistic gelatin. Gelatin-based material can be used in phantom applications, but unfortunately, this type of phantom has a short lifespan and is relatively heavyweight. Therefore, this article explores a long-lasting and lightweight (-91.17%) textile-based anatomically realistic head phantom that provides comparable functional performance to a gelatin-based head phantom. The result proved that the textile-based head phantom can accurately mimic body-electrode frequency responses which make it suitable for the controlled validation of new electrodes. The signal-to-noise ratio (SNR) of the textile-based head phantom was found to be significantly better than the ballistic gelatin-based head providing a 15.95 dB ± 1.666 (±10.45%) SNR at a 95% confidence interval.

Effect of skull thickness and conductivity on current propagation for noninvasively injected currents

Objective.When currents are injected into the scalp, e.g. during transcranial current stimulation, the resulting currents generated in the brain are substantially affected by the changes in conductivity and geometry of intermediate tissue. In this work, we introduce the concept of 'skull-transparent' currents, for which the changing conductivity does not significantly alter the field while propagating through the head.Approach.We establish transfer functions relating scalp currents to head potentials in accepted simplified models of the head, and find approximations for which skull-transparency holds. The current fields resulting from specified current patterns are calculated in multiple head models, including MRI heads and compared with homogeneous heads to characterize the transparency. Experimental validation is performed by measuring the current field in head phantoms.Main results.The main theoretical result is derived from observing that at high spatial frequencies, in the transfer function relating currents injected into the scalp to potential generated inside the head, the conductivity terms form a multiplicative factor and do not otherwise influence the transfer function. This observation is utilized to design injected current waveforms that maintain nearly identical focusing patterns independently of the changes in skull conductivity and thickness for a wide range of conductivity and thickness values in an idealized spherical head model as well as in a realistic MRI-based head model. Experimental measurements of the current field in an agar-based head phantom confirm the transparency of these patterns.Significance.Our results suggest the possibility that well-chosen patterns of current injection result in precise focusing inside the brain even withouta prioriknowledge of exact conductivities of intermediate layers.

A Simulation-Based Methodology of Developing 3D Printed Anthropomorphic Phantoms for Microwave Imaging Systems

This work is devoted to the development and manufacturing of realistic benchmark phantoms to evaluate the performance of microwave imaging devices. The 3D (3 dimensional) printed phantoms contain several cavities, designed to be filled with liquid solutions that mimic biological tissues in terms of complex permittivity over a wide frequency range. Numerical versions (stereolithography (STL) format files) of these phantoms were used to perform simulations to investigate experimental parameters. The purpose of this paper is two-fold. First, a general methodology for the development of a biological phantom is presented. Second, this approach is applied to the particular case of the experimental device developed by the Department of Electronics and Telecommunications at Politecnico di Torino (POLITO) that currently uses a homogeneous version of the head phantom considered in this paper. Numerical versions of the introduced inhomogeneous head phantoms were used to evaluate the effect of various parameters related to their development, such as the permittivity of the equivalent biological tissue, coupling medium, thickness and nature of the phantom walls, and number of compartments. To shed light on the effects of blood circulation on the recognition of a randomly shaped stroke, a numerical brain model including blood vessels was considered.

Stereotactic Neuro-Navigation Phantom Designs: A Systematic Review

Diverse stereotactic neuro-navigation systems are used daily in neurosurgery and novel systems are continuously being developed. Prior to clinical implementation of new surgical tools, methods or instruments, in vitro experiments on phantoms should be conducted. A stereotactic neuro-navigation phantom denotes a rigid or deformable structure resembling the cranium with the intracranial area. The use of phantoms is essential for the testing of complete procedures and their workflows, as well as for the final validation of the application accuracy. The aim of this study is to provide a systematic review of stereotactic neuro-navigation phantom designs, to identify their most relevant features, and to identify methodologies for measuring the target point error, the entry point error, and the angular error (α). The literature on phantom designs used for evaluating the accuracy of stereotactic neuro-navigation systems, i.e., robotic navigation systems, stereotactic frames, frameless navigation systems, and aiming devices, was searched. Eligible articles among the articles written in English in the period 2000–2020 were identified through the electronic databases PubMed, IEEE, Web of Science, and Scopus. The majority of phantom designs presented in those articles provide a suitable methodology for measuring the target point error, while there is a lack of objective measurements of the entry point error and angular error. We identified the need for a universal phantom design, which would be compatible with most common imaging techniques (e.g., computed tomography and magnetic resonance imaging) and suitable for simultaneous measurement of the target point, entry point, and angular errors.

Design, Fabrication, and Validation of a Polymethyl Methacrylate Head Phantom for Dosimetric Verification of Cranial Radiotherapy Treatment Plans

Purpose:

The present study aims to design and fabricate a novel, versatile, and cost-effective Polymethyl Methacrylate (PMMA) head phantom for the dosimetric pretreatment verification of radiotherapy (RT) treatment plans.

Materials and Methods:

The head phantom designing involves slice-wise modeling of an adult head using PMMA. The phantom has provisions to hold detectors such as ionization chambers of different sizes, Gafchromic films, gel dosimeter, and optically stimulated luminescence dosimeter. For the point dose verification purpose, 15 volumetric modulated arc therapy patient plans were selected, and doses were measured using a CC13 ionization chamber. The percentage gamma passing rate was calculated for acceptance criteria 3%/3 mm and 2%/2 mm using OmniPro I’mRT film QA software, and Gafchromic EBT3 films were used for 2D planar dose verification.

Results:

Treatment planning system calculated, and the measured point doses showed a percentage deviation ranged from 0.26 to 1.92. The planar dose fluence measurements, for set acceptance criteria of 3%/3 mm and 2%/2 mm, percentages of points having gamma value <1 were in the range of 99.17 ± 0.25 to 99.88 ± 0.15 and 93.16 ± 0.38 to 98.89 ± 0.23, respectively. Measured dose verification indices were within the acceptable limit.

Conclusions:

The dosimetric study reveals that head phantom can be used for routine pretreatment verification for the cranial RT, especially for stereotactic radiosurgery/RT as a part of patient-specific quality assurance. The presently fabricated and validated phantom is novel, versatile, and cost-effective, and many institutes can afford it.

A simple head-sized phantom for realistic static and radiofrequency characterization at high fields

PURPOSE

To demonstrate a simple head-sized phantom for realistic static and RF field characterization in high field systems.

METHODS

The head-sized phantom was composed of an ellipsoidal compartment and a spherical cavity to mimic the nasal cavity. The phantom was filled with an aqueous solution of polyvinylpyrrolidone (PVP), to mimic the average dielectric properties of brain tissue. The static and RF field distributions were characterized on a 7T MRI system and compared to in vivo measurements and simulations. MR thermometry was performed, and the results were compared to thermal simulations for RF validation purposes.

RESULTS

Accurate reproduction of both static and RF fields patterns observed in vivo was confirmed experimentally and was shown to be strongly affected by the inclusion of the spherical cavity. MR thermometry and transmit efficiency ( B1+) measurements were obtained in close agreement with simulations (peak values agreeing within 0.3 °C and 0.02 μT/√W) as well as fiber optic thermal probes (RMSE < 0.18 °C).

CONCLUSIONS

A simple head-sized phantom has been presented that produces B₀ and B1+ nonuniformities similar to those encountered in the human head and allows for accurate MR thermometry measurements, making this a suitable reference phantom for RF validation and methodological development in high field MRI.