CT-Based Image-Guided Navigation and the DaVinci Robot in Spine Oncology: Changing Surgical Paradigms.
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ABSTRACT:
SUBMITTER: Amin AG
PROVIDER: S-EPMC8436350 | biostudies-literature | 2021 Oct
REPOSITORIES: biostudies-literature
Publications
CT-Based Image-Guided Navigation and the DaVinci Robot in Spine Oncology: Changing Surgical Paradigms.
Amin Anubhav G AG Barzilai Ori O Bilsky Mark H MH
HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20210720 3
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Project description: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.
| S-EPMC6339594 | biostudies-literature
Project description:PurposeTo compare cone-beam computed tomography (CT) navigation vs conventional CT image guidance during biopsies.Materials and methodsPatients scheduled for image-guided biopsies were prospectively and randomly assigned to conventional CT guidance vs cone-beam CT navigation. Radiation dose, accuracy of final needle position, rate of histopathologic diagnosis, and number of needle repositions to reach the target (defined as pullback to adjust position) were compared.ResultsA total of 58 patients (mean age, 57 y; 62.1% men) were randomized: 29 patients underwent 33 biopsies with CT guidance and 29 patients with 33 lesions underwent biopsy with cone-beam CT navigation. The average body mass index (BMI) was similar between groups, at 28.8 kg/m(2) ± 6.55 (P = .18). There was no difference between groups in terms of patient and lesion characteristics (eg, size, depth). The average lesion size was 29.1 ± 12.7mm for CT group vs 32.1mm ±16.8mm for cone-beam CT group (P < 0.59). Location of lesions was equally divided between the 2 groups, 20 lung lesions, 18 renal lesions and 20 other abdominal lesions. Mean number of needle repositions in the cone-beam CT group was 0.3 ± 0.5, compared with 1.9 ± 2.3 with conventional CT (P < .001). The average skin entry dose was 29% lower with cone-beam CT than with conventional CT (P < .04 accounting for BMI). The average estimated effective dose for the planning scan from phantom data was 49% lower with cone-beam CT vs conventional CT (P = .018). Accuracy, defined as the difference between planned and final needle positions, was 4.9 mm ± 4.1 for the cone-beam CT group, compared with 12.2 mm ± 8.1 for conventional CT (P < .001). Histopathologic diagnosis rates were similar between groups, at 90.9% for conventional CT and 93.9% for cone-beam CT (P = .67).ConclusionsCone-beam CT navigation for biopsies improved targeting accuracy with fewer needle repositions, lower skin entry dose, and lower effective dose for planning scan, and a comparable histopathologic diagnosis rate.
| S-EPMC7869923 | biostudies-literature
Project description:The surgical treatment of congenital heart disease requires navigational assistance with transesophageal echocardiography (TEE); however, TEE images are often difficult to interpret and provide very limited anatomical information. Registering preoperative CT images to intraoperative TEE images provides surgeons with richer and more useful anatomical information. Yet, CT and TEE images differ substantially in terms of scale and geometry. In the present research, we propose a novel method for the registration of CT and TEE images for navigation during surgical repair of large defects in patients with congenital heart disease. Valve data was used for the coarse registration to determine the basic location. This was followed by the use of an enhanced probability model map to overcome gray-level differences between the two imaging modalities. Finally, the rapid optimization of mutual information was achieved by migrating parameters. This method was tested on a dataset of 240 images from 12 infant, children (≤ 3 years old), and adult patients with congenital heart disease. Compared to the "bronze standard" registration, the proposed method was more accurate with an average Dice coefficient of 0.91 and an average root mean square of target registration error of 1.2655 mm.
| S-EPMC6091287 | biostudies-literature
Project description:An unpredictable dynamic surgical environment makes it necessary to measure morphological information of target tissue real-time for laparoscopic image-guided navigation. The stereo vision method for intraoperative tissue 3D reconstruction has the most potential for clinical development benefiting from its high reconstruction accuracy and laparoscopy compatibility. However, existing stereo vision methods have difficulty in achieving high reconstruction accuracy in real time. Also, intraoperative tissue reconstruction results often contain complex background and instrument information that prevents clinical development for image-guided systems. Taking laparoscopic partial nephrectomy (LPN) as the research object, this paper realizes a real-time dense reconstruction and extraction of the kidney tissue surface. The central symmetrical Census based semi-global block stereo matching algorithm is proposed to generate a dense disparity map. A GPU-based pixel-by-pixel connectivity segmentation mechanism is designed to segment the renal tissue area. An in-vitro porcine heart, in-vivo porcine kidney and offline clinical LPN data were performed to evaluate the accuracy and effectiveness of our approach. The algorithm achieved a reconstruction accuracy of ± 2 mm with a real-time update rate of 21 fps for an HD image size of 960 × 540, and 91.0% target tissue segmentation accuracy even with surgical instrument occlusions. Experimental results have demonstrated that the proposed method could accurately reconstruct and extract renal surface in real-time in LPN. The measurement results can be used directly for image-guided systems. Our method provides a new way to measure geometric information of target tissue intraoperatively in laparoscopy surgery.Supplementary informationThe online version contains supplementary material available at 10.1007/s13534-023-00263-1.
| S-EPMC10130295 | biostudies-literature
Project description:Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS's navigation system overcoming the earlier version's issues, aiming to move the RAFS system into a surgical environment.The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance.Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about [Formula: see text] (phantom) and [Formula: see text] (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error [Formula: see text], [Formula: see text].Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.
| S-EPMC5541125 | biostudies-other
Project description:Glial-lineage malignancies (gliomas) recurrently mutate and/or delete the master regulators of apoptosis p53 and/or p16/CDKN2A, undermining apoptosis-intending (cytotoxic) treatments. By contrast to disrupted p53/p16, glioma cells are live-wired with the master transcription factor circuits that specify and drive glial lineage fates: these transcription factors activate early-glial and replication programs as expected, but fail in their other usual function of forcing onward glial lineage-maturation-late-glial genes have constitutively "closed" chromatin requiring chromatin-remodeling for activation-glioma-genesis disrupts several epigenetic components needed to perform this work, and simultaneously amplifies repressing epigenetic machinery instead. Pharmacologic inhibition of repressing epigenetic enzymes thus allows activation of late-glial genes and terminates glioma self-replication (self-replication = replication without lineage-maturation), independent of p53/p16/apoptosis. Lineage-specifying master transcription factors therefore contrast with p53/p16 in being enriched in self-replicating glioma cells, reveal a cause-effect relationship between aberrant epigenetic repression of late-lineage programs and malignant self-replication, and point to specific epigenetic targets for noncytotoxic glioma-therapy.
| S-EPMC9474618 | biostudies-literature
Project description:Intraoperative localization of target anatomy and critical structures defined in preoperative MR/CT images can be achieved through the use of multimodality deformable registration. We propose a symmetric diffeomorphic deformable registration algorithm incorporating a modality-independent neighborhood descriptor (MIND) and a robust Huber metric for MR-to-CT registration. The method, called MIND Demons, finds a deformation field between two images by optimizing an energy functional that incorporates both the forward and inverse deformations, smoothness on the integrated velocity fields, a modality-insensitive similarity function suitable to multimodality images, and smoothness on the diffeomorphisms themselves. Direct optimization without relying on the exponential map and stationary velocity field approximation used in conventional diffeomorphic Demons is carried out using a Gauss-Newton method for fast convergence. Registration performance and sensitivity to registration parameters were analyzed in simulation, phantom experiments, and clinical studies emulating application in image-guided spine surgery, and results were compared to mutual information (MI) free-form deformation (FFD), local MI (LMI) FFD, normalized MI (NMI) Demons, and MIND with a diffusion-based registration method (MIND-elastic). The method yielded sub-voxel invertibility (0.008 mm) and nonzero-positive Jacobian determinants. It also showed improved registration accuracy in comparison to the reference methods, with mean target registration error (TRE) of 1.7 mm compared to 11.3, 3.1, 5.6, and 2.4 mm for MI FFD, LMI FFD, NMI Demons, and MIND-elastic methods, respectively. Validation in clinical studies demonstrated realistic deformations with sub-voxel TRE in cases of cervical, thoracic, and lumbar spine.
| S-EPMC5097014 | biostudies-literature
Project description:Transesophageal echocardiography (TEE) has become an essential tool in interventional cardiologist's daily toolbox which allows a continuous visualization of the movement of the visceral organ without trauma and the observation of the heartbeat in real time, due to the sensor's location at the esophagus directly behind the heart and it becomes useful for navigation during the surgery. However, TEE images provide very limited data on clear anatomically cardiac structures. Instead, computed tomography (CT) images can provide anatomical information of cardiac structures, which can be used as guidance to interpret TEE images. In this paper, we will focus on how to transfer the anatomical information from CT images to TEE images via registration, which is quite challenging but significant to physicians and clinicians due to the extreme morphological deformation and different appearance between CT and TEE images of the same person. In this paper, we proposed a learning-based method to register cardiac CT images to TEE images. In the proposed method, to reduce the deformation between two images, we introduce the Cycle Generative Adversarial Network (CycleGAN) into our method simulating TEE-like images from CT images to reduce their appearance gap. Then, we perform nongrid registration to align TEE-like images with TEE images. The experimental results on both children' and adults' CT and TEE images show that our proposed method outperforms other compared methods. It is quite noted that reducing the appearance gap between CT and TEE images can benefit physicians and clinicians to get the anatomical information of ROIs in TEE images during the cardiac surgical operation.
| S-EPMC7352142 | biostudies-literature
Project description:BackgroundAn intravascular ultrasound catheter (IVUSc) was developed for intracardiac ultrasound to assess interventions with compelling results. However, intrahepatic vascular exploration was rarely tested and was always associated with X-ray techniques. The aim of this study was to demonstrate the feasibility to navigate through the whole liver using an IVUSc, providing high-quality images and making it unnecessary to use ionizing radiation.MethodsAn ex vivo pig visceral block and an in vivo pig model were used in this study. The IVUS equipment was composed of an US system, and of an 8 French lateral firing IVUSc capable of producing 90-degree sector images in the longitudinal plane. After accessing the intravascular space with the IVUSc into the models, predetermined anatomical landmarks were visualized from the inferior vena cava and hepatic veins and corroborated.ResultsIVUS navigation was achieved in both models successfully. The entire navigation protocol took 87 and 48 min respectively, and 100% (21/21) and 96.15% (25/26) of the landmarks were correctly identified with the IVUSc alone in the ex vivo and in vivo models respectively. IVUS allowed to clearly visualize the vasculature beyond third-order branches of the hepatic and portal veins.ConclusionsA complete IVUS liver navigation is feasible using the IVUSc alone, making it unnecessary to use ionizing radiation. This approach provides high-definition and real-time images of the complex liver structure and offers a great potential for future clinical applications during diagnostic and therapeutic interventions.
| S-EPMC7797115 | biostudies-literature
Project description:To assess the perioperative and short-term functional outcomes of robot-assisted partial nephrectomy (RAPN) with intraoperative navigation using an ultra-high-resolution computed tomography (UHR-CT) scanner, we retrospectively analyzed 323 patients who underwent RAPN using an UHR-CT or area-detector CT (ADCT). Perioperative outcomes and the postoperative preservation ratio of estimated glomerular filtration rate (eGFR) were compared. After the propensity score matching, we evaluated 99 patients in each group. Although the median warm ischemia time (WIT) was less than 25 min in both groups, it was significantly shorter in the UHR-CT group than in the ADCT group (15 min vs. 17 min, p = 0.032). Moreover, the estimated blood loss (EBL) was significantly lower in the UHR-CT group than in the ADCT group (33 mL vs. 50 mL, p = 0.028). However, there were no significant intergroup differences in the postoperative preservation ratio of eGFR at 3 or 6 months of follow-up (ADCT 91.8% vs. UHR-CT 93.5%, p = 0.195; and ADCT 91.7% vs. UHR-CT 94.0%, p = 0.160, respectively). Although no differences in short-term renal function were observed in intraoperative navigation for RAPN in this propensity score-matched cohort, this study is the first to demonstrate that UHR-CT resulted in a shorter WIT and lower EBL than ADCT.
| S-EPMC9032210 | biostudies-literature