Jasper N Smit1, Koert F D Kuhlmann2, Oleksandra V Ivashchenko2,3, Bart R Thomson2,4, Thomas Langø5,6, Niels F M Kok2, Matteo Fusaglia2, Theo J M Ruers2,7. 1. Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. j.smit@nki.nl. 2. Department of Surgical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands. 3. Department of Radiology, Medical Physics Group, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands. 4. Department of Neurosurgery, University Hospital and University of Zurich, Zurich, Switzerland. 5. Research Group for Medical Technology, SINTEF, Trondheim, Norway. 6. Norwegian National Advisory Unit for Ultrasound and Image-Guided Therapy, St. Olavs Hospital, Trondheim, Norway. 7. Faculty of Science and Technology (TNW), Nanobiophysics Group (NBP), University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
Abstract
PURPOSE: Despite extensive preoperative imaging, intraoperative localization of liver lesions after systemic treatment can be challenging. Therefore, an image-guided navigation setup is explored that links preoperative diagnostic scans and 3D models to intraoperative ultrasound (US), enabling overlay of detailed diagnostic images on intraoperative US. Aim of this study is to assess the workflow and accuracy of such a navigation system which compensates for liver motion. METHODS: Electromagnetic (EM) tracking was used for organ tracking and movement of the transducer. After laparotomy, a sensor was attached to the liver surface while the EM-tracked US transducer enabled image acquisition and landmark digitization. Landmarks surrounding the lesion were selected during patient-specific preoperative 3D planning and identified for registration during surgery. Endpoints were accuracy and additional times of the investigative steps. Accuracy was computed at the center of the target lesion. RESULTS: In total, 22 navigated procedures were performed. Navigation provided useful visualization of preoperative 3D models and their overlay on US imaging. Landmark-based registration resulted in a mean fiducial registration error of 10.3 ± 4.3 mm, and a mean target registration error of 8.5 ± 4.2 mm. Navigation was available after an average of 12.7 min. CONCLUSION: We developed a navigation method combining ultrasound with active liver tracking for organ motion compensation, with an accuracy below 10 mm. Fixation of the liver sensor near the target lesion compensates for local movement and contributes to improved reliability during navigation. This represents an important step forward in providing surgical navigation throughout the procedure. TRIAL REGISTRATION: This study is registered in the Netherlands Trial Register (number NL7951).
PURPOSE: Despite extensive preoperative imaging, intraoperative localization of liver lesions after systemic treatment can be challenging. Therefore, an image-guided navigation setup is explored that links preoperative diagnostic scans and 3D models to intraoperative ultrasound (US), enabling overlay of detailed diagnostic images on intraoperative US. Aim of this study is to assess the workflow and accuracy of such a navigation system which compensates for liver motion. METHODS: Electromagnetic (EM) tracking was used for organ tracking and movement of the transducer. After laparotomy, a sensor was attached to the liver surface while the EM-tracked US transducer enabled image acquisition and landmark digitization. Landmarks surrounding the lesion were selected during patient-specific preoperative 3D planning and identified for registration during surgery. Endpoints were accuracy and additional times of the investigative steps. Accuracy was computed at the center of the target lesion. RESULTS: In total, 22 navigated procedures were performed. Navigation provided useful visualization of preoperative 3D models and their overlay on US imaging. Landmark-based registration resulted in a mean fiducial registration error of 10.3 ± 4.3 mm, and a mean target registration error of 8.5 ± 4.2 mm. Navigation was available after an average of 12.7 min. CONCLUSION: We developed a navigation method combining ultrasound with active liver tracking for organ motion compensation, with an accuracy below 10 mm. Fixation of the liver sensor near the target lesion compensates for local movement and contributes to improved reliability during navigation. This represents an important step forward in providing surgical navigation throughout the procedure. TRIAL REGISTRATION: This study is registered in the Netherlands Trial Register (number NL7951).
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