Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

Lai, Marco; Skyrman, Simon; Shan, Caifeng; Babić, Draženko; Homan, Robert; Edström, Erik; Persson, Oscar; Burström, Gustav; Elmi-Terander, Adrian; Hendriks, Benno H. W.

doi:10.1371/journal.pone.0227312

Cited by 31 publications

(34 citation statements)

References 45 publications

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“…This superimposition is displayed on a tablet, where the color of the virtual scalpel stick and an azimuth auxiliary circle increase the accuracy, intuitiveness, and efficiency of EVD surgery. The resulting accuracy is within 2.01 ± 1.12 mm, presenting a significant improvement over the optical positioning navigation (18.8 ± 8.56 mm) proposed by Ieiri et al [ 32 ], the mobile AR for percutaneous nephrolithotomy (7.9 mm) proposed by Müller et al [ 28 ], the phantom and porcine model AR evaluation (2.8 ± 2.7 and 3.52 ± 3.00 mm proposed by Kenngott et al [ 33 ], the AR imaging for endonasal skull base surgery (2.8 ± 2.7 mm) proposed by Lai et al [ 34 ], and the image positioning navigation (2.5 mm) proposed by Deng et al [ 35 ]. Table 3 shows that the proposed optical positioning method provided the best results in terms of average accuracy and standard deviation.…”

Section: Resultsmentioning

confidence: 99%

Augmented Reality Surgical Navigation System for External Ventricular Drain

et al. 2022

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Augmented reality surgery systems are playing an increasing role in the operating room, but applying such systems to neurosurgery presents particular challenges. In addition to using augmented reality technology to display the position of the surgical target position in 3D in real time, the application must also display the scalpel entry point and scalpel orientation, with accurate superposition on the patient. To improve the intuitiveness, efficiency, and accuracy of extra-ventricular drain surgery, this paper proposes an augmented reality surgical navigation system which accurately superimposes the surgical target position, scalpel entry point, and scalpel direction on a patient’s head and displays this data on a tablet. The accuracy of the optical measurement system (NDI Polaris Vicra) was first independently tested, and then complemented by the design of functions to help the surgeon quickly identify the surgical target position and determine the preferred entry point. A tablet PC was used to display the superimposed images of the surgical target, entry point, and scalpel on top of the patient, allowing for correct scalpel orientation. Digital imaging and communications in medicine (DICOM) results for the patient’s computed tomography were used to create a phantom and its associated AR model. This model was then imported into the application, which was then executed on the tablet. In the preoperative phase, the technician first spent 5–7 min to superimpose the virtual image of the head and the scalpel. The surgeon then took 2 min to identify the intended target position and entry point position on the tablet, which then dynamically displayed the superimposed image of the head, target position, entry point position, and scalpel (including the scalpel tip and scalpel orientation). Multiple experiments were successfully conducted on the phantom, along with six practical trials of clinical neurosurgical EVD. In the 2D-plane-superposition model, the optical measurement system (NDI Polaris Vicra) provided highly accurate visualization (2.01 ± 1.12 mm). In hospital-based clinical trials, the average technician preparation time was 6 min, while the surgeon required an average of 3.5 min to set the target and entry-point positions and accurately overlay the orientation with an NDI surgical stick. In the preparation phase, the average time required for the DICOM-formatted image processing and program import was 120 ± 30 min. The accuracy of the designed augmented reality optical surgical navigation system met clinical requirements, and can provide a visual and intuitive guide for neurosurgeons. The surgeon can use the tablet application to obtain real-time DICOM-formatted images of the patient, change the position of the surgical entry point, and instantly obtain an updated surgical path and surgical angle. The proposed design can be used as the basis for various augmented reality brain surgery navigation systems in the future.

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Section: Resultsmentioning

confidence: 99%

Augmented Reality Surgical Navigation System for External Ventricular Drain

et al. 2022

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“…In this way, surgery can be simulated in a safe environment with lower associated costs. 22 Besides the use for pituitary-tumor surgery and brain biopsies, the head phantom would also be interesting for other types of procedures, including removal of brain and skull-base tumors, such as gliomas, meningiomas, chondrosarcomas or chordomas. 23,24 MR and CT images of either patients or cadavers with the mentioned pathologies could be used for creating the phantoms.…”

Section: Discussionmentioning

confidence: 99%

Development of a CT-compatible anthropomorphic skull phantom for surgical planning, training, and simulation

Lai

Skyrman

Kor

et al. 2021

Medical Imaging 2021: Imaging Informatics for Healthcare, Research, and Applications

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Neurosurgical procedures require high accuracy and skills, so that practical surgical training is a key factor for successful patient outcomes. Neurosurgical training has been traditionally performed on human cadavers, or more recently on simulation models including virtual reality (VR) platforms. However, these methods have several drawbacks, including ethical and practical concerns. Anthropomorphic phantoms could solve most of the issues related to cadaveric models, and are suitable for simulating several neurosurgical procedures. The aim of this study was to design a realistic and CT-compatible anthropomorphic head phantom that could be used for surgical training and simulation, with a specific focus on endo-nasal skull-base surgery and brain biopsy. A head phantom was created by segmenting a Cone Beam Computed Tomography (CBCT) image and a T1-weighted MR image from a cadaver. The skull, which includes a complete structure of the nasal cavity and detailed skullbase anatomy, is 3D printed using PLA with calcium. The brain phantom is produced using a 3D printed mold, casting a mixture of PVA, water and coolant. The radiodensity and mechanical properties of the phantom were tested and adjusted in material choice to mimic real-life conditions. In general, surgeons have a positive attitude in using the phantom. The skull and the eloquent structures at the skull-base, as well as the brain parenchyma were realistically reproduced. The head phantom can be employed for neurosurgical education, training and surgical planning, and can be successfully used for simulating endo-nasal skull-base surgery and brain biopsies.

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“…7,8 Wang et al 9 performed MR image fusion on CT scans by automatically detecting and tracking markers located on the patient skin, achieving a patient-to-image registration. Similarly, in Lai et al 10,11 CT images were overlaid on top of the endoscopic view, by using an optical tracking system for endoscope tracking to conduct experiments on a phantom model, reaching a good accuracy in tracking and rendering the augmented view. Thus, the fusion of MR information on optical cameras by directly tracking markers on a patient, can be used in this specific application to assess the patient position and correct for it.…”

Section: Introductionmentioning

confidence: 99%

Augmented-reality visualization for improved patient positioning workflow during MR-HIFU therapy

Manni

Ferrer

Vincent

et al. 2021

Medical Imaging 2021: Image-Guided Procedures, Robotic Interventions, and Modeling

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Fusion of augmented reality imaging with the endoscopic view for endonasal skull base surgery; a novel application for surgical navigation based on intraoperative cone beam computed tomography and optical tracking

Cited by 31 publications

References 45 publications

Augmented Reality Surgical Navigation System for External Ventricular Drain

Augmented Reality Surgical Navigation System for External Ventricular Drain

Development of a CT-compatible anthropomorphic skull phantom for surgical planning, training, and simulation

Augmented-reality visualization for improved patient positioning workflow during MR-HIFU therapy

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