Abstract
Augmented reality (AR) offers a new medical treatment approach. We aimed to evaluate frameless (mask) fixation navigation using a 3D-printed patient model with fixed-AR technology for gamma knife radiosurgery (GKRS). Fixed-AR navigation was developed using the inside-out method with visual inertial odometry algorithms, and the flexible Quick Response marker was created for object-feature recognition. Virtual 3D-patient models for AR-rendering were created via 3D-scanning utilizing TrueDepth and cone-beam computed tomography (CBCT) to generate a new GammaKnife Icon™ model. A 3D-printed patient model included fiducial markers, and virtual 3D-patient models were used to validate registration accuracy. Registration accuracy between initial frameless fixation and re-fixation navigated fixed-AR was validated through visualization and quantitative method. The quantitative method was validated through set-up errors, fiducial marker coordinates, and high-definition motion management (HDMM) values. A 3D-printed model and virtual models were correctly overlapped under frameless fixation. Virtual models from both 3D-scanning and CBCT were enough to tolerate the navigated frameless re-fixation. Although the CBCT virtual model consistently delivered more accurate results, 3D-scanning was sufficient. Frameless re-fixation accuracy navigated in virtual models had mean set-up errors within 1 mm and 1.5° in all axes. Mean fiducial marker differences from coordinates in virtual models were within 2.5 mm in all axes, and mean 3D errors were within 3 mm. Mean HDMM difference values in virtual models were within 1.5 mm of initial HDMM values. The variability from navigation fixed-AR is enough to consider repositioning frameless fixation without CBCT scanning for treating patients fractionated with large multiple metastases lesions (> 3 cm) who have difficulty enduring long beam-on time. This system could be applied to novel GKRS navigation for frameless fixation with reduced preparation time.
Highlights
Augmented reality (AR) offers a new medical treatment approach
We investigated the navigation of frameless fixation using fixed-AR with the virtual models of cone-beam computed tomography (CBCT) scans and 3D-scans into a 3D-printed patient model for gamma knife radiosurgery (GKRS)
To complement the fixed device state, the quick response (QR) marker attached to the mask indicator and iPad Pro was installed to the cradle beside a couch bed
Summary
Augmented reality (AR) offers a new medical treatment approach. We aimed to evaluate frameless (mask) fixation navigation using a 3D-printed patient model with fixed-AR technology for gamma knife radiosurgery (GKRS). The variability from navigation fixed-AR is enough to consider repositioning frameless fixation without CBCT scanning for treating patients fractionated with large multiple metastases lesions (> 3 cm) who have difficulty enduring long beam-on time. CBCT could be acquired by either a higher signal (CTDI 6.3) preset or lower dose (CTDI 2.5) and registered with the stereotactically-defined image set for comparison between patient coordinates at the time of treatment imaging; the HDMM system can currently be used for head immobilization with a thermoplastic mask instead of a head-frame[14] It is the frameless fixation of the GK IconTM. The potential of TrueDepth in the recent iPad Pro as 3D-scanning in Heges application was evaluated using fixed-AR in GKRS To apply this new AR technology for GKRS, the virtual models were established using existing planning CBCT images, and a novel TrueDepth 3D-scanning method. We investigated the navigation of frameless fixation using fixed-AR with the virtual models of CBCT scans and 3D-scans into a 3D-printed patient model for GKRS
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