Fiducial Markers Research Articles

The Effect of Fiducial Marker Number and Configuration on Registration Error in Dynamic Implant Surgery.

Objective: To verify the effect of fiducial marker number and configuration on target registration error (TRE) for dynamic computer-aided zygomatic implant surgery. Material and Methods: All patients who underwent zygomatic implant surgery with navigation from January 2018 to December 2021 were enrolled. For each patient, 6 to 8 miniscrews were placed intraorally as fiducial markers before the surgery. After the registration procedure, the TRE, which represents the distance between the target of the image space and the real position of the fiducial markers, was calculated. SPSS (22.0) was used for statistical analysis. Results: A total of 325 titanium miniscrews were placed in 47 patients who underwent zygomatic implant placement by navigation. The lowest TRE was 0.2 mm, compared to the highest TRE of 1.9 mm. There was no significant difference in the mean TRE value among the different titanium miniscrew groups (P = .07). A total of 8 miniscrews in 7 patients were lost in the maxillary tuberosity area prior to and during navigation surgery, which resulted in an irregular polygonal distribution of fiducial markers. However, there was no statistically significant difference in TRE between a polygonal distribution (0.62 ± 0.35 mm) and an irregular polygonal distribution (0.68 ± 0.33 mm) (P = .35). Conclusion: A scattered, polygonal distribution with of a minimum of five fiducial markers in an edentulous maxilla could achieve acceptable TRE values in registration. It seems that the registration error was not influenced by the absence of one corner in a polygon distribution.

Poster 118: False Profile Radiograph Sourcil-Edge and Bone-Edge Measurements Both Correlate to Different Weight-Bearing Regions of the Acetabulum: A Three-Dimensional Analysis

Objectives: The acetabular sourcil has been thought of as the radiographic representation of the weightbearing dome of the acetabulum; however, there are limited modern data to support this supposition. In the literature, assessment of weightbearing acetabular coverage has been described using both the sourcil-edge and bone-edge as anatomic landmarks, leading to confusion and controversy in classification of hip dysplasia, indications for hip preservation surgery, and intraoperative coverage assessment. The purpose of this study was to localize the three-dimensional (3D) anatomic correlates of the sourcil-edge and bone-edge radiographic position on false profile radiographs. The authors hypothesized that the sourcil-edge on the false profile represents anterolateral coverage while the bone-edge represents anterior coverage. Methods: Forty hips were grouped by large or small differences between bone-edge and sourcil-edge anterior center edge angles (ACEA). The small difference group comprised the lowest quartile of sourcil-edge to bone-edge difference of an initial cohort of 80 hips, while the large difference group comprised the highest quartile of difference. 3D surface mesh models and digitally reconstructed radiographs (DRRs) were generated from hip computed tomography scans using the 3D Slicer Image Computing Platform (Figures 1 & 3). Sourcil-edge, bone-edge, and ACEAs were identified on DRRs and registered to the 3D models with fiducial markers. Intersection of bone-edge and sourcil-edge projection lines with the acetabular rim were obtained from the 3D models (Figures 2 & 4). 3D Anterior acetabular rim morphology was correlated with ACEA difference. Results: The bone-edge and sourcil-edge projections intersected the acetabular rim at a mean of 2:08 ± 0:25 and 1:20 ± 0:24 o’clock, respectively. The 3D models consistently demonstrated that, in both large and small discrepancy groups, the sourcil-edge corresponded to an area just posterior to the AIIS projection while the bone-edge corresponded to the weight-bearing region inferior to the AIIS (Figures 2 & 4). Additionally, in large discrepancy hips, the bone-edge corresponded to a more prominent acetabular coverage in the region of the AIIS than when compared to the small discrepancy hips. Conclusions: This study demonstrates that both the sourcil-edge and bone-edge projections on false profile radiographs correlate with differing weightbearing regions of the acetabulum. The sourcil-edge ACEA represents coverage at 1:20 o’clock on the acetabular rim and is consistently posterior to the AIIS, while the bone-edge measurement represents the region of the acetabular rim at 2:08 o’clock and is consistently inferior to the AIIS. In hips with a large discrepancy between bone-edge and sourcil-edge (highest quartile), ACEA measurement differs by a mean of 19.7 degrees based on the selection of these radiographic landmarks. These findings have substantial implications for hip preservation surgery technique and clinical decision making. A comprehensive understanding of femoral head coverage is essential for the treatment of young adult hip pathology. Although the sourcil and bone edge are two of the most important radiographic landmarks for assessment of acetabular dysplasia, descriptions of these landmarks are often over simplified. Some authors have advocated for greater utilization of measurements of coverage to the bone edge as it can be more consistently identified. Other authors have advocated for utilizing the sourcil-edge measurement as this is more representative of the “weight bearing dome”. These descriptions are limited as they do not improve our understanding of the anatomic and radiographic structure of the anterior acetabular rim. Although the concept of the “weight bearing dome” is classically described, it lacks anatomic precision. The present study clarifies the anatomic features of the acetabular rim that correspond to these radiographic features. Increased difference between the sourcil-edge and bone edge is generated by the differences in undulation of the anterosuperior acetabular rim. Acetabuli that have maximal anterior rim prominence at or near the superior-most aspect of the acetabulum (generally counterclockwise from the AIIS) tend to demonstrate smaller discrepancy between the bone-edge and sourcil-edge (Figure 4). Acetabuli that have maximal rim prominence medial and anterior to the superior-most aspect of the acetabulum generally demonstrate larger discrepancy (Figure 2). The present anatomic description can be utilized by the hip arthroscopist to better determine which areas of the anterior rim may cause impingement. Similarly, while conducting a periacetabular osteotomy, the surgeon may use this information to better understand how acetabular rotation is contributing to both anterior and anterolateral coverage. In conclusion, on false profile radiographs, the sourcil-edge corresponds to superior femoral head coverage, while the bone-edge corresponds to anterosuperior coverage. False profile radiographs with a large discrepancy between sourcil-edge and bone-edge measurements demonstrate a prominent weight bearing surface in the region of the AIIS. These data regarding the radiographic phenomena of the acetabular rim can aid in clinical decision-making and intraoperative technique.

Nonlinear Imaging Histopathology: A Pipeline to Correlate Gold-Standard Hematoxylin and Eosin Staining With Modern Nonlinear Microscopy.

Hematoxylin and eosin (H&E) staining, the century-old technique, has been the gold standard tool for pathologists to detect anomalies in tissues and diseases such as cancer. H&E staining is a cumbersome, time-consuming process that delays and wastes precious minutes during an intraoperative diagnosis. However, even in the modern era, real-time label-free imaging techniques such as simultaneous label-free autofluorescence multiharmonic (SLAM) microscopy have delivered several more layers of information to characterize a tissue with high precision. Still, they have yet to translate to the clinic. The slow translation rate can be attributed to the lack of direct comparisons between the old and new techniques. Our approach to solving this problem is to: 1) reduce dimensions by pre-sectioning the tissue in 500 μm slices, and 2) produce fiducial laser markings which appear in both SLAM and histological imaging. High peak-power femtosecond laser pulses enable ablation in a controlled and contained manner. We perform laser marking on a grid of points encompassing the SLAM region of interest. We optimize laser power, numerical aperture, and timing to produce axially extended marking, hence multilayered fiducial markers, with minimal damage to the surrounding tissues. We performed this co-registration over an area of 3 × 3 mm2 of freshly excised mouse kidney and intestine, followed by standard H&E staining. Reduced dimensionality and the use of laser markings provided a comparison of the old and new techniques, giving a wealth of correlative information and elevating the potential of translating nonlinear microscopy to the clinic for rapid pathological assessment.

Analytical Models for Pose Estimate Variance of Planar Fiducial Markers for Mobile Robot Localisation

Planar fiducial markers are commonly used to estimate a pose of a camera relative to the marker. This information can be combined with other sensor data to provide a global or local position estimate of the system in the environment using a state estimator such as the Kalman filter. To achieve accurate estimates, the observation noise covariance matrix must be properly configured to reflect the sensor output’s characteristics. However, the observation noise of the pose obtained from planar fiducial markers varies across the measurement range and this fact needs to be taken into account during the sensor fusion to provide a reliable estimate. In this work, we present experimental measurements of the fiducial markers in real and simulation scenarios for 2D pose estimation. Based on these measurements, we propose analytical functions that approximate the variances of pose estimates. We demonstrate the effectiveness of our approach in a 2D robot localisation experiment, where we present a method for estimating covariance model parameters based on user measurements and a technique for fusing pose estimates from multiple markers.

Mandibular Flexure and Its Significance: An In Vivo Cone Beam-Computed Tomography Proof-of-Concept Study.

The aim of this study was to assess intra-arch mandibular dimensional changes that may occur during mouth opening using cone beam-computed tomography (CBCT). Fifteen patients in need of any type of treatment whose execution considered a pre- and post-CBCT assessment consented and were enrolled. CBCTs were taken with the following settings: 90 kV, 8 mA, field of view (FOV) 140 by 100 mm (height and diameter), Voxel size 0.25 mm (high resolution). The pre-CBCT was executed in the maximum mandibular opening (MO), while the post-CBCT was in the maximum intercuspation (MI). A thermoplastic stent with radiopaque fiducial markers (steel ball bearings) was fabricated for each patient. Measurements were made using radiographic markers between contralateral canines and contralateral first molars and between ipsilateral canines and first molars on both sides. Paired t-tests were performed to evaluate the difference between open and closed positions on these four measurements. In the MO position were registered a significative tightening of the mandible at the canine (-0.49 mm, SD 0.54 mm; p < 0.001) and molar points (-0.81 mm, SD 0.63 mm; p < 0.001) and a significative shortening of the mandible on the right (-0.84 mm, SD 0.80 mm; p < 0.001) and left sides (-0.87 mm, SD 0.49 mm; p < 0.001). Within the study limitations, mandibular flexure determined a significant shortening and tightening between maximum intercuspation to maximum opening positions. Mandibular dimensional changes should be considered in light of other patient factors in the treatment planning of implant positioning and long-span complete arch implant-supported fixed prostheses in order to avoid technical complications.

Impact of planning organ at risk volume margins and matching method on late gastrointestinal toxicity in moderately hypofractionated IMRT for locally advanced pancreatic ductal adenocarcinoma

BackgroundThis study examined the differences in late gastrointestinal (GI) toxicities in moderately hypofractionated intensity-modulated radiation therapy (IMRT) for locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) by changing the planning organs at risk volume (PRV) margin and the target matching method and assessed the causes of adverse events.MethodsWe examined 37 patients with LA-PDAC who underwent moderately hypofractionated IMRT between 2016 and 2020 at our institution; 23 patients were treated with wide PRV margins and soft tissue matching (Protocol A) and 14 with narrow PRV margins and fiducial marker matching (Protocol B). The GI toxicities, local control (LC) rate, and overall survival (OS) were assessed for each protocol. The initially planned and daily doses to the gross tumor volume (GTV), stomach, and duodenum, reproduced from cone-beam computed tomography, were evaluated.ResultsThe late GI toxicity rate of grades 3–4 was higher in Protocol B (42.9%) than in Protocol A (4.3%). Although the 2-year LC rates were significantly higher in Protocol B (90.0%) than in Protocol A (33.3%), no significant difference was observed in OS rates. In the initial plan, no deviations were found for the stomach and duodenum from the dose constraints in either protocol. In contrast, daily dose evaluation for the stomach to duodenal bulb revealed that the frequency of deviation of V3 Gy per session was 44.8% in Protocol B, which was significantly higher than the 24.3% in Protocol A.ConclusionsReducing PRV margins with fiducial marker matching increased GI toxicities in exchange for improved LC. Daily dose analysis indicated the trade-off between the GTV dose coverage and the irradiated doses to the GI. This study showed that even with strict matching methods, the PRV margin could not be reduced safely because of GI inter-fractional error, which is expected to be resolved with online adaptive radiotherapy.

Intra-prostatic gold fiducial marker insertion for image-guided radiotherapy (IGRT): five-year experience on 795 patients

IntroductionProstate cancer is the second most commonly diagnosed cancer in males. The use of intra-prostatic fiducial markers (FM) for image-guided radiotherapy (IGRT) has become widespread due to their accuracy, relatively safe use, low cost, and reproducibility. FM provides a tool to monitor prostate position and volume changes. Many studies reported low to moderate rates of complications following FM implantation. In the current study, we present our five years’ experience regarding the insertion technique, technical success, and rates of complication and migration of intraprostatic insertion of FM gold marker.MethodsFrom January 2018 to January 2023, 795 patients with prostate cancer candidate for IGRT (with or without a history of radical prostatectomy) enrolled in this study. We used three fiducial markers (3*0.6 mm) inserted through an 18-gauge Chiba needle under transrectal ultrasonography (TRUS) guidance. The patients were observed for complications up to seven days after the procedure. Besides, the rate of marker migration was recorded.ResultsAll procedures were completed successfully, and all patients tolerated the procedure well with minimal discomfort. The rate of sepsis after the procedure was 1%, and transient urinary obstruction was 1.6%. Only two patients experienced marker migration shortly after insertion, and no fiducial migration was reported throughout radiotherapy. No other major complication was recorded.DiscussionTRUS-guided intraprostatic FM implantation is technically feasible, safe, and well-tolerated in most patients. The FM migration can seldom occur, with negligible effects. This study can provide convincing evidence that TRUS-guided intra-prostatic FM insertion is an appropriate choice for IGRT.

Smart Radiotherapy Biomaterials for Image-Guided In Situ Cancer Vaccination.

Recent studies have highlighted the potential of smart radiotherapy biomaterials (SRBs) for combining radiotherapy and immunotherapy. These SRBs include smart fiducial markers and smart nanoparticles made with high atomic number materials that can provide requisite image contrast during radiotherapy, increase tumor immunogenicity, and provide sustained local delivery of immunotherapy. Here, we review the state-of-the-art in this area of research, the challenges and opportunities, with a focus on in situ vaccination to expand the role of radiotherapy in the treatment of both local and metastatic disease. A roadmap for clinical translation is outlined with a focus on specific cancers where such an approach is readily translatable or will have the highest impact. The potential of FLASH radiotherapy to synergize with SRBs is discussed including prospects for using SRBs in place of currently used inert radiotherapy biomaterials such as fiducial markers, or spacers. While the bulk of this review focuses on the last decade, in some cases, relevant foundational work extends as far back as the last two and half decades.

Structural analysis of the water channel AQP2 by single-particle cryo-EM

Water channels, which are small membrane proteins almost entirely buried in lipid membranes, are challenging research targets for single-particle cryo-electron microscopy (cryo-EM), a powerful technique routinely used to determine the structures of membrane proteins. Because the single-particle method enables structural analysis of a whole protein with flexible parts that interfere with crystallization, we have focused our efforts on analyzing water channel structures. Here, utilizing this system, we analyzed the structure of full-length aquaporin-2 (AQP2), a primary regulator of vasopressin-dependent reabsorption of water at the renal collecting ducts. The 2.9 Å resolution map revealed a cytoplasmic extension of the cryo-EM density that was presumed to be the highly flexible C-terminus at which the localization of AQP2 is regulated in the renal collecting duct cells. We also observed a continuous density along the common water pathway inside the channel pore and lipid-like molecules at the membrane interface. Observations of these constructions in the AQP2 structure analyzed without any fiducial markers (e.g., a rigidly bound antibody) indicate that single-particle cryo-EM will be useful for investigating water channels in native states as well as in complexes with chemical compounds.

An intelligent tracking system for surgical instruments in complex surgical environment

In recent years, the problem of visual occlusion in optical surgical tracking system has attracted widespread attention. To solve this problem, this paper proposes a tracking system for surgical instruments based on data fusion of multicamera modules. Multicamera modules are used to track surgical instruments from different angles to solve the problem of tracking occlusion in monocular tracking. Firstly, occlusion of monocular tracking based on different fiducial marker is analyzed, and a fast calibration method of tracking system for surgical instrument based on multicamera module is proposed. The calibration of the tracking system is mainly divided into the calibration of surgical instruments and the fast calibration between multicamera modules. On this basis, the occlusion detection mechanism is proposed to screen out the data with large errors, and the fuzzy control theory is used to calculate the support degree between different modules. Finally, the serviceable data is fused based on the least square method and the position of surgical instruments is estimated. The average accuracy of static positioning and dynamic trajectory tracking is mm and mm respectively. The real-time performance of the proposed system is 35 frames per second (fps). Compared with the existing optical tracking system, the method proposed in this paper has stronger anti-occlusion and simpler operation.

RegiSTORM: channel registration for multi-color stochastic optical reconstruction microscopy

BackgroundStochastic optical reconstruction microscopy (STORM), a super-resolution microscopy technique based on single-molecule localizations, has become popular to characterize sub-diffraction limit targets. However, due to lengthy image acquisition, STORM recordings are prone to sample drift. Existing cross-correlation or fiducial marker-based algorithms allow correcting the drift within each channel, but misalignment between channels remains due to interchannel drift accumulating during sequential channel acquisition. This is a major drawback in multi-color STORM, a technique of utmost importance for the characterization of various biological interactions.ResultsWe developed RegiSTORM, a software for reducing channel misalignment by accurately registering STORM channels utilizing fiducial markers in the sample. RegiSTORM identifies fiducials from the STORM localization data based on their non-blinking nature and uses them as landmarks for channel registration. We first demonstrated accurate registration on recordings of fiducials only, as evidenced by significantly reduced target registration error with all the tested channel combinations. Next, we validated the performance in a more practically relevant setup on cells multi-stained for tubulin. Finally, we showed that RegiSTORM successfully registers two-color STORM recordings of cargo-loaded lipid nanoparticles without fiducials, demonstrating the broader applicability of this software.ConclusionsThe developed RegiSTORM software was demonstrated to be able to accurately register multiple STORM channels and is freely available as open-source (MIT license) at https://github.com/oystein676/RegiSTORM.git and https://doi.org/10.5281/zenodo.5509861 (archived), and runs as a standalone executable (Windows) or via Python (Mac OS, Linux).

Validation of automated image co-registration integrated into in-house software for voxel-based internal dosimetry on single-photon emission computed tomography images.

To develop an automated co-registration system and test its performance, with and without a fiducial marker, on single-photon emission computed tomography (SPECT) images. Three SPECT/CT scans were acquired for each rotation of a Jaszczak phantom (to 0°, 5°, and 10° in relation to the bed axis), with and without a fiducial marker. Two rigid co-registration software packages-SPM12 and NMDose-coreg-were employed, and the percent root mean square error (%RMSE) was calculated in order to assess the quality of the co-registrations. Uniformity, contrast, and resolution were measured before and after co-registration. The NMDose-coreg software was employed to calculate the renal doses in 12 patients treated with 177Lu-DOTATATE, and we compared those with the values obtained with the Organ Level INternal Dose Assessment for EXponential Modeling (OLINDA/EXM) software. The use of a fiducial marker had no significant effect on the quality of co-registration on SPECT images, as measured by %RMSE (p = 0.40). After co-registration, uniformity, contrast, and resolution did not differ between the images acquired with fiducial markers and those acquired without. Preliminary clinical application showed mean total processing times of 9 ± 3 min/patient for NMDose-coreg and 64 ± 10 min/patient for OLINDA/EXM, with a strong correlation between the two, despite the lower renal doses obtained with NMDose-coreg. The use of NMDose-coreg allows fast co-registration of SPECT images, with no loss of uniformity, contrast, or resolution. The use of a fiducial marker does not appear to increase the accuracy of co-registration on phantoms.

Nail it! vision-based drift correction for accurate mixed reality surgical guidance.

Mixed reality-guided surgery through head-mounted displays (HMDs) is gaining interest among surgeons. However, precise tracking of HMDs relative to the surgical environment is crucial for successful outcomes. Without fiducial markers, spatial tracking of the HMD suffers from millimeter- to centimeter-scale drift, resulting in misaligned visualization of registered overlays. Methods and workflows capable of automatically correcting for drift after patient registration are essential to assuring accurate execution of surgical plans. We present a mixed reality surgical navigation workflow that continuously corrects for drift after patient registration using only image-based methods. We demonstrate its feasibility and capabilities using the Microsoft HoloLens on glenoid pin placement in total shoulder arthroplasty. A phantom study was conducted involving five users with each user placing pins on six glenoids of different deformity, followed by a cadaver study by an attending surgeon. In both studies, all users were satisfied with the registration overlay before drilling the pin. Postoperative CT scans showed 1.5mm error in entry point deviation and 2.4[Formula: see text] error in pin orientation on average in the phantom study and 2.5mm and 1.5[Formula: see text] in the cadaver study. A trained user takes around 90s to complete the workflow. Our method also outperformed HoloLens native tracking in drift correction. Our findings suggest that image-based drift correction can provide mixed reality environments precisely aligned with patient anatomy, enabling pin placement with consistently high accuracy. These techniques constitute a next step toward purely image-based mixed reality surgical guidance, without requiring patient markers or external tracking hardware.

Initial results of a prospective, multicenter study on the use of a biosynthesized cellulose membrane as a separation in de novo CIED implantations

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Public Grant: EIC Accelerator pilot –SME Instrument (H2020-EIC-SMEInst-2018-2020) Private Company: Hylomorph AG Background Fibrosis is the result of foreign body reaction against the hardware of cardiac implantable electronic devices (CIEDs). Generator pocket fibrotic adhesions increase the complexity and risks of CIED revision surgeries. There is limited evidence that synthetic or ex vivo resorbable envelopes can prevent or reduce fibrosis. Objective We conducted a multicenter, prospective, single-arm, interventional study of microengineered biosynthesized cellulose (BC) as separation layer for CIED pockets. Patients who were undergoing a CIED de novo implantation were included to receive the protective device. The primary end point was the maintenance of a detectable barrier between the CIED generator and the surrounding tissue at 12 months. The secondary end point for safety was procedure-related or system-related complications within 12 months. Methods High resolution ultrasound (HRUS) imaging of the protective layer, the CIED and the surrounding tissue of the generator pocket were collected at the day of implant, and at one, six-, and twelve-months follow-up visits in 35 patients (of 46 recruited). The images were individually processed and analyzed. Results HRUS imaging allowed the reproducible detection of (1) the CIED interface as fiducial reference marker, (2) the densification of the surrounding tissue and (3) the segregation between the two. A detectable separation between the CIED and the surrounding tissue was identified in all patients at all follow-up visits demonstrating the enforcement of a durable and stable barrier. The evolution of HRUS signal intensity indicated a time-dependent densification compatible with the buildup of fibrotic tissue around the generator. The thickness of this tissue was measured rendering values below 1 mm. Mean time for cellulose membrane application was 7.5±4 minutes. Investigational device related major complications were 0%. Conclusion Adjunctive use of an antifibrotic device established a durable separation between the CIED and the surrounding soft tissue in the generator pocket without a significantly higher incidence of complications or a relevantly increased procedural time. HRUS imaging indicated a limited buildup of denser tissue around the generator and no adhesions inside the cellulose membrane. Altogether these results suggest that BC may be beneficial for post-implantation pocket health as an alternative to envelopes of synthetic or animal origin and may enable easy pocket access in revision procedures.

Feasibility and guidelines for the use of an injectable fiducial marker (BioXmark ®) to improve target delineation in preclinical radiotherapy studies using mouse models.

Preclinical models of radiotherapy (RT) response are vital for the continued success and evolution of RT in the treatment of cancer. The irradiation of tissues in mouse models necessitates high levels of precision and accuracy to recapitulate clinical exposures and limit adverse effects on animal welfare. This requirement has been met by technological advances in preclinical RT platforms established over the past decade. Small animal RT systems use onboard computed tomography (CT) imaging to delineate target volumes and have significantly refined radiobiology experiments with major 3Rs impacts. However, the CT imaging is limited by the differential attenuation of tissues resulting in poor contrast in soft tissues. Clinically, radio-opaque fiducial markers (FMs) are used to establish anatomical reference points during treatment planning to ensure accuracy beam targeting, this approach is yet to translate back preclinical models. We report on the use of a novel liquid FM BioXmark ® developed by Nanovi A/S (Kongens Lyngby, Denmark) that can be used to improve the visualisation of soft tissue targets during beam targeting and minimise dose to surrounding organs at risk. We present descriptive protocols and methods for the use of BioXmark ® in experimental male and female C57BL/6J mouse models. These guidelines outline the optimum needle size for uptake (18-gauge) and injection (25- or 26-gauge) of BioXmark ® for use in mouse models along with recommended injection volumes (10-20 µl) for visualisation on preclinical cone beam CT (CBCT) scans. Injection techniques include subcutaneous, intraperitoneal, intra-tumoral and prostate injections. The use of BioXmark ® can help to standardise targeting methods, improve alignment in preclinical image-guided RT and significantly improve the welfare of experimental animals with the reduction of normal tissue exposure to RT.

An integrated 3D printed radioluminescent-based phantom for quality assurance on a robotic-arm linac

Objective. To develop, characterize and improve upon a high-resolution 3D printed radioluminescence-based imaging phantom for quality assurance (QA) of a robotic arm linear accelerator. Approach. A phantom was constructed which consisted of a scintillating sheet, fiducial markers, a low-cost complementary metal-oxide semiconductor camera and a 3D printed light–tight enclosure. The camera, equipped with a 12 mm lens, was angled 45 degrees from the horizontal axis with a direct line of sight of the scintillating sheet. A perspective image transformation with optical distortion correction was employed to obtain beam’s eye view images for different collimators. Beam profiles, Iris™ field size, multileaf collimator leaf positioning and central laser-radiation field coincidence QA tests were performed and compared against data obtained with gafchromic film. The phantom’s short-term stability, sensitivity to changes in output, field size and leaf positioning were also assessed. Main Results. The limiting resolution of the optical system was measured to be ∼0.26 mm. Field size, as measured by the radioluminescence system for Iris apertures, agreed to within 0.2 mm of the values measured using film. The imaging system was sensitive to field size changes well below 0.2 mm and output changes as small as 1 monitor unit (MU). For the optical setup, the mean leaf deviation error for banks X1 and X2 was 0.21 and 0.17 mm at 800 mm source to axis distance, whereas the mean difference for the film dataset was 0.16 mm and 0.22 mm for banks X1 and X2, respectively. The optical system was able to detect leaf positioning errors as small as 0.2 mm. Compared with film data, excellent agreement was seen for relative central axis beam profiles for 10 mm and 5 mm beams. Significance. The phantom presented here is an alternative to film and electronic portal imager devices, due to its low-cost, portability, and high spatial and temporal resolution.

Fiducial Markers Allow Accurate and Reproducible Delivery of Liver Stereotactic Body Radiation Therapy

Fiducial markers are utilized for image guided radiotherapy (IGRT) alignment during the delivery of liver stereotactic body radiosurgery (SBRT). There are limited data demonstrating the impact of matching fiducials on the accuracy of liver SBRT. This study quantifies the benefit of fiducial-based alignment and improvements in inter-observer reliability. Nineteen patients with 24 liver lesions were treated with SBRT. Target localization was performed using fiducial markers on cone-beam computed tomography (CBCT). Each CBCT procedure was retrospectively realigned to match both the liver edge and fiducial markers. The shifts were recorded by seven independent observers. Inter-observer variability was analyzed by calculating the mean error and uncertainty for the set-up. The mean absolute Cartesian error observed from fiducial and liver edge-based alignment was 1.5 mm and 5.3 mm, respectively. The mean uncertainty from fiducial and liver edge-based alignment was 1.8 mm and 4.5 mm, respectively. An error of 5 mm or greater was observed 50% of the time when aligning to the liver surface versus 5% of the time when aligning to fiducial markers. Aligning to the liver edge significantly increased the error, resulting in increased shifts when compared to alignment to fiducials. Tumors of 3 cm or farther from the liver dome had higher mean errors when aligned without fiducials (4.8 cm vs. 4.4 cm, p = 0.003). Our data support the use of fiducial markers for safer and more accurate liver SBRT.

Implementation of an Optical Measurement Method for Monitoring Mechanical Behaviour

There is a gap between mechanical measurement methods under laboratory conditions and those under real conditions of structural monitoring. This paper proposes a method that applies well-established computer vision developments to photomechanics in difficult conditions. It is therefore a technique that is flexible and versatile while maintaining satisfying accuracy. It consists in marker tracking using ArUco fiducial markers as measurement points. It allows locating markers in non-optimal conditions of camera orientation and position. A homography process was used to analyse pictures taken with a view angle. The accuracy of the method was estimated, especially in case of out-of-plane motions, and the impact of the view angle and of the distance between camera and markers on the location error was studied. The method was applied in creep tests to measure crack parameters as well as the transverse expansion of wooden beams. In the application example presented, it enabled to compute distances between markers with only 0.28% of relative error and hence to measure the crack parameters and the long-term shrinkage-swelling of the wooden beams. However, the impacts of brightness variations and camera parameters have not been estimated. This method is very promising when experimental conditions are variable and when multiple measurements are necessary.

Analysis of the Robotic-Based In Situ Bioprinting Workflow for the Regeneration of Damaged Tissues through a Case Study.

This study aims to critically analyse the workflow of the in situ bioprinting procedure, presenting a simulated neurosurgical case study, based on a real traumatic event, for collecting quantitative data in support of this innovative approach. After a traumatic event involving the head, bone fragments may have to be removed and a replacement implant placed through a highly demanding surgical procedure in terms of surgeon dexterity. A promising alternative to the current surgical technique is the use of a robotic arm to deposit the biomaterials directly onto the damaged site of the patient following a planned curved surface, which can be designed pre-operatively. Here we achieved an accurate planning-patient registration through pre-operative fiducial markers positioned around the surgical area, reconstructed starting from computed tomography images. Exploiting the availability of multiple degrees of freedom for the regeneration of complex and also overhanging parts typical of anatomical defects, in this work the robotic platform IMAGObot was used to regenerate a cranial defect on a patient-specific phantom. The in situ bioprinting process was then successfully performed showing the great potential of this innovative technology in the field of cranial surgery. In particular, the accuracy of the deposition process was quantified, as well as the duration of the whole procedure was compared to a standard surgical practice. Further investigations include a biological characterisation over time of the printed construct as well as an in vitro and in vivo analysis of the proposed approach, to better analyse the biomaterial performances in terms of osteo-integration with the native tissue.

Using augmented reality to guide bone conduction device implantation

Exact placement of bone conduction implants requires avoidance of critical structures. Existing guidance technologies for intraoperative placement have lacked widespread adoption given accessibility challenges and significant cognitive loading. The purpose of this study is to examine the application of augmented reality (AR) guided surgery on accuracy, duration, and ease on bone conduction implantation. Five surgeons surgically implanted two different types of conduction implants on cadaveric specimens with and without AR projection. Pre- and postoperative computer tomography scans were superimposed to calculate centre-to-centre distances and angular accuracies. Wilcoxon signed-rank testing was used to compare centre-to-centre (C-C) and angular accuracies between the control and experimental arms. Additionally, projection accuracy was derived from the distance between the bony fiducials and the projected fiducials using image guidance coordinates. Both operative time (4.3 ± 1.2 min. vs. 6.6 ± 3.5 min., p = 0.030) and centre-to-centre distances surgery (1.9 ± 1.6 mm vs. 9.0 ± 5.3 mm, p < 0.001) were significantly less in augmented reality guided surgery. The difference in angular accuracy, however, was not significantly different. The overall average distance between the bony fiducial markings and the AR projected fiducials was 1.7 ± 0.6 mm. With direct intraoperative reference, AR-guided surgery enhances bone conduction implant placement while reduces operative time when compared to conventional surgical planning.