Mean Target Registration Error Research Articles

Dynamic, three‐dimensional optical tracking of an ablative laser beam

Surgical resection remains the treatment of choice for brain tumors with infiltrating margins but is currently limited by visual discrimination between normal and neoplastic marginal tissues during surgery. Imaging modalities such as computed tomography, magnetic resonance, positron emission tomography, and optical techniques can accurately localize tumor margins. We believe coupling the fine resolution of current imaging techniques with the precise cutting of midinfrared lasers through image-guided neurosurgery can greatly enhance tumor margin resection. This paper describes a feasibility study designed to optically track in three-dimensional space the articulated arm delivery of a noncontact ablative laser beam. To enable optical tracking of the laser beam focus, infrared-emitting diodes (IREDs) were attached to a handpiece machined for the distal end of the articulated arm of a surgical carbon dioxide laser. Crosstalk between the ablative laser beam and the tracking diodes was measured. The geometry of the adapted laser handpiece was characterized to track an externally attached passive tip and the laser beam focus. Target localization accuracies were assessed for both instrument points-of-interest and the sources of tracking errors were investigated. Stray infrared laser light did not affect optical tracking accuracy. The mean target registration errors while optically tracking the laser handpiece with a passive tip and the laser beam focus were 1.31+/-0.50 mm and 2.31+/-0.92 mm, respectively, and were equivalent to the errors tracking a 24-IRED pen probe from Northern Digital in a side-by-side comparison. The majority of error during ablation tracking derived from registration accuracy between physical space and the defined space of the ablation phantom and from an inability to freehand align the laser focus with the target in a consistent manner. While their magnitudes depend on spatial details of the tracking setup (e.g., number and distribution of fiducial points, working distance from the camera, etc.), these errors are inherent to any freehand laser surgery.

Frameless image guidance improves accuracy in three-dimensional interstitial brachytherapy needle placement

The aim of this work was to adapt a computer-assisted real-time three-dimensional (3D) navigation system for interstitial brachytherapy procedures. The 3-D navigation system Surgical Planning and Orientation Computer System (SPOCS; Aesculap, Tuttlingen, Germany) was adapted for use in interstitial brachytherapy. A special needle holder with mounted infrared-emitting diodes (IRED) for 3D navigation-based needle implantation was developed. Measurements were made on a series of different phantoms to study the feasibility and the overall accuracy and precision of the navigation system with regard to single-needle application and volume implants (multiple-needle implantations). In all, 250 single implants and 20 volume implants were performed. Accuracy was measured as the target registration error (TRE) between the preoperatively defined and the achieved target position. Analyses of the 250 different targets showed a mean TRE for single-needle applications of 1.1 mm (SD +/- 0.4 mm), 0.9 mm (SD +/- 0.3 mm), and 0.7 mm (SD +/- 0.3 mm) in the x, y, and z direction, respectively. The maximal deviation was 2.3 mm. The corresponding TRE in the x, y, and z direction for volume implants was 1.6 mm (SD +/- 0.4 mm), 1.9 mm (SD +/- 0.6 mm), and 1.0 mm (SD +/- 0.4 mm), respectively. The maximum deviation was 2.9 mm. The adaptation of a commercially available surgical planning and navigation system to interstitial brachytherapy is feasible. It enables virtual planning and improved accuracy in 3D interstitial needle implantation.

Submillimetric target-registration error using a novel, non-invasive fiducial system for image-guided otologic surgery

Objective: Otologic surgery is undertaken to treat ailments of the ear, including persistent infections, hearing loss, vertigo, and cancer. Typically performed on otherwise-healthy patients in outpatient facilities, the application of image-guided surgery (IGS) has been limited because accurate (<1 mm), non-invasive fiducial systems for otologic surgery have not been available. We now present such a fiducial system.Methods: A dental bite-block was fitted with a custom-designed rigid frame with 7 fiducial markers surrounding each external ear. The bones containing the ear (i.e., the temporal bones) of 3 cadaveric skulls were removed and replaced with discs containing 13 surgical targets arranged in a cross-hair pattern about the centroid of each ear. The surgical targets (26/skull) and fiducial markers (14/skull) were identified both within CT scans using a published algorithm and in physical space using an infrared optical tracking system. Fiducial registration error (FRE), fiducial localization error (FLE), and target registration error (TRE) were calculated.Results: For all trials, root mean square FRE=0.66, FLE=0.72, and TRE=0.77mm. The mean TRE for n=234 independent targets was 0.73 with a standard deviation of 0.25mm.Conclusions: Using a novel, non-invasive fiducial system (the EarMark™), submillimetric accuracy was repeatably achieved. This system will facilitate image-guided otologic surgery.

Anatomical image-based rigid registration between fluoroscopic X-ray and CT: methods comparison and experimental results

This paper describes a practical, whole system approach to rigid registration between preoperative CT and intraoperative X-rays obtained with a tracked C-arm and demonstrates its efficacy experimentally. Our approach is generic, targeted to orthopaedic surgery, and includes fluoroscopic X-ray calibration, image distortion correction, optical tracking, and 2D/3D image registration. For 2D/3D image registration, we use two new gradient-based and intensity-based algorithms which are fast, robust, and accurate in realistic setups. Our experiments on simulated, in vitro, and cadaver show that an overall mean target registration error of 1–1.5 mm (2 mm worst case), which succeeds on the first try 95% or more of the time in less than 2 min, is practically feasible.