Navigation Software Research Articles

Risk of injury to the femoral blood vessels based on the extent of acetabular dysplasia in total hip arthroplasty

We evaluated the course of the femoral blood vessels of patients with acetabular dysplasia. Patients were divided into five groups: those with Crowe type I, II, III, and IV dysplastic hips and those with normal hips. A computed tomography-based hip navigation software was used to measure the distance between the femoral blood vessels and the anterior pelvic wall in four axial planes located 10–40 mm proximal to the pelvic teardrop. In Crowe Groups I through IV, the distance was shortest at a point 20 mm proximal to the pelvic teardrop. Furthermore, the distance decreased as the Crowe classification grade increased. Because the femoral blood vessels pass close to the pelvis in many patients in Crowe III and IV hips, caution is required during surgery in these patients.

Surgical Stereo X-Ray Navigation

Hardware and software for surgical instrument navigation using stereo X-ray imaging were developed. The developed surgical stereo X-ray navigation system provides 3D imaging in the process of surgery or during diagnostic examination of deep-lying abnormal foci or structural abnormalities of organs and tissues. Application of the developed system makes it possible to reduce considerably the duration of surgery. The obtained 3D X-ray images are automatically processed to provide accurate real-time guidance of the medical instrument (i.e., adjustment of the penetration depth, position, and orientation of the instrument). The developed technique of stereo X-ray navigation can be used for purposes of upgrading medical X-ray equipment, such as C-arch (Arcoscope) surgical X-ray devices.

Effects of roles assignment and learning styles on pair learning in robotics education

Pair learning (PL) in robotics education is derived from pair programming, and impacted by many factors. Two important factors were identified including roles assignment and learning styles in this study. The roles assignment involved Driver–Navigator Pair and Software–Hardware Pair. For the learning style, the dimension of active/reflective was adopted. Therefore, a 2*3 factorial design was employed with the between-subjects factors roles assignment and learning styles. After a one-semester robotics course, we evaluated 66 fifth-grade students’ learning achievements, attitude towards robotics, engagement, mental efforts, compatibility, and attitude towards PL. The results indicated that there was no statistically significant difference among different pairs in the above six indicators. Moreover, there was no significant difference in the learning outcomes among pairs of different learning styles. One important explanation is that the joint effect of PL might bridge the difference in learning performance that may be caused by learning style.

Robot-Assisted Pedicle Screw Placement: Learning Curve Experience

To describe the learning curve of pedicle screw placement using robot-assisted spine surgery of an experienced neurosurgeon and 2 supervised neurosurgical fellows. The first 120 cases of robot-assisted spine surgery at our institution were assessed. Patient variables included age, body mass index, and indication for surgery. Intraoperative variables included the vertebral level of screw placement, number of screws placed by each operator, intraoperative blood loss, and operative time. Postoperative variables included length of stay, discharge disposition, 30-day readmissions, wound complications, and hardware revisions. Screw accuracy was determined with image overlay analysis comparing planned screw trajectory on the navigation software with the intraoperative computed tomography scan with final screw placement. Two-dimensional accuracy was determined for the tip of the screw, tail of the screw, and angle at the screw was placed. The supervising physician and first fellow began utilizing the robot concurrently upon its arrival, and the second fellow began using the robot after the system had been in place for 7 months. Both experienced surgeon and first fellow displayed a learning curve and achieved statistically significant improvement of accuracy after 30 screws. The second fellow had significantly better accuracy than the experienced surgeon in his first 30 screws. There were no complications from hardware placement in either group. There were no returns to the operating room for hardware issues. Robot-assisted spine surgery is a safe, accurate method of pedicle screw instrumentation. Our data show similar learning adaptation rates for the first fellow and the experienced surgeon. Techniques learned by the attending surgeon were immediately transferable to a new learner, who was able to achieve a faster learning curve than both the first fellow and the experienced surgeon.

Spatial Correlation between Traffic and Air Pollution in Beijing

Many studies have attempted to model the sophisticated influence of traffic emissions on air pollution, but most models only calculate the contribution of traffic emissions near monitoring sites. It is difficult to observe the near-surface dynamics such as wind, rain, and human activities and precisely distinguish traffic emissions. These obstacles make model simulation very expensive in practice. The regional distribution patterns that can help adjust policies and actions taken remain unknown. Therefore, this article proposes a grid-oriented geostatistics-based approach to overcome these obstacles. We chose central Beijing as the study area. An experiment implemented the approach on data collected from Global Positioning System navigation software, car rental companies, and meteorology stations. The results suggest that the northwest area of Beijing has high traffic-related air pollution (TRAP) and the southeast area has low TRAP. Unlike modeling-based methods, this work uses geostatistical methods to directly study the spatiotemporal connections between traffic and PM2.5 (particulate matter with diameter less than 2.5 μm) from the phenomenon. The calculation is conducted under no hypotheses and has little risk of producing results contradictory to facts. This work provides a reference for future TRAP research on directly learning from the phenomenon and assists decision makers with seamless spatiotemporal heat maps of TRAP distribution. Key Words: Beijing, geospatial statistics, PM2.5, spatial correlation, traffic-related air pollution.

Development of Urban Road Order Index Based on Driving Behavior and Speed Variation

This study uses driving behavior and speed variation data from navigation software to propose a traffic order index (TOI) for evaluating the order of traffic on urban roads. Based on the significance analysis of driving behaviors and speed variation under different road types and congestion levels, the TOI calculation method is proposed by using the order of preference by similarity to ideal solution (TOPSIS) method. Through a case study of an urban area in Beijing, the distribution of TOI under different road types and congestion levels is described, and the hourly and daily TOI heat maps are generated to show changes in TOI for urban roads during different periods. The relationships between TOI, congestion index (CI) and crash data were explored. A nonlinear relationship of TOI and CI was discovered, and roads with more crashes or longer crash durations were associated with a lower level of traffic order. The TOI could help traffic management departments better understand the order of traffic on roads, reveal causes of the poor level of traffic order in some roads, and more reasonably dispatch traffic police to handle traffic crashes.

MIS approaches in the cervical spine.

Minimally invasive surgical approaches for the treatment of spinal pathologies have accelerated over the past three decades and resulted in superior functional outcomes with less complications. Yet cervical pathologies have been slower to gain traction for multiple anatomical factors and its "high-risk" profile. Various minimally invasive techniques for cervical disease have now been described and validated in long-term studies with comparable outcomes to traditional open approaches and concomitant reduction in morbidity and socioeconomic costs. Transnasal operations can be used to treat ventral upper cervical disease, circumventing traditional and morbid transoral approaches. Posterior-based focused treatments for radiculopathy and myelopathy such as tubular-guided foraminotomies and unilateral laminotomies for bilateral cord decompression have also been described and becoming increasingly less invasive. Cervical fusions can now be performed percutaneously through modified, stand-alone facet joint cages that can be packed with allogeneic bone graft. These advances have been facilitated by the development of intraoperative imaging technologies (intraoperative CT) and 3-dimensional stereotactic navigation software. While this review focuses on these procedures and evidence-based outcomes data, the future for MIS applications in cervical spine surgery will continue to evolve over the coming years with wider indications and technological adjuncts.

CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study

CORR® Tumor Board: Can Navigation Improve the Ability to Achieve Tumor-free Margins in Pelvic and Sacral Primary Bone Sarcoma Resections? A Historically Controlled Study

A hybrid operating room for combined surgical and endovascular procedures for cerebrovascular diseases: a clinical experience at a single centre

Purpose: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR).Material and methods: A single-plane DSA system with 3-dimensional rotational angiography (3DRA), cone-beam computed tomography, and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of neurovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorised into five subcategorical procedures according to the dominance of surgical and/or endovascular procedures: intraoperative angiographic evaluation, combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, surgical approach for interventional procedure, and frameless stereotaxic operation.Results: Intraoperative angiography revealed unsatisfactory clipping of intracranial aneurysms in 6 (13.6%) patients and remnant AVMs in 1 (16.7%) patient, which were determined as complete surgical outcome via indocyanine green videoangiography. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial haemorrhage (ICH) were treated by partial embolisation and surgical clipping. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolisation. In 1 (0.8%) complicated case of 103 intra-arterial (IA) thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. Direct puncture of the common carotid artery or vertebral artery was performed to achieve interventional access to treat aneurysm or recanalise vessel occlusions in 7 cases. In 27 cases of ICH, frameless stereotaxic haematoma aspiration was performed using XperGuide® system. All procedures were performed in single sessions without any procedural complications.Conclusion: Hybrid OR with a fully equipped DSA system could provide safe and precise treatment for neurovascular diseases. Hybrid procedures for neurovascular diseases in hybrid OR are a promising new trend.

Minimally Invasive Single-Position Lateral Interbody Fusion With Robotic Bilateral Percutaneous Pedicle Screw Fixation: 2-Dimensional Operative Video.

Lateral interbody fusion has distinct advantages over traditional posterior approaches. When adjunctive percutaneous pedicle screw fixation is required, placement from the lateral decubitus position theoretically increases safety and improves operative efficiency by obviating the need for repositioning. However, safe cannulation of the contralateral, down-side pedicles remains technically challenging and often prohibitive. In this video, we present the case of a 59-yr-old man with refractory back pain and bilateral lower extremity radiculopathy that was worse on the left than right side. The patient provided written informed consent before undergoing treatment. We performed minimally invasive single-position lateral interbody fusion with robotic (ExcelsiusGPS, Globus Medical Inc, Audubon, Pennsylvania) bilateral percutaneous pedicle screw fixation for the treatment of asymmetric disc degeneration, dynamic instability, and left paracentral disc herniation with corresponding stenosis at the L3-4 level. A left-sided minimally invasive transpsoas lateral interbody graft was placed with fluoroscopic guidance. Without changing the position of the patient or breaking the sterile field, an intraoperative cone-beam computed tomography image was obtained for navigational screw placement with stereotactic trackers in the iliac spine. Screw trajectories were planned using the robotic navigation software and were placed percutaneously in the bilateral L3 and L4 pedicles using the robotic arm. Concomitant lateral fluoroscopy may be used if desired to ensure the fidelity of the robotic guidance. The patient recovered well postoperatively and was discharged home within 36 h, without complication. Single-position lateral interbody fusion and percutaneous pedicle screw fixation can be accomplished using robotic-assisted navigation and pedicle screw placement. Used with permission from Barrow Neurological Institute.

Catheter guided cerebral glioma resection combined with awake craniotomy: its usefulness and surgical outcome

Purpose: A challenging aspect of glioma surgery is to distinguish tumour tissue from surrounding eloquent structures and perform resection with accuracy. Various technologies have been used to address this issue including neuronavigator, intraoperative magnetic resonant imaging, intraoperative ultrasound, and fluorescence, each of which has certain drawbacks and limitations. In this study, authors demonstrate the technique of using stereotactically placed catheters as guidance during cerebral glioma resection and report the surgical outcomes.Materials and methods: This study included patients with intrinsic cerebral tumour adjacent to the eloquent structures. Catheter trajectories were planned using three-dimensional cerebral reconstruction on navigation software and catheters were stereotactically placed to mark the intended extent of resection. All craniotomies were performed in awake fashion under neurophysiologic mapping and continuous physical examination for safe maximal resection. Clinical outcome and intended versus actual extent of resection were analysed.Results: Between January 2015 and December 2016, 15 consecutive patients (8 males and 7 females) with intrinsic cerebral tumour underwent craniotomy with this technique. Median age was 43 years. Seven patients (46.7%) had worsening neurological status within 24 h postoperatively. Of these 7 patients, 6 patients (85.7%) regained preoperative neurological status by 6 months. The intended extent of resections were total, subtotal and partial in 3 (20%), 9 (60%), and 3 (20%) patients, respectively. The actual extent of resections were total, subtotal and partial in 3 (20%), 8(53.3%), and 4 (26.7%) patients, respectively. There were no catheter related complications. There was no 30-day postoperative mortality.Conclusions: Catheter guided resection along with awake surgery and neurophysiologic monitoring is a valid technique for infiltrative tumour, especially for ones locating near eloquent structures where the margin of error is low. This is a simple and economical technique which requires only standard equipment widely available to neurosurgical operating theatres.

The Accuracy of Alignment Determined by Patient-Specific Instrumentation System in Total Knee Arthroplasty.

PurposeThe aim of this study is to assess the accuracy of alignment determined by patient-specific instrumentation system in total knee arthroplasty (TKA).Materials and MethodsTwenty-seven TKAs using patient-specific instrument were reviewed. The intraoperative pin location determined by the patient-specific guide was recorded using imageless navigation software. Data recorded included tibial coronal alignment and posterior slope, femoral coronal alignment and sagittal alignment, and transepicondylar axis. A discrepancy within ±3° in each plane was considered an acceptable result.ResultsOn the tibia, an acceptable alignment was obtained in 24 (88.1%) in the coronal plane and 21 (77.8%) in the sagittal plane. On the femur, a satisfactory alignment was obtained in 25 (92.6%) in the coronal plane and 24 (88.1%) in the sagittal plane. Based on the transepicondylar axis, a satisfactory alignment was obtained in 23 (85.1%).ConclusionsSatisfactory alignment was obtained in more than 85% of each plane of the femur and in the coronal plane of the tibia and relative to the transepicondylar axis. Sufficeint experience and precise preoperative planning are required to improve the accuracy of sagittal alignment of the tibia.

Safety and Efficacy of Combined Transarterial Embolization and Percutaneous Radiofrequency Ablation for Liver Tumors Using Cone-Beam CT and Needle Navigation Software in a Single Session

PurposeTo assess the safety and efficacy of single-session transarterial embolization and radiofrequency (RF) ablation for hepatic tumors with the use of needle navigation software. Materials and MethodsRetrospective analysis was conducted of 24 patients with liver cancer undergoing embolization followed by RF ablation between May 2014 and August 2017. Twelve patients each underwent (i) embolization and computed tomography (CT)–guided RF ablation during different sessions (group 1) and (ii) embolization followed by RF ablation with cone-beam CT and Needle Assist software in 1 session (group 2). Median age (70.5 y [range, 58–78 y] vs 70.5 y [range, 50–82 y]; P = .76) and performance status (0/1) were comparable between groups. Median tumor size was significantly larger in group 2 (2 cm [range, 1.0–7.3 cm] vs 3.2 cm [range, 1.1–9.6 cm]; P < .03). Procedure time, effective dose, and number of scans were examined. Efficacy was assessed by modified Response Evaluation Criteria In Solid Tumors after 1 month. Safety was assessed by Society of Interventional Radiology adverse event classification. ResultsGroup 1 had a mean of 8.5 CT scans, vs a mean of 5.0 cone-beam CT scans in group 2 (P < .001). Median procedure times were 110 min in group 1 and 199.5 min in group 2 (P < .001). Median effective doses were 68.8 mSv in group 1 and 55.4 mSv in group 2 (P = .38). There was no difference in complete response between groups (66.7% vs 63.6%; P = 1). ConclusionsTransarterial embolization followed by RF ablation with cone-beam CT and needle guidance software in a single session seems to be safe and effective.

InVesalius Navigator, a free and open-source software for navigated transcranial magnetic stimulation

InVesalius Navigator, a free and open-source software for navigated transcranial magnetic stimulation

Diagnostic Yield of the Virtual Bronchoscopic Navigation System Guided Sampling of Peripheral Lung Lesions using Ultrathin Bronchoscope and Protected Bronchial Brush.

The use of an ultrathin bronchoscope (UB) to diagnose peripheral pulmonary lesions is described. A virtual bronchoscopic navigation system was used to direct the ultrathin scope to the nodule. One of the constraints of this technique was the inability to confirm the target lesion position during biopsy by using a conventional linear endobronchial ultrasound probe, since the probe does not fit into a 1.2 mm working channel of this bronchoscope. The aim of the study was to review our institutional experience with the use of a UB for sampling peripheral pulmonary lesions using the transbronchial brush guided by virtual bronchoscopy. We describe a technique wherein we attempt to brush all the visible bronchial sub-segments once the bronchoscope has reached close to the nodule. In total, 52 patients underwent the procedure between 2010 and 2017. A multiplanar computed tomography (CT) scan of the chest was obtained and subsequently uploaded to the Lung Point Virtual bronchoscopy navigation software. The UB was parked close to the lesion. All visible airway branches were then brushed using a protected bronchial brush. The data were retrospectively abstracted from the electronic medical records using standardized forms. A total of 52 lesions (40 solid, 8 part-solid, 3 cavitary, and 1 ground-glass) were sampled using a transbronchial brush (median, 2; range, 1-8). Twenty-four lesions were under 2 cm in size. The overall success rates were 67.3%. The average diameter of nodules was 2.7±1.01 cm; 65% lesions were in the outer-third of the lungs. The cancer-specific sensitivity was 72.5%. The presence of bronchus sign; location of the lesion; and the characteristics, size, and stage of cancer did not have any impact on the diagnostic yield. Virtual bronchoscopy-guided ultrathin bronchoscopy with bronchial brushing is safe and has a diagnostic yield comparable to other described techniques for evaluating peripheral pulmonary nodules.

Semi-automatic guidance of a biopsy catheter to peripheral airways targets using a novel robotic and computer navigation system

During lung cancer screening, suspected nodules are detected using computed tomography. Although most nodules are benign, a tissue diagnostic is still required. Currently, all diagnostic procedures that use image-guided tools expose both the patient and the medical doctor to damaging X-ray radiation. The present study describes the development of a novel robotic and electromagnetic tracking navigation system to guide a catheter in the peripheral airways and made of a navigation software and a patent pending robotic system, EndoRoTM that inserts and guides the catheter semi-automatically to reach a specific target in the airways without the need of CT or fluoroscopy scanning. The preliminary tests on a benchtop airway model showed that the novel robotic system allows navigation through the bronchial tree, in both manual manipulation with a joystick and semi-automatic computer manipulation without fluoroscopy scanning. Overall, the new robotic system will allow a more precise guidance of the biopsy catheters to targets located in the peripheral airways, will reduce injury, and improve the clinical outcomes in early cancer diagnosis and treatment.

Four-Year Experience Using an Advanced Interdisciplinary Hybrid Operating Room : Potentials in Treatment of Cerebrovascular Disease.

ObjectiveTo describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR).MethodsA single-plane DSA system with 3-dimensional rotational angiography, cone-beam computed tomography (CBCT), and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of cerebrovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorized into three subcategorical procedures : combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, and frameless stereotaxic operation.ResultsForty-nine of 191 procedures were performed using hybrid techniques. Four cases of blood blister aneurysms and a ruptured posterior inferior cerebellar artery aneurysm were treated using bypass surgery and endovascular trapping. Eight cases of ruptured aneurysm with intracranial hemorrhage (ICH) were treated by partial embolization and surgical clipping. Six cases of ruptured arteriovenous malformation with ICH were treated by Onyx embolization of nidus and subsequent surgical removal of nidus and ICH. Two (5.4%) of the 37 cases of pre-mature rupture during clipping were secured by endovascular coil embolization. In one (0.8%) complicated case of 103 intra-arterial thrombectomy procedures, emergency surgical embolectomy with bypass surgery was performed. In 27 cases of ICH, frameless stereotaxic hematoma aspiration was performed using XperGuide® system (Philips Medical Systems, Best, the Netherlands). All procedures were performed in single sessions without any procedural complications.ConclusionHybrid OR with a fully equipped DSA system could provide precise and safe treatment strategies for cerebrovascular diseases. Especially, we could suggest a strategy to cope flexibly in complex lesions or unexpected situations in hybrid OR. CBCT with real-time navigation software could augment the usefulness of hybrid OR.

A New Navigation Message Demodulation Algorithm for Satellite Navigation Receiver

A new navigation message demodulation algorithm for satellite navigation software receiver is researched. The detailed phase and frequency information of the carrier are obtained by analyzing the phase angle of the DFT component of the satellite navigation IF signal, and navigation messages are demodulated by adjusting the initial phase of the adjacent data block is π flipped or not. The detailed implementation steps of the method are presented, and the reason of phase angle discontinuity of kernel function is analyzed and compensated. Finally, the method is verified by simulation and actual signal respectively and compared with the traditional phase-locked loop method. The results show that the carrier frequency accuracy of new algorithm can reach 10 Hz, more precise than traditional method; signal tracking can effectively output navigation message information, the method with data block processing to obtain the phase angle is more suitable for software radio ideas.

Commissioning the First Mobile Dedicated Accelerator for Intraoperative Electron Radiotherapy in Iran

Introduction: Intraoperative radiotherapy is a radiotherapy technique in which a high single fraction of radiation dose is delivered to the patient after surgery and Concurrent with anesthesia time. The most frequent method for IORT implementation is Intraoperative electron radiotherapy (IOERT), in which, some dedicated and high dose per pulse electron accelerators are employed for radiotherapy. Recently, Iran is also equipped to these dedicated machines for IOERT. Commissioning procedure of this dedicated IOERT machine and dosimetric characteristics of intraoperative electron beam have been evaluated in current study. Materials and Methods: LIAC accelerator, a mobile dedicated IOERT machine with the maximum energy of 12 MeV, was commissioned in this study. Commissioning procedure was performed inside a MP3-XS automatic water phantom which is introduced for small field dosimetry. 10 cm diameter reference applicator was considered and applicator edge was in contact to the phantom surface. All of measurements including percentage depth dose (PDD) along clinical axis, transverse dose profiles (TDP) at the depth of maximum dose and output factors (OF) were performed using ionometric dosimetry. During the measurements, Advanced Markus and Semiflex ion chambers were employed as field and reference detector, respectively. All of the obtained data were processed and analyzed using Mephysto Navigator software. Results: Measured PDDs showed that the intraoperative electron beam has a steep dose fall-off gradient which increases with decrement of electron energy. This fact can effectively spare the underlying healthy tissues. The symmetry and flatness of obtained TDPs at all studied energies were less than 2% which can improve the dose uniformity inside the tumor bed. As expected, the OFs were increased with increment of electron energy, but In contrast to the conventional accelerator, OF values reduce at greater radiation field sizes. Conclusion: According to the obtained results, it can be concluded that dosimetric characteristics of intraoperative electron beam are quite favorable regarding to the mandatory issues which should be satisfied in intraoperative radiotherapy.

MRI Robot for Prostate Focal Laser Ablation: An Ex Vivo Study in Human Prostate

Purpose: A novel grid-template-mimicking MR-compatible robot was developed for in-gantry MRI-guided focal laser ablation of prostate cancer. Method: A substantially compact robot was designed and prototyped to meet in-gantry lithotomy ergonomics and allow for accommodation in the perineum. The controller software was reconfigured and integrated with the custom-designed navigation and multi-focal ablation software. Three experiments were conducted: (1) free space accuracy test; (2) phantom study under computed tomography (CT) guidance for image-guided accuracy test and overall workflow; and (3) magnetic resonance imaging (MRI)-guided focal laser ablation of an ex vivo prostate. The free space accuracy study included five targets that were selected across the workspace. The robot was then commanded five times to each target. The phantom study used a gel phantom made with color changing thermos-chromic ink, and four spherical metal fiducials were deployed with the robot. Then, laser ablation was applied, and the phantom was sliced for gross observation. For an MR-guided ex vivo test, a prostate from a donor who died of prostate cancer was obtained and multi-focally ablated using the system within the MRI gantry. The tissue was sliced after ablation for validation. Results: free-space accuracy was 0.38 ± 0.27 mm. The overall system targeting accuracy under CT guidance (including robot, registration, and insertion error) was 2.17 ± 0.47 mm. The planned ablation zone was successfully covered in both acrylamide gel phantom and in human prostate tissue. Conclusions: The new robot can accurately facilitate fiber targeting for MR-guided focal laser ablation of targetable prostate cancer.