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Proceedings Paper

Clinical implementation of intraoperative cone-beam CT in head and neck surgery
Author(s): M. J. Daly; H. Chan; S. Nithiananthan; J. Qiu; E. Barker; G. Bachar; B. J. Dixon; J. C. Irish; J. H. Siewerdsen
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Paper Abstract

A prototype mobile C-arm for cone-beam CT (CBCT) has been translated to a prospective clinical trial in head and neck surgery. The flat-panel CBCT C-arm was developed in collaboration with Siemens Healthcare, and demonstrates both sub-mm spatial resolution and soft-tissue visibility at low radiation dose (e.g., <1/5th of a typical diagnostic head CT). CBCT images are available ~15 seconds after scan completion (~1 min acquisition) and reviewed at bedside using custom 3D visualization software based on the open-source Image-Guided Surgery Toolkit (IGSTK). The CBCT C-arm has been successfully deployed in 15 head and neck cases and streamlined into the surgical environment using human factors engineering methods and expert feedback from surgeons, nurses, and anesthetists. Intraoperative imaging is implemented in a manner that maintains operating field sterility, reduces image artifacts (e.g., carbon fiber OR table) and minimizes radiation exposure. Image reviews conducted with surgical staff indicate bony detail and soft-tissue visualization sufficient for intraoperative guidance, with additional artifact management (e.g., metal, scatter) promising further improvements. Clinical trial deployment suggests a role for intraoperative CBCT in guiding complex head and neck surgical tasks, including planning mandible and maxilla resection margins, guiding subcranial and endonasal approaches to skull base tumours, and verifying maxillofacial reconstruction alignment. Ongoing translational research into complimentary image-guidance subsystems include novel methods for real-time tool tracking, fusion of endoscopic video and CBCT, and deformable registration of preoperative volumes and planning contours with intraoperative CBCT.

Paper Details

Date Published: 1 March 2011
PDF: 8 pages
Proc. SPIE 7964, Medical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling, 796426 (1 March 2011); doi: 10.1117/12.878976
Show Author Affiliations
M. J. Daly, Ontario Cancer Institute (Canada)
Univ. of Toronto (Canada)
H. Chan, Ontario Cancer Institute (Canada)
S. Nithiananthan, The Johns Hopkins Univ. (United States)
J. Qiu, Ontario Cancer Institute (Canada)
E. Barker, Univ. of Toronto (Canada)
Princess Margaret Hospital (Canada)
G. Bachar, Univ. of Toronto (Canada)
Princess Margaret Hospital (Canada)
B. J. Dixon, Univ. of Toronto (Canada)
Princess Margaret Hospital (Canada)
J. C. Irish, Univ. of Toronto (Canada)
Princess Margaret Hospital (Canada)
J. H. Siewerdsen, The Johns Hopkins Univ. (United States)

Published in SPIE Proceedings Vol. 7964:
Medical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling
Kenneth H. Wong; David R. Holmes, Editor(s)

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