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Proceedings Paper

Architecture of a high-performance surgical guidance system based on C-arm cone-beam CT: software platform for technical integration and clinical translation
Author(s): Ali Uneri; Sebastian Schafer; Daniel Mirota; Sajendra Nithiananthan; Yoshito Otake; Sureerat Reaungamornrat; Jongheun Yoo; J. Webster Stayman; Douglas Reh; Gary L. Gallia; A. Jay Khanna; Gregory Hager; Russell H. Taylor; Gerhard Kleinszig; Jeffrey H. Siewerdsen
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Paper Abstract

Intraoperative imaging modalities are becoming more prevalent in recent years, and the need for integration of these modalities with surgical guidance is rising, creating new possibilities as well as challenges. In the context of such emerging technologies and new clinical applications, a software architecture for cone-beam CT (CBCT) guided surgery has been developed with emphasis on binding open-source surgical navigation libraries and integrating intraoperative CBCT with novel, application-specific registration and guidance technologies. The architecture design is focused on accelerating translation of task-specific technical development in a wide range of applications, including orthopaedic, head-and-neck, and thoracic surgeries. The surgical guidance system is interfaced with a prototype mobile C-arm for high-quality CBCT and through a modular software architecture, integration of different tools and devices consistent with surgical workflow in each of these applications is realized. Specific modules are developed according to the surgical task, such as: 3D-3D rigid or deformable registration of preoperative images, surgical planning data, and up-to-date CBCT images; 3D-2D registration of planning and image data in real-time fluoroscopy and/or digitally reconstructed radiographs (DRRs); compatibility with infrared, electromagnetic, and video-based trackers used individually or in hybrid arrangements; augmented overlay of image and planning data in endoscopic or in-room video; real-time "virtual fluoroscopy" computed from GPU-accelerated DRRs; and multi-modality image display. The platform aims to minimize offline data processing by exposing quantitative tools that analyze and communicate factors of geometric precision. The system was translated to preclinical phantom and cadaver studies for assessment of fiducial (FRE) and target registration error (TRE) showing sub-mm accuracy in targeting and video overlay within intraoperative CBCT. The work culminates in the development of a CBCT guidance system (reported here for the first time) that leverages the technical developments in Carm CBCT and associated technologies for realizing a high-performance system for translation to clinical studies.

Paper Details

Date Published: 1 March 2011
PDF: 7 pages
Proc. SPIE 7964, Medical Imaging 2011: Visualization, Image-Guided Procedures, and Modeling, 796422 (1 March 2011); doi: 10.1117/12.878191
Show Author Affiliations
Ali Uneri, Johns Hopkins Univ. (United States)
Sebastian Schafer, Johns Hopkins Univ. (United States)
Daniel Mirota, Johns Hopkins Univ. (United States)
Sajendra Nithiananthan, Johns Hopkins Univ. (United States)
Yoshito Otake, Johns Hopkins Univ. (United States)
Sureerat Reaungamornrat, Johns Hopkins Univ. (United States)
Jongheun Yoo, Johns Hopkins Univ. (United States)
J. Webster Stayman, Johns Hopkins Univ. (United States)
Douglas Reh, Johns Hopkins Medical Institute (United States)
Gary L. Gallia, Johns Hopkins Medical Institute (United States)
A. Jay Khanna, Johns Hopkins Medical Institute (United States)
Gregory Hager, Johns Hopkins Univ. (United States)
Russell H. Taylor, Johns Hopkins Univ. (United States)
Gerhard Kleinszig, Siemens Healthcare (Germany)
Jeffrey H. Siewerdsen, 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 III, Editor(s)

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