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CBCT‐based navigation system for open liver surgery: Accurate guidance toward mobile and deformable targets with a semi‐rigid organ approximation and electromagnetic tracking of the liver
Author(s) -
Ivashchenko Oleksandra V.,
Kuhlmann Koert F.D.,
Veen Ruben,
Pouw Bas,
Kok Niels F. M.,
Hoetjes Nikie J.,
Smit Jasper N.,
Klompenhouwer Elisabeth G.,
Nijkamp Jasper,
Ruers Theodoor J. M.
Publication year - 2021
Publication title -
medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.473
H-Index - 180
eISSN - 2473-4209
pISSN - 0094-2405
DOI - 10.1002/mp.14825
Subject(s) - navigation system , image guided surgery , medicine , tracking (education) , guidance system , visualization , computer science , computer vision , radiology , artificial intelligence , psychology , pedagogy , engineering , aerospace engineering
Purpose The surgical navigation system that provides guidance throughout the surgery can facilitate safer and more radical liver resections, but such a system should also be able to handle organ motion. This work investigates the accuracy of intraoperative surgical guidance during open liver resection, with a semi‐rigid organ approximation and electromagnetic tracking of the target area. Methods The suggested navigation technique incorporates a preoperative 3D liver model based on diagnostic 4D MRI scan, intraoperative contrast‐enhanced CBCT imaging and electromagnetic (EM) tracking of the liver surface, as well as surgical instruments, by means of six degrees‐of‐freedom micro‐EM sensors. Results The system was evaluated during surgeries with 35 patients and resulted in an accurate and intuitive real‐time visualization of liver anatomy and tumor's location, confirmed by intraoperative checks on visible anatomical landmarks. Based on accuracy measurements verified by intraoperative CBCT, the system’s average accuracy was 4.0 ± 3.0 mm, while the total surgical delay due to navigation stayed below 20 min. Conclusions The electromagnetic navigation system for open liver surgery developed in this work allows for accurate localization of liver lesions and critical anatomical structures surrounding the resection area, even when the liver was manipulated. However, further clinically integrating the method requires shortening the guidance‐related surgical delay, which can be achieved by shifting to faster intraoperative imaging like ultrasound. Our approach is adaptable to navigation on other mobile and deformable organs, and therefore may benefit various clinical applications.