Johns Hopkins Medicine researchers have devised a computerized process that could make minimally invasive surgery more accurate and streamlined using equipment already common in the operating room.
In a report published recently in the journal Physics in Medicine and Biology, the researchers say initial testing of the algorithm shows that their image-based guidance system is potentially superior to conventional tracking systems that have been the mainstay of surgical navigation over the last decade.
In a written statement accompanying the report's publication, co-author Jeffrey Siewerdsen said current state-of-the-art surgical navigation involves an often cumbersome process in which someone--usually a surgical technician, resident or fellow--manually registers points on the patients body to those in a preoperative CT image. This process enables a computer to orient the image of the patient within the geometry of the operating room. The registration process can be error-prone, require multiple manual attempts to achieve high accuracy, and tends to degrade over the course of the operation, Siewerdsen said.
Siewerdsens team used a mobile C-arm, already a piece of equipment used in many surgeries, to develop an alternative. They suspected that a fast, accurate registration algorithm could be devised to match two-dimensional X-ray images to the three-dimensional preoperative CT scan in a way that would be automatic and remain up to date throughout the operation.
Starting with a mathematical algorithm they had previously developed to help surgeons locate specific vertebrae during spine surgery, the team adapted the method to the task of surgical navigation. When they tested the method on cadavers, they found a level of accuracy better than 2 millimeters and consistently better than a conventional surgical tracker, which has 2 to 4 millimeters of accuracy in surgical settings.
The team is translating the method to a system suitable for clinical studies. While the system could potentially be used in a wide range of procedures, Siewerdsen expects it to be most useful in minimally invasive surgeries, such as spinal and intracranial neurosurgery.
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