A novel method and workflow for stereotactic surgery with a mobile intraoperative CT imaging device

xCAT®, (Xoran Technologies, LLC., Ann Arbor, MI) is a CT imaging device that has been used for minimally invasive surgeries. Designed with flat panel and cone-beam imaging technique, it provides a fast, low-dose CT imaging alternative for diagnosis and examination purposes at hospitals. With its unique compact and mobile characteristics, it allows scanning inside crowded operating rooms (OR). The xCAT allows acquisition of images in the OR that show the most recent morphology during the procedure. This can potentially improve outcomes of surgical procedures such as deep brain stimulation (DBS) and other neurosurgeries, since brain displacement and deformation (brain shift) often occur between pre-operative imaging and electrode placement during surgery. However, the small gantry size of the compact scanner obstructs scanning of patients with stereotactic frames or skull clamp. In this study, we explored a novel method, in which we first utilized the xCAT to obtain CT images with fiducial markers, registered the stereotactic frame with those markers, and finally, target measurements were calculated and set up on the frame. The new procedure workflow provides a means to use CT images obtained inside of OR for stereotactic surgery and can be used in current intraoperative settings. Our phantom validation study in lab shows that the procedure workflow with this method is easy to conduct.