Fusion of intraoperative cone-beam CT and endoscopic video for image-guided procedures

Methods for accurate registration and fusion of intraoperative cone-beam CT (CBCT) with endoscopic video have been developed and integrated into a system for surgical guidance that accounts for intraoperative anatomical deformation and tissue excision. The system is based on a prototype mobile C-Arm for intraoperative CBCT that provides low-dose 3D image updates on demand with sub-mm spatial resolution and soft-tissue visibility, and also incorporates subsystems for real-time tracking and navigation, video endoscopy, deformable image registration of preoperative images and surgical plans, and 3D visualization software. The position and pose of the endoscope are geometrically registered to 3D CBCT images by way of real-time optical tracking (NDI Polaris) for rigid endoscopes (e.g., head and neck surgery), and electromagnetic tracking (NDI Aurora) for flexible endoscopes (e.g., bronchoscopes, colonoscopes). The intrinsic (focal length, principal point, non-linear distortion) and extrinsic (translation, rotation) parameters of the endoscopic camera are calibrated from images of a planar calibration checkerboard (2.5×2.5 mm2 squares) obtained at different perspectives. Video-CBCT registration enables a variety of 3D visualization options (e.g., oblique CBCT slices at the endoscope tip, augmentation of video with CBCT images and planning data, virtual reality representations of CBCT [surface renderings]), which can reveal anatomical structures not directly visible in the endoscopic view - e.g., critical structures obscured by blood or behind the visible anatomical surface. Video-CBCT fusion is evaluated in pre-clinical sinus and skull base surgical experiments, and is currently being incorporated into an ongoing prospective clinical trial in CBCT-guided head and neck surgery.

[1]  Cari M Whyne,et al.  Intraoperative cone-beam CT for correction of periaxial malrotation of the femoral shaft: a surface-matching approach. , 2007, Medical physics.

[2]  Harley Chan,et al.  Intraoperative use of cone-beam computed tomography in a cadaveric ossified cochlea model , 2009, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[3]  Jeffrey H. Siewerdsen,et al.  Flat-panel cone-beam CT: a novel imaging technology for image-guided procedures , 2001, SPIE Medical Imaging.

[4]  J H Siewerdsen,et al.  Geometric calibration of a mobile C-arm for intraoperative cone-beam CT. , 2008, Medical physics.

[5]  David A Jaffray,et al.  Cone-beam computed tomography on a mobile C-arm: novel intraoperative imaging technology for guidance of head and neck surgery. , 2008, Journal of otolaryngology - head & neck surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale.

[6]  J H Siewerdsen,et al.  Automatic image-to-world registration based on x-ray projections in cone-beam CT-guided interventions. , 2009, Medical physics.

[7]  Jeffrey H. Siewerdsen,et al.  High-performance intraoperative cone-beam CT on a mobile C-arm: an integrated system for guidance of head and neck surgery , 2009, Medical Imaging.

[8]  Rainer Graumann,et al.  3D soft tissue imaging with a mobile C-arm , 2007, Comput. Medical Imaging Graph..

[9]  Juho Kannala,et al.  A generic camera model and calibration method for conventional, wide-angle, and fish-eye lenses , 2006, IEEE Transactions on Pattern Analysis and Machine Intelligence.

[10]  R. Bucholz,et al.  The next generation of navigational technology. , 2005, Otolaryngologic clinics of North America.

[11]  Jeffrey H. Siewerdsen,et al.  Intraoperative Cone-beam CT for Guidance of Temporal Bone Surgery , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[12]  K. Brock,et al.  Demons deformable registration for CBCT-guided procedures in the head and neck: convergence and accuracy. , 2009, Medical physics.

[13]  J H Siewerdsen,et al.  Investigation of C‐Arm Cone‐Beam CT‐Guided Surgery of the Frontal Recess , 2005, The Laryngoscope.

[14]  John Wong,et al.  Flat-panel cone-beam CT on a mobile isocentric C-arm for image-guided brachytherapy , 2002, SPIE Medical Imaging.

[15]  B. Wilson,et al.  Volume CT with a flat-panel detector on a mobile, isocentric C-arm: pre-clinical investigation in guidance of minimally invasive surgery. , 2005, Medical physics.

[16]  Jeffrey H. Siewerdsen,et al.  Multimode C-arm fluoroscopy, tomosynthesis, and cone-beam CT for image-guided interventions: from proof of principle to patient protocols , 2007, SPIE Medical Imaging.