Biomedical Paper Real Time 3-Dimensional Ultrasound for Guiding Surgical Tasks

Objective: Two-dimensional ultrasound (US) can only guide basic interventional tasks due to limited spatial orientation information offered by this imaging modality. High resolution real time 3-D US can potentially overcome this limitation thereby expanding the applications for interventional US. The following study examines the benefits of real time 3-D US in performing both basic and complex image-guided surgical tasks. Materials and Methods: Seven surgical trainees performed three tasks in an endoscopic testing tank using 2-D US, biplanar 2-D US, and 3-D US for guidance. Surgeon-controlled US imaging was also tested. The evaluation tasks were (1) Bead-in-Hole Navigation, (2) Bead-to-Bead Navigation, and (3) Clip Fixation. Performance measures included completion time, tool tip trajectory, and error rates with endoscope performance serving as a control measure for each subject. Results: Compared to 2-D US guidance, completion times decreased significantly with 3-D US for both Bead-in-Hole Navigation (50%, p=0.046) and Bead-to-Bead Navigation (77%, p=0.009). Furthermore, tool tip tracking for Bead-to-Bead Navigation demonstrated greater navigational accuracy using 3-D US vs. 2-D US (46%, p=0.040). Biplanar 2-D imaging and surgeon-controlled 2-D US did not significantly improve performance vs. conventional 2-D US. In real time 3-D mode, surgeon-controlled imaging and changes in 3-D image presentation by adjusting the perspective of the 3-D image did not diminish performance for Bead-to-Bead Navigation. For Clip Fixation, completion times proved excessive with 2-D US guidance (> 240 s); however, with real time 3-D US imaging, completion times and error rates were comparable to endoscope-guided performance. Conclusions: Real time 3-D US can guide basic surgical tasks more efficiently and accurately than 2-D US imaging. Real time 3-D US can also guide more complex surgical tasks which may prove useful for procedures where optical imaging is suboptimal as in fetal surgery or intracardiac interventions.

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