Int J Comput Assist Radiol Surg - An electromagnetic Tracker-in-Table configuration for X-ray fluoroscopy and cone-beam CT-guided surgery.


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RPOSE: A novel electromagnetic tracking configuration was characterized and implemented for image-guided surgery incorporating C-arm fluoroscopy and/or cone-beam CT (CBCT). The tracker employed a field generator (FG) with an open rectangular aperture and a frame enclosure with two essentially hollow sides, yielding a design that presents little or no X-ray attenuation across the C-arm orbit. The "Window" FG (WFG) was characterized in comparison with a conventional "Aurora" FG (AFG), and a configuration in which the WFG was incorporated directly into the operating table was investigated in preclinical phantom studies.METHOD: The geometric accuracy and field of view (FOV) of the WFG and AFG were evaluated in terms of target registration error (TRE) using an acrylic phantom on an (electromagnetic compatible) experimental bench. The WFG design was incorporated in a prototype operating table featuring a carbon fiber top beneath, which the FG could be translated for positioning under the patient. The X-ray compatibility was evaluated using a prototype mobile C-arm for fluoroscopy and CBCT in an anthropomorphic chest phantom. The susceptibility to EM field distortion associated with surgical tools (e.g., spine screws) and the C-arm itself was investigated in terms of TRE, and calibration methods were tested to provide robust image-world registration with minimal perturbation from the rotational C-arm.RESULTS: The WFG demonstrated mean TRE of 1.28 ? 0.79?mm compared to 1.13 ? 0.72?mm for the AFG, with no statistically significant difference between the two (p?=?0.32 and n?=?250). The WFG exhibited a deeper field of view by ~10?cm providing an equivalent degree of geometric accuracy to a depth of z ~55?cm, compared to z ~45?cm for the AFG. Although the presence of a small number of spine screws did not degrade tracker accuracy, the mobile C-arm perturbed the electromagnetic field sufficiently to degrade TRE; however, a calibration method was identified to mitigate the effect. Specifically, the average calibration between posterior-anterior and lateral orientations of the C-arm was found to yield fairly robust registration for any C-arm pose with only a slight reduction in geometric accuracy (1.43 ? 0.31?mm in comparison with 1.28 ? 0.79?mm, p?=?0.05). The WFG demonstrated reasonable X-ray compatibility, although the initial design of the window frame included suboptimal material and shape of the side bars that caused a level of streak artifacts in CBCT reconstructions. The streak artifacts were of sufficient magnitude to degrade soft-tissue visibility in CBCT but were negligible in the context of high-contrast imaging tasks (e.g., bone visualization).CONCLUSION: The open frame of the WFG offers a potentially valuable configuration for electromagnetic trackers in image-guided surgery applications that are based on X-ray fluoroscopy and/or CBCT. The geometric accuracy and FOV are comparable to the conventional AFG and offers increased depth (z-direction) FOV. Incorporation directly within the operating table offers a streamlined implementation in which the tracker is in place but "invisible," potentially simplifying tableside logistics, avoidance of the sterile field, and compatibility with X-ray imaging.

Resumo Limpo

rpose novel electromagnet track configur character implement imageguid surgeri incorpor carm fluoroscopi andor conebeam ct cbct tracker employ field generat fg open rectangular apertur frame enclosur two essenti hollow side yield design present littl xray attenu across carm orbit window fg wfg character comparison convent aurora fg afg configur wfg incorpor direct oper tabl investig preclin phantom studiesmethod geometr accuraci field view fov wfg afg evalu term target registr error tre use acryl phantom electromagnet compat experiment bench wfg design incorpor prototyp oper tabl featur carbon fiber top beneath fg translat posit patient xray compat evalu use prototyp mobil carm fluoroscopi cbct anthropomorph chest phantom suscept em field distort associ surgic tool eg spine screw carm investig term tre calibr method test provid robust imageworld registr minim perturb rotat carmresult wfg demonstr mean tre mm compar mm afg statist signific differ two p n wfg exhibit deeper field view cm provid equival degre geometr accuraci depth z cm compar z cm afg although presenc small number spine screw degrad tracker accuraci mobil carm perturb electromagnet field suffici degrad tre howev calibr method identifi mitig effect specif averag calibr posterioranterior later orient carm found yield fair robust registr carm pose slight reduct geometr accuraci mm comparison mm p wfg demonstr reason xray compat although initi design window frame includ suboptim materi shape side bar caus level streak artifact cbct reconstruct streak artifact suffici magnitud degrad softtissu visibl cbct neglig context highcontrast imag task eg bone visualizationconclus open frame wfg offer potenti valuabl configur electromagnet tracker imageguid surgeri applic base xray fluoroscopi andor cbct geometr accuraci fov compar convent afg offer increas depth zdirect fov incorpor direct within oper tabl offer streamlin implement tracker place invis potenti simplifi tablesid logist avoid steril field compat xray imag

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