Int J Comput Assist Radiol Surg - Accuracy considerations in image-guided cardiac interventions: experience and lessons learned.

Tópicos

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Resumo

TIVATION: Medical imaging and its application in interventional guidance has revolutionized the development of minimally invasive surgical procedures leading to reduced patient trauma, fewer risks, and shorter recovery times. However, a frequently posed question with regard to an image guidance system is "how accurate is it?" On one hand, the accuracy challenge can be posed in terms of the tolerable clinical error associated with the procedure; on the other hand, accuracy is bound by the limitations of the system's components, including modeling, patient registration, and surgical instrument tracking, all of which ultimately impact the overall targeting capabilities of the system.METHODS: While these processes are not unique to any interventional specialty, this paper discusses them in the context of two different cardiac image guidance platforms: a model-enhanced ultrasound platform for intracardiac interventions and a prototype system for advanced visualization in image-guided cardiac ablation therapy.RESULTS: Pre-operative modeling techniques involving manual, semi-automatic and registration-based segmentation are discussed. The performance and limitations of clinically feasible approaches for patient registration evaluated both in the laboratory and in the operating room are presented. Our experience with two different magnetic tracking systems for instrument and ultrasound transducer localization is reported. Ultimately, the overall accuracy of the systems is discussed based on both in vitro and preliminary in vivo experience.CONCLUSION: While clinical accuracy is specific to a particular patient and procedure and vastly dependent on the surgeon's experience, the system's engineering limitations are critical to determine whether the clinical requirements can be met.

Resumo Limpo

tivat medic imag applic intervent guidanc revolution develop minim invas surgic procedur lead reduc patient trauma fewer risk shorter recoveri time howev frequent pose question regard imag guidanc system accur one hand accuraci challeng can pose term toler clinic error associ procedur hand accuraci bound limit system compon includ model patient registr surgic instrument track ultim impact overal target capabl systemmethod process uniqu intervent specialti paper discuss context two differ cardiac imag guidanc platform modelenhanc ultrasound platform intracardiac intervent prototyp system advanc visual imageguid cardiac ablat therapyresult preoper model techniqu involv manual semiautomat registrationbas segment discuss perform limit clinic feasibl approach patient registr evalu laboratori oper room present experi two differ magnet track system instrument ultrasound transduc local report ultim overal accuraci system discuss base vitro preliminari vivo experienceconclus clinic accuraci specif particular patient procedur vast depend surgeon experi system engin limit critic determin whether clinic requir can met

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