Xiang Bowen, Heiselman Jon S, Richey Winona L, D'Angelica Michael I, Wei Alice, Kingham T Peter, Servin Frankangel, Pereira Kyvia, Geevarghese Sunil K, Jarnagin William R, Miga Michael I
Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.
Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States.
J Med Imaging (Bellingham). 2024 Mar;11(2):025001. doi: 10.1117/1.JMI.11.2.025001. Epub 2024 Mar 4.
To study the difference between rigid registration and nonrigid registration using two forms of digitization (contact and noncontact) in human liver surgery.
A Conoprobe device attachment and sterilization process was developed to enable prospective noncontact intraoperative acquisition of organ surface data in the operating room (OR). The noncontact Conoprobe digitization method was compared against stylus-based acquisition in the context of image-to-physical registration for image-guided surgical navigation. Data from patients undergoing liver resection were analyzed under an Institutional Review Board-approved study at Memorial Sloan Kettering Cancer Center. Organ surface coverage of each surface acquisition method was compared. Registration accuracies resulting from the acquisition techniques were compared for (1) rigid registration method (RRM), (2) model-based nonrigid registration method (NRM) using surface data only, and (3) NRM with one subsurface feature (vena cava) from tracked intraoperative ultrasound (NRM-VC). Novel vessel centerline and tumor targets were segmented and compared to their registered preoperative counterparts for accuracy validation.
Surface data coverage collected by stylus and Conoprobe were and , respectively. The average difference between stylus data and Conoprobe data using NRM was and using NRM-VC was , indicating the registrations to Conoprobe data performed worse than to stylus data with both NRM approaches. However, using the stylus and Conoprobe acquisition methods led to significant improvement of NRM-VC over RRM by average differences of 4.48 and 3.66 mm, respectively.
The first use of a sterile-field amenable Conoprobe surface acquisition strategy in the OR is reported for open liver surgery. Under clinical conditions, the nonrigid registration significantly outperformed standard-of-care rigid registration, and acquisition by contact-based stylus and noncontact-based Conoprobe produced similar registration results. The accuracy benefits of noncontact surface acquisition with a Conoprobe are likely obscured by inferior data coverage and intrinsic noise within acquisition systems.
研究在肝脏手术中使用两种数字化形式（接触式和非接触式）时刚性配准和非刚性配准之间的差异。
开发了一种Conoprobe设备附件和消毒程序，以便在手术室（OR）中进行前瞻性非接触式术中器官表面数据采集。在图像引导手术导航的图像到物理配准的背景下，将非接触式Conoprobe数字化方法与基于触笔的采集方法进行了比较。在纪念斯隆凯特琳癌症中心一项经机构审查委员会批准的研究中，对接受肝切除术患者的数据进行了分析。比较了每种表面采集方法的器官表面覆盖率。比较了采集技术产生的配准精度，包括（1）刚性配准方法（RRM），（2）仅使用表面数据的基于模型的非刚性配准方法（NRM），以及（3）使用来自术中跟踪超声的一个地下特征（腔静脉）的NRM（NRM-VC）。对新的血管中心线和肿瘤靶点进行了分割，并与术前配准的对应物进行比较以验证准确性。
触笔和Conoprobe收集的表面数据覆盖率分别为 和 。使用NRM时，触笔数据和Conoprobe数据之间的平均差异为 ，使用NRM-VC时为 ，这表明在两种NRM方法中，与触笔数据相比，Conoprobe数据的配准效果更差。然而，使用触笔和Conoprobe采集方法分别使NRM-VC比RRM平均差异4.48和3.66毫米，有显著改善。
报告了在开放肝脏手术中首次在手术室使用适合无菌场的Conoprobe表面采集策略。在临床条件下，非刚性配准明显优于护理标准的刚性配准，基于接触式触笔和非接触式Conoprobe的采集产生了相似的配准结果。Conoprobe非接触表面采集的准确性优势可能因采集系统内较差的数据覆盖率和固有噪声而被掩盖。
