image-guided interventions: technology review and clinical ......image-guided interventions:...

Image-Guided Interventions: Technology Review and Clinical

ApplicationsKevin Cleary1 and Terry M. Peters2

Annual Reviews of Biomedical Engineering (2010)

1 Georgetown University2 Robarts Research Institute

IGI Journal Club

Why this paper?

• IGI stands for Image-Guided Interventions

• Too short self-notice to prepare the JC

• Challenge: Get the big picture of who does what

IGI Journal Club - Nov 25 2015

Friday’s DRC Neuro Journal Club - June 15 2012IGI Journal Club - Nov 25 2015

“Al que no quiere caldo le dan dos tazas” - Popular saying

Some other related papers

• Image-guided procedures: A review - Z. Yaniv & K. Cleary (2006)

• Ultrasonic image analysis and image-guided interventions - J.A. Noble, N. Navab & H. Becher (2011)

• Computer-integrated surgery and medical robotics. - R.H.Taylor & L. Joskowicz (2002)

• Image-guided surgery: From X-rays to virtual reality. T.M. Peters (2000)

• The process and development of image-guided procedures. R Galloway (2001)


And many other application-focused…

IGI: DefinitionIGI Journal Club - Nov 25 2015

Image-guided interventions are medical procedures that use computer-based systems to provide virtual image overlays to help the physician precisely visualize and target the surgical site. -Cleary & Peters

Image-guided systems aim at augmenting and complementing the physician's ability to understand the spatial structure of the anatomy by integrating medical images and other sources of information, such as tracked instruments. -Yaniv & Cleary

Image-guided surgery is the general term used for any surgical procedure where the surgeon employs tracked surgical instruments in conjunction with preoperative or intra-operative images in order to indirectly guide the procedure. -Wikipedia

IGI: Aims1. Mitigate the learning curve for minimally invasive

procedures and reduce the variability of the outcome, narrowing the gap between exceptional and standard practice;

2. Enable new minimally invasive procedures, allowing to perform procedures that were previously considered too dangerous;

3. Transform qualitative procedure evaluations into quantitative ones, enabling a quantitative comparison between plan and execution.


A bit of historyIGI Journal Club - Nov 25 2015

X-ray imaging to guide the removal of an industrial sewing needle from a woman’s hand (Birmingham)

1895:

Bullet removed from a victim’s leg by using the radiograph that had been made of the limb (McGill Univ)

1908: Horsley & Clarke report the stereotactic frame.

1970s: Appearance of computed tomography.

1981: Personal computer.

1987: Peters et al. report the first PC-based systems with the capability to plan stereotactic procedures from CT, MRI

1990s: Attempts to move beyond the constraints of the stereotactic frame. Improved imaging and visualisation. Tracking systems.

IGI WorkflowIGI Journal Club - Nov 25 2015

Yaniv & Cleary (2006)


Source: E Doctor et al. Image-Guided Interventions Technology and Applications Workshop.


GuotaiMaria

Michael E.

PankajMarcel

François LuisRachel George

EfthymiosWenfeng

Tom’sJosh

Roz

Sebastiano

FranciscoMartin

pre-op inter-op

Sacha

IGI ElementsIGI Journal Club - Nov 25 2015

Medical imaging, and image processing. Data visualisation.Segmentation.Registration.Tracking systems.Human Computer Interaction (HCI).

Imaging.Segmentation. Registration. Tracking.Visualisation. Robotics.

TrackingRegistration.Visualisation.Software.

Imaging.Registration.Image processing. Visualisation and simulation.Tracking.Robotics.

About robotics

• Robotic surgery: A current perspective - A. Lanfranco et al (2004)

• Medical robotics in computer-integrated surgery - R.H. Taylor & D. Stoianovici (2003)

• State of the art in surgical robotics: clinical applications and technology challenges - K. Cleary & C. Nguyen.(2001)


About simulation

• Preparation for the actual surgery, i.e., planning

• Common in cardiac procedures

• EpiNav


ImagingIGI Journal Club - Nov 25 2015

Source: Yaniv & Cleary (2006)

Imaging: Challenges

• Modalities can observe: low resolution, limited field of view, geometric distortion, noise.

• For most procedures, physicians are still highly dependent on their abi l ity to mental ly reconstruct a three-dimensional scene based on two-dimensional intra-operative images


Visualisation

• A vital link in the procedural chain.

• The surgeon no longer needs to navigate with respect to a single radiograph or CT/MRI image.

• Access to a wealth of 3D (and even 4D) data, often complemented with images from various modalities.


VisualisationIGI Journal Club - Nov 25 2015

Visualisation: Challenges

• When images from multiple modalities are being displayed, it is important that they be presented unambiguously to the user.

• Physicians tend to prefer “familiar” views over more complex 3D renderings.


Segmentation

• We all know what segmentation is.

• A lot of work has been done but, no one yet is fully satisfied.

• Intra-operative?


Segmentation: Challenges

• Approach 1: User explicitly defines the desired segmentation

• Approach 2: Algorithms were the specification is implicit.


A balance between both needs to be achieved.


Registration(spatial alignment)

• We also all know what registration is about.

• In the most common clinical scenario, preoperative images must be aligned with the patient on the procedure table.

• Multi-modal fusion


Registration: Challenges

• To date, commercial systems only use rigid registration.

• Some approaches are invasive or require extra-hardware.

• Deformable algorithms lack the robustness required for clinical practice and have only been applied in very limited trials.


Tracking

• Key element of IGI.

• Devices are used to track the positions of instruments relative to patient anatomy.


TrackingIGI Journal Club - Nov 25 2015


Tracking: Challenges

• Optical tracking systems require that a line of sight be maintained between the tracking device and the instrument to be tracked.

• Electromagnetic devices are sensitive to metal objects in the environment.

• Ultrasound-based tracking is slow (static objects).


Software

• Integrates information from tracking systems, correlate the data with the relevant images, and display real-time updates of the instruments and patient.

• Current open source packages:

• 3D Slicer

• MITK

• IGSTK


Software: Challenges

• It needs to be:

• Stable

• Robust

• Easy to use


IGI: Applications

• Image-guided neurosurgery

• Orthopaedics

• Cardiac interventions*


* very complex setups

Overall

• IGI is still evolving as medical imaging and computing power continue to improve.

• Most systems are at the prototype stage.

• Surgery continues to move toward minimally invasive interventions, requiring IGI to improve the precision and quality of medical procedures.

• Research groups are encouraged to form multidisciplinary partnerships between scientific and clinical personnel.


My overallIGI Journal Club - Nov 25 2015

Difficult to get the big

picture

Imaging

Tough segmentation

problem

Segmentation

No one-to-one

mapping

Registration

Difficult to display

Visualisation

Maintaining line of sight can be challenging

Tracking

How can all these parts be

integrated?

Software

In conclusionIGI Journal Club - Nov 25 2015

The journal club is not particularly popular

But… we have to make part of one

So, can we do better?

In conclusion (2)

Different areas of interest: Good & bad


Structured journal club?How can all these parts be

integrated?

Software

AgendaIGI Journal Club - Nov 25 2015

Date Presenter Category

Dec 2 Wenqi Li Special guest

Dec 9 Sebastiano Ferraris Image registration

Jan 13 Marcel Tella Amo

Jan 20 Michael Ebner

Jan 27 Rachel Sparks

Upcoming planning• George Dwyer

• Efthymios Maneas

• Guotai Wang

• Luis Carlos García

• Tom Doel

• Dzhoskun Shakir

• Pankaj Daga

• Hina Lad

• Martin Kochan

• Yijing Xie

• François Ch.

• Tom Vercauteren

• Ester Bonmati

• Francisco Vasconcelos


Dates: Feb. 3 - March 23

Thanks for your time


image-guided interventions: technology review and clinical ......image-guided interventions:...

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