Error analysis in neuronavigation
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1 Fakultät für Informatik - Humanoids and Intelligence Systems Lab Institut für Anthropomatik Mittwochs von 12:15-13:45 Error analysis in neuronavigation Uwe Spetzger Neurochirurgische Klinik, Klinikum Karlsruhe
2 Application of CAS arm-system for navigation-guided cranial surgery (Department of Neurosurgery, RWTH Technical University of Aachen 1990)
3 Application of CAS opticalsystem during endonasal navigation-guided surgery (Department of ENT, RWTH Technical University of Aachen 1992)
4 Navigated Brain Surgery - Status Quo and Perspectives Key issues: Error analysis in navigated brain surgery Machine-made errors Strategical errors Man-made errors Brain shift Intraoperative data refreshment Intraoperative workflow Education - Simulation - Training
5 Navigated Brain Surgery Error analysis Data acquisition Incompatibility of image data (CT, MR, DSA, PET, etc.) Data transfer problems (storage, disk drive, network) Slice thickness (extented investigation, motion artifacts) Image distortion errors (non-linearity of gradient fields) Artefacts (foreign bodies, magnetic susceptibility) Image reconstruction (accuracy of raw data)
6 Fusion - Matching of multimodal image data CT - MRI MRI - PET
7 Navigated Brain Surgery Error analysis Technical errors System inaccuracy (< 0.2 mm) Implementation of guided tools (plausibility checks) Hardware failures due to high-tech in a hostile jungle (system abusers, autoclaving of LED s, cable breakage) Rare technical malfunctions, when systems are used adequately!
8 Navigated Brain Surgery Error analysis Problems with fiducials Loss of adhesive skin markers (refixation by the patient) CT-markers have better registration accuracy (more defined and precise center or lower coefficient of spatial image distortion in CT-scanning) Bone screw fiducials (high accuracy vs. invasiveness) Tooth splint (repeatable, accurate and noninvasiv) Marker-free contactless registration (surface-laser-scanning)
9 Navigated Brain Surgery Error analysis Registration errors Spatial arrangement of the skin fiducials (RMSE) Loss of rigid fixation of dynamic reference frame User dependent registration accuracy Brain shift Tumor debulking, loss of CSF, sitting position, etc.
10 Intraoperative application Craniotomy Low grade glioma Tailoring of craniotomy Determination of resection
11 Intraoperative application Heads-up dislay of segmented tumor size Temporal glioma - Craniotomy planning - Cortical approach - Borderlines of resection
12 Navigated Brain Surgery Error analysis Strategical errors Lack of experience and exact knowledge of the system Awareness of virtual radiological reality No on-line information No replacement for well-founded anatomical knowledge and for surgical experience Surgeons have to know the multiple sources of error
13 Intraoperative navigation - pointer or microscope Strategical error
14 Navigated Brain Surgery - Status Quo and Perspectives Key issues: Error analysis in navigated brain surgery Machine-made errors Strategical errors Brain shift Intraoperative data refreshment Intraoperative workflow Simulation - Education - Training
15 Navigated Brain Surgery - Status Quo and Perspectives Brain shift Computer analysis with intraoperative MRI Vector graphics (vectors correlating length with force) shift happens!
16 Navigated Brain Surgery - Status Quo and Perspectives Key issues: Error analysis in navigated brain surgery Machine-made errors Strategical errors Brain shift Intraoperative data refreshment Intraoperative workflow Simulation - Education - Training
17 Navigated Brain Surgery - Status Quo and Perspectives Intraoperative CT-imaging Mobile CT (Tomoscan M, Philips Medical Systems) Cranial and spinal imaging (on-line data refreshment) Different OR-table solutions (restricted positioning) Problems of skull fixation (carbon head rest, special pins) X-ray (limitations) Work-flow analysis (cost : benefit and effort : benefit)
18 Navigated Brain Surgery - Status Quo and Perspectives Intraoperative MR-imaging Experiences with over cases (since March 1996) Intraoperative high-quality data refreshment Special equipment (compatible instruments, microscope, etc.) Excellent indications Resection control in glioma surgery Epilepsy surgery Transsphenoidal pituitary adenoma resection Therapy control in cryo- or laserablation
19 Construction design Intracranial MR-guided biopsy in realtime Computer simulated workflow (range of motion inside the gantry)
20 Feasability study experimental melon-test Mov00551.mpg Mov00551.mpg
21 Phantom study accuracy tests MR based planning and real-time controlled Testflight to target (mean tolerance of precision < 0.5 mm)
22 MRI - US Intraoperative ultrasound - Fusion with MRI
23 Navigated Brain Surgery - Status Quo and Perspectives Key issues: Error analysis in navigated brain surgery Machine-made errors Strategical errors Brain shift Intraoperative data refreshment Intraoperative workflow Simulation - Education - Training
24 Intraoperative orientation: Pointer - Microscope 3D graphical anatomical imaging of the topography Planning of the adequate approch
25 Navigation-guided skull base surgery Heads-up display (2D vs. 3D) High passive accuracy (pointing-mode) Acceptable active accuracy (working-mode) Modification of tracking of specific instruments Optimal graphical-anatomical orientation Virtual reality Real virtuality
26 Navigated Brain Surgery - Status Quo and Perspectives Key issues: Error analysis in navigated brain surgery Machine-made errors Strategical errors Brain shift Intraoperative data refreshment Intraoperative workflow Simulation - Education - Training
27 Navigated Brain Surgery Simulation - Education - Training Detailed preoperative planning (interactive learning) Microsurgical anatomy (multiplanar and 3D visualization) Approach and pathway planning Simulation of operations ( unbloody surgical training )
28 Computeranimated anatomy - Interactive planning of surgery
29 Practical neurosurgical training Simulation Virtual neurosurgery
30 Virtual ventricular drainage Trajectory planning Length of the drainage Freeze of the adjustment Opening of the monitor screen Interactive learning Unbloody training
31 Interactive neurosurgical training Simulation - Virtual ventricular drainage 145 virtual VD 66 (46%) optimal position 79 (54%) malposition Ventr. index drainage optimal position 0,09-0, (32%) 0,20-0, (46%) > 0,5 6 5 (83%)
32 Navigated Brain Surgery - Status Quo and Perspectives Virtual ventricular drainage - Cumulative malpositions Position Nucleus caudatus 25 Corpus callosum 21 Contralateral ventricle 11 Striatum 7 Capsula interna 5 Thalamus 4 Contralateral callosal 4 My goodness 2 n
33 16 machine-made errors vs. 112 man-made errors totally, 128 failures (7.1 %) Navigated Brain Surgery Error analysis Experiences of totally 1796 navigated procedures Errors due to complex man-machine interaction!
34 erratum humanum est machines never err
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