UGM09ABS Daly

From IGSTK

High-Performance Intraoperative Cone-Beam CT on a Mobile C-Arm: An Integrated System for Guidance of Head and Neck Surgery

JH Siewerdsen, MJ Daly, H Chan, S Nithiananthan, NM Hamming, KK Brock, and JC Irish

A system for intraoperative cone-beam CT (CBCT) surgical guidance has been developed and translated to initial trials in head and neck surgery. The system provides 3D image updates on demand with sub-mm spatial resolution and soft-tissue visibility at low radiation dose, thus overcoming conventional limitations associated with preoperative imaging alone. A previously reported mobile C-arm provides the imaging platform, which has been integrated with several critical subsystems for streamlined implementation in the OR, including: real-time tracking and navigation (infrared stereoscopic cameras); fast 3D deformable image registration (a newly developed multi-scale Demons algorithm); 3D planning and definition of target and normal structures; and registration / visualization of intraoperative CBCT with the surgical plan, preoperative images, and endoscopy. Quantitative evaluation of surgical performance demonstrates a significant advantage in achieving complete tumor excision in challenging sinus and skull base ablation tasks. The ability to visualize the surgical plan in the context of intraoperative image data delineating residual tumor and neighboring critical structures boosts surgical confidence and performance. The system has been translated to a prospective trial involving 12 patients undergoing head and neck surgery. The trial represents the first implementation of the research prototype in the clinical setting, demonstrates the image quality and surgical precision that can be achieved, and provides a valuable basis for human factors analysis and workflow studies that will greatly augment streamlined implementation of such systems in complex OR environments.