Real-time virtual intraoperative CT in endoscopic sinus surgery.
Real-time virtual intraoperative CT in endoscopic sinus surgery.
复制标题
内窥镜鼻窦手术中的实时虚拟术中 CT。
DOI：
10.1007/s11548-021-02536-5
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发表时间：
2022
影响因子：
3
通讯作者：
Bly,Randall
中科院分区：
文献类型：
--
作者：
Li,Yangming;Konuthula,Neeraja;Humphreys,IanM;Moe,Kris;Hannaford,Blake;Bly,Randall
目的内窥镜鼻窦手术 (ESS) 通常在术前计算机断层扫描 (CT) 的引导下进行，随着手术的进展，计算机断层扫描越来越偏离实际的患者解剖结构。研究报告称，ESS 的翻修手术率在 28% 至 47% 之间。本文提出了一种可以实时更新术前 CT 以提高 ESS 手术完整性的方法。该工作提出并比较了三种使用器械运动数据和解剖结构实时预测手术修改的新颖方法。这些方法使用学习技术，例如非参数过滤和高斯过程回归，将手术修改与器械尖端位置、尖端轨迹和器械形状相关联。术前 CT 图像集通过修改预测进行更新，以用作虚拟术中 CT。 结果在 8 例 ESS 尸体病例中对三种方法进行了比较，这些病例由 5 名外科医生进行，包括以下代表性 ESS 手术：上颌窦造口术、钩突切除术、筛前和后筛窦切除术以及蝶窦切开术。实验结果表明，在手术完整性评估中，骰子相似系数> 86％，F分数> 92％，精度> 89.91％，准确性指标在临床上可接受。在三种方法中，基于尖端轨迹的估计器的精度最高，为 96.87%。结论这项工作表明，虚拟修改的术中 CT 扫描提高了实际手术场景与参考模型之间的一致性，并可以提高 ESS 的手术完整性。与实际的术中CT扫描相比，所提出的方法对现有手术方案没有影响，不需要额外的硬件，不会使患者暴露在辐射下，并且不会延长麻醉时间。
PurposeEndoscopic sinus surgery (ESS) is typically guided under preoperative computed tomography (CT), which increasingly diverges from actual patient anatomy as the surgery progresses. Studies have reported that the revision surgery rate in ESS ranges between 28 and 47%. This paper presents a method that can update the preoperative CT in real time to improve surgical completeness in ESS.ApproachThe work presents and compares three novel methods that use instrument motion data and anatomical structures to predict surgical modifications in real time. The methods use learning techniques, such as nonparametric filtering and Gaussian process regression, to correlate surgical modifications with instrument tip positions, tip trajectories, and instrument shapes. Preoperative CT image sets are updated with modification predictions to serve as a virtual intraoperative CT.ResultsThe three methods were compared in eight ESS cadaver cases, which were performed by five surgeons and included the following representative ESS operations: maxillary antrostomy, uncinectomy, anterior and posterior ethmoidectomy, and sphenoidotomy. Experimental results showed accuracy metrics that were clinically acceptable with dice similarity coefficients > 86%, with F-score > 92% and precision > 89.91% in surgical completeness evaluation. Among the three methods, the tip trajectory-based estimator had the highest precision of 96.87%.ConclusionsThis work demonstrated that virtually modified intraoperative CT scans improved the consistency between the actual surgical scene and the reference model, and could lead to improved surgical completeness in ESS. Compared to actual intraoperative CT scans, the proposed method has no impact on existing surgical protocols, does not require extra hardware, does not expose the patient to radiation, and does not lengthen time under anesthesia.