Enhanced tumour localization, visualization, resection and radiotherapy in computer-aided surgery: Assisting surgeons via robotics and augmented-reality image-overlay technologies

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For early-stage breast cancer, treatment options include mastectomy in which the breast is fully removed and lumpectomy (breast-conserving surgery) in which only the tumour and a portion of the adjacent tissue are removed. Lumpectomy is often preferred by women for a number of factors including cosmesis. Since the breast is highly deformable, it is difficult for the surgeon to keep track of the tumour location, orientation and shape during surgery based on preoperative mammogram/ultrasound images. When a breast tumour is palpable, i.e., it can be felt by the surgeon's hand, performing lumpectomy is relatively straightforward. When the tumour is impalpable, however, the surgeon must perform the surgery by relying on a guidewire implanted preoperatively into the breast for marking the tumour location. This imprecise way fails to clearly identify an impalpable tumour for the surgeon and causes repeat surgeries that reduce the cosmetic benefits of lumpectomy and may delay supplemental treatments for breast cancer. These challenges can be mitigated with better localization and visualization of tumours. We propose a robotics and augmented reality-based surgeon-assist solution to the issues of planning and executing breast lumpectomy using algorithms for ultrasound image-based tumour finding and tracking and augmented-reality tumour visualization. The augmented-reality display will visually guide the surgeon to the tumour location in an unobtrusive and intuitive manner by overlaying an image of the tumour on the patient's physical breast. This technology will enable surgeons to more accurately plan and execute lumpectomy. Our low-cost solution improves the accuracy in lesion localization/visualization, reduces the procedure length, and enhances the surgeon's situational awareness while enhancing post-lumpectomy breast cosmesis for patients.