Genetic evolutionary taboo search for optimal marker placement in infrared patient setup

Quantitative Augmented Reality-Assisted Free-Hand Orthognathic Surgery Using Electromagnetic Tracking and Skin-Attached Dynamic Reference

The purpose of this study was to develop a quantitative AR-assisted free-hand orthognathic surgery method using electromagnetic (EM) tracking and skin-attached dynamic reference. The authors proposed a novel, simplified, and convenient workflow for augmented reality (AR)-assisted orthognathic surgery based on optical marker-less tracking, a comfortable display, and a non-invasive, skin-attached dynamic reference frame. The 2 registrations between the physical (EM tracking) and CT image spaces and between the physical and AR camera spaces, essential processes in AR-assisted surgery, were pre-operatively performed using the registration body complex and 3D depth camera. The intraoperative model of the maxillary bone segment (MBS) was superimposed on the real patient image with the simulated goal model on a flat-panel display, and the MBS was freely handled for repositioning with respect to the skin-attached dynamic reference tool (SRT) with quantitative visualization of landmarks of interest using only EM tracking. To evaluate the accuracy of AR-assisted Le Fort I surgery, the MBS of the phantom was simulated and repositioned by 6 translational and three rotational movements. The mean absolute deviations (MADs) between the simulation and post-operative positions of MBS landmarks by the SRT were 0.20, 0.34, 0.29, and 0.55 mm in x- (left lateral, right lateral), y- (setback, advance), and z- (impaction, elongation) directions, and RMS, respectively, while those by the BRT were 0.23, 0.37, 0.30, and 0.60 mm. There were no significant differences between the translation and rotation surgeries or among surgeries in the x-, y-, and z-axes for the SRT. The MADs in the x-, y-, and z-axes exhibited no significant differences between the SRT and BRT. The developed method showed high accuracy and reliability in free-hand orthognathic surgery using EM tracking and skin-attached dynamic reference.

Optimization Model for the Distribution of Fiducial Markers in Liver Intervention

The distribution of fiducial markers is one of the main factors affected the accuracy of optical navigation system. However, many studies have been focused on improving the fiducial registration accuracy or the target registration accuracy, but few solutions involve optimization model for the distribution of fiducial markers. In this paper, we propose an optimization model for the distribution of fiducial markers to improve the optical navigation accuracy. The strategy of optimization model is reducing the distribution from three dimensional to two dimensional to obtain the 2D optimal distribution by using optimization algorithm in terms of the marker number and the expectation equation of target registration error (TRE), and then extend the 2D optimal distribution in two dimensional to three dimensional to calculate the optimal distribution according to the distance parameter and the expectation equation of TRE. The results of the experiments show that the averaged TRE for the human phantom is approximately 1.00 mm by applying the proposed optimization model, and the averaged TRE for the abdominal phantom is 0.59 mm. The experimental results of liver simulator model and ex-vivo porcine liver model show that the proposed optimization model can be effectively applied in liver intervention.

Orientation Uncertainty Characteristics of Some Pose Measuring Systems

We investigate the performance of pose measuring systems which determine an object's pose from measurement of a few fiducial markers attached to the object. Such systems use point-based, rigid body registration to get the orientation matrix. Uncertainty in the fiducials' measurement propagates to the uncertainty of the orientation matrix. This orientation uncertainty then propagates to points on the object's surface. This propagation is anisotropic, and the direction along which the uncertainty is the smallest is determined by the eigenvector associated with the largest eigenvalue of the orientation data's covariance matrix. This eigenvector in the coordinate frame defined by the fiducials remains almost fixed for any rotation of the object. However, the remaining two eigenvectors vary widely and the direction along which the propagated uncertainty is the largest cannot be determined from the object's pose. Conditions that result in such a behavior and practical consequences of it are presented.

Selection of Fiducial Locations and Performance Metrics for Point-Based Rigid-Body Registration

A method is described to select the location and number of fiducials used in point-based, rigid-body registration of two coordinate frames. Two indices are introduced which are used to search for the optimum configuration of fiducials. They can be used to quickly evaluate a large number of configurations because no actual registration is involved in their calculation. Furthermore, configurations yielding small values of the indices correlate well with configurations which result in optimum registrations. Three registration performance metrics are discussed, and it is shown that optimization of different metrics leads to different selection of fiducial configurations. If an optimized configuration is selected as a starting configuration of N fiducials, the addition of extra fiducials does not significantly improve the registration in most cases. This work is based on 3D data acquired with three different instruments, each having different noise and bias characteristics.

Optimal marker placement in hadrontherapy: intelligent optimization strategies with augmented Lagrangian pattern search

PURPOSE

In high precision photon radiotherapy and in hadrontherapy, it is crucial to minimize the occurrence of geometrical deviations with respect to the treatment plan in each treatment session. To this end, point-based infrared (IR) optical tracking for patient set-up quality assessment is performed. Such tracking depends on external fiducial points placement. The main purpose of our work is to propose a new algorithm based on simulated annealing and augmented Lagrangian pattern search (SAPS), which is able to take into account prior knowledge, such as spatial constraints, during the optimization process.

MATERIAL AND METHODS

The SAPS algorithm was tested on data related to head and neck and pelvic cancer patients, and that were fitted with external surface markers for IR optical tracking applied for patient set-up preliminary correction. The integrated algorithm was tested considering optimality measures obtained with Computed Tomography (CT) images (i.e. the ratio between the so-called target registration error and fiducial registration error, TRE/FRE) and assessing the marker spatial distribution. Comparison has been performed with randomly selected marker configuration and with the GETS algorithm (Genetic Evolutionary Taboo Search), also taking into account the presence of organs at risk.

RESULTS

The results obtained with SAPS highlight improvements with respect to the other approaches: (i) TRE/FRE ratio decreases; (ii) marker distribution satisfies both marker visibility and spatial constraints. We have also investigated how the TRE/FRE ratio is influenced by the number of markers, obtaining significant TRE/FRE reduction with respect to the random configurations, when a high number of markers is used.

CONCLUSIONS

The SAPS algorithm is a valuable strategy for fiducial configuration optimization in IR optical tracking applied for patient set-up error detection and correction in radiation therapy, showing that taking into account prior knowledge is valuable in this optimization process. Further work will be focused on the computational optimization of the SAPS algorithm toward fast point-of-care applications.

Computer assisted planning of autologous fat grafting in breast

Autologous fat grafting is an emerging and promising surgical technique in regenerative medicine, and its application is quickly spreading in plastic and reconstructive surgery of the breast. However, despite the advantages of the technique, surgical complications may occur, such as implanted tissue necrosis and resorption and onset of microcalcifications. In view of the hypothesis that the uniformity of the lipoaspirate transplantation is related to graft survival and a lower probability of complications, we developed an interactive lipomodeling planning software application based on a genetic algorithm that allows automatic optimization of the uniformity of fat tissue distribution. The input dataset consists of a 3D model of the patient's thorax, created from MRI scans, on which relevant structures are segmented. The developed software was tested starting from either an automatically generated plan or an initial guess of the optimal surgical plan, and in both cases the application yielded a consistent improvement in the planned fat tissue distribution by optimizing the position of the insertion points and the direction of the insertion pathways. On the basis of the simulations performed, the use of genetic algorithms for optimization of the geometry of autologous fat transfer in the breast proved to be effective. These results will foster further activities focused on the comparison of predicted optimized geometries and those obtained in real surgical cases as a means of obtaining a deeper knowledge of the potential influence of a uniform fat tissue distribution on the quality of the surgical outcome. The presented application is also put forward as representing a noteworthy step towards the clinical application of computer assisted planning tools in breast surgery.

Fiducial optimization for minimal target registration error in image-guided neurosurgery

This paper presents new methods for the optimal selection of anatomical landmarks and optimal placement of fiducial markers in image-guided neurosurgery. These methods allow the surgeon to optimally plan fiducial marker locations on routine diagnostic images before preoperative imaging and to intraoperatively select the set of fiducial markers and anatomical landmarks that minimize the expected target registration error (TRE). The optimization relies on a novel empirical simulation-based TRE estimation method built on actual fiducial localization error (FLE) data. Our methods take the guesswork out of the registration process and can reduce localization error without additional imaging and hardware. Our clinical experiments on five patients who underwent brain surgery with a navigation system show that optimizing one marker location and the anatomical landmarks configuration reduced the TRE. The average TRE values using the usual fiducials setup and using the suggested method were 4.7 mm and 3.2 mm, respectively. We observed a maximum improvement of 4 mm. Reducing the target registration error has the potential to support safer and more accurate minimally invasive neurosurgical procedures.

Technical performance of a commercial laser surface scanning system for patient setup correction in radiotherapy

In conformal radiotherapy, careful setup of the patient and setup verification prior to irradiation is essential. The technical performance of a commercial 3D-surface imaging system (Galaxy, LAP Laser, Lüneburg, Germany) for patient setup correction was evaluated. The system reconstructs a 3D-surface model by scanning the patient with a laser line while a camera records its reflections. This surface model is then compared with a reference model and a setup correction with 6 degrees of freedom is derived. The calibration stability of the system was investigated using the daily check phantom of the manufacturer. The accuracy and reproducibility of the system were investigated with an anthropomorphic phantom by performing 1D- and 3D-shifts with and without breathing of the phantom, respectively. In addition, measurements in a healthy volunteer were performed. With a few exceptions, the day-by-day variations of the calibration were <0.5mm in LAT and LNG direction and <1.5mm in VRT direction, respectively. Besides day-by-day variations, also baseline-shifts of up to 3mm were observed. The lowest observed accuracy of the system in detecting pre-defined shifts of the rigid phantom was found in lateral direction. Here, mean deviations of -0.15 ± 0.46 mm for 1D-shifts and -0.12 ± 0.26 mm for 3D-shifts were found. For the ventilated phantom, the lowest observed accuracy was found in vertical direction with mean deviations of 1.16 ± 0.6mm for 1D-shifts and -0.45 ± 0.57 mm for 3D-shifts. In a healthy volunteer, the accuracy was lowest in longitudinal direction with 1.7 ± 1.5mm. The overall technical accuracy of the surface imaging system can be considered to be acceptable for application in fractionated radiotherapy. For special radiotherapy techniques such as SBRT, an increased accuracy might be necessary. To define the clinical role of the system, patient studies for different target locations are required.