Biomedical subjects

Michael Figl

Publications and source records attributed to Michael Figl.

14 recordsLinked to original sources

PubMed2006

Accuracy of treatment planning based on stereolithography in computer assisted surgery.

Three-dimensional stereolithographic models (SL models), made of solid acrylic resin derived from computed-tomography (CT) data, are an established tool for preoperative treatment planning in numerous fields of medicine. An innovative approach, combining stereolithography with computer-assisted point-to-point navigation, can support the precise surgical realization of a plan that has been defined on an SL model preoperatively. The essential prerequisites for the application of such an approach are: (1) The accuracy of the SL models (including accuracy of the CT scan and correspondence of the model with the patient's anatomy) and (2) the registration method used for the transfer of the plan from the SL model to the patient (i.e., whether the applied registration markers can be added to the SL model corresponding to the markers at the patient with an accuracy that keeps the "cumulative error" at the end of the chain of errors, in the order of the accuracy of contemporary navigation systems). In this study, we focus on these two topics: By applying image-matching techniques, we fuse the original CT data of the patient with the corresponding CT data of the scanned SL model, and measure the deviations of defined parameter (e.g., distances between anatomical points). To evaluate the registration method used for the planning transfer, we apply a point-merge algorithm, using four marker points that should be located at exactly corresponding positions at the patient and at connective bars that are added to the surface of the SL model. Again, deviations at defined anatomical structures are measured and analyzed statistically. Our results prove sufficient correspondence of the two data sets and accuracy of the registration method for routine clinical application. The evaluation of the SL model accuracy revealed an arithmetic mean of the relative deviations from 0.8% to 5.4%, with an overall mean deviation of 2.2%. Mean deviations of the investigated anatomical structures ranged from 0.8 mm to 3.2 mm. An overall mean (comprising all structures) of 2.5 mm was found. The fiducial registration error of the point-merge algorithm ranged from 1.0 mm to 1.4 mm. The evaluated chain of errors showed a mean deviation of 2.5 mm. This study verifies that preoperative planning on SL models and intraoperative transfer of this plan with computer assisted navigation is a suitable and sufficiently reliable method for clinical applications.

Algorithms↗

PubMed2005

Stability of miniature electromagnetic tracking systems.

This study aims at a comparative evaluation of two recently introduced electromagnetic tracking systems under reproducible simulated operating-room (OR) conditions: the recently launched Medtronic StealthStation, Treon-EM and the NDI Aurora. We investigate if and to what extent these systems provide improved performance and stability in the presence of surgical instruments as possible sources of distortions compared with earlier reports on electromagnetic tracking technology. To investigate possible distortions under pseudo-realistic OR conditions, a large Langenbeck hook, a dental drill with its handle and an ultrasonic (US) scanhead are fixed on a special measurement rack at variable distances from the navigation sensor. The position measurements made by the Treon-EM were least affected by the presence of the instruments. The lengths of the mean deviation vectors were 0.21 mm for the Langenbeck hook, 0.23 mm for the drill with handle and 0.56 mm for the US scanhead. The Aurora was influenced by the three sources of distortion to a higher degree. A mean deviation vector of 1.44 mm length was observed in the vicinity of the Langenbeck hook, 0.53 mm length with the drill and 2.37 mm due to the US scanhead. The maximum of the root mean squared error (RMSE) for all coordinates in the presence of the Langenbeck hook was 0.3 mm for the Treon and 2.1 mm for the Aurora; the drill caused a maximum RMSE of 0.2 mm with the Treon and 1.2 mm with the Aurora. In the presence of the US scanhead, the maximum RMSE was 1.4 mm for the Treon and 5.1 mm for the Aurora. The new generation of electromagnetic tracking systems has significantly improved compared to common systems that were available in the middle of the 1990s and has reached a high level of technical development. We conclude that, in general, both systems are suitable for routine clinical application.

Artifacts↗

PubMed2005

Wobbled splatting--a fast perspective volume rendering method for simulation of x-ray images from CT.

3D/2D registration, the automatic assignment of a global rigid-body transformation matching the coordinate systems of patient and preoperative volume scan using projection images, is an important topic in image-guided therapy and radiation oncology. A crucial part of most 3D/2D registration algorithms is the fast computation of digitally rendered radiographs (DRRs) to be compared iteratively to radiographs or portal images. Since registration is an iterative process, fast generation of DRRs-which are perspective summed voxel renderings-is desired. In this note, we present a simple and rapid method for generation of DRRs based on splat rendering. As opposed to conventional splatting, antialiasing of the resulting images is not achieved by means of computing a discrete point spread function (a so-called footprint), but by stochastic distortion of either the voxel positions in the volume scan or by the simulation of a focal spot of the x-ray tube with non-zero diameter. Our method generates slightly blurred DRRs suitable for registration purposes at framerates of approximately 10 Hz when rendering volume images with a size of 30 MB.

Algorithms↗

PubMed2005

Seven years of clinical experience with teleconsultation in craniomaxillofacial surgery.

PURPOSE: In this work the experiences from 50 telemedically supported treatments in craniomaxillofacial surgery are summarized and different setups for their technical realization are described. Furthermore, for the first time the innovative UMTS (universal mobile telecommunication system) is applied for the transmission of arthroscopic videos of the temporomandibular joint and other craniomaxillofacial structures. MATERIALS AND METHODS: The combination of computer-assisted navigation technology in augmented reality environments with telecommunication is used for execution of interactive stereotaxic teleconsultation. Furthermore, treatments without navigation are telemedically supported. This study is composed of 4 technical system configurations: 1) integrated services digital network (ISDN)-based videoconferencing without remote control of the navigation computer; 2) transmission control protocol/internet protocol (TCP/IP)-based interactive teleconsultation via bundled ISDN lines (including remote control of the navigation computer); 3) TCP/IP-based interactive teleconsultation via network; 4) combination of TCP/IP-connection and ISDN-based videoconferencing. The telemedically supported treatments are: orbitozygomatic osteotomies, positioning of the mandibular condyle in orthognathic surgery, insertion of implants, positioning of the maxilla in orthognathic surgery, distraction osteogenesis, arthroscopies of the temporomandibular joint, and operation simulations on stereolithographic models. The surgical interventions are evaluated on a 5-level system performance scale from the technical point of view. In a separate trial 20 videosequences of arthroscopies of the temporomandibular joint are transmitted via UMTS cellular phones and independently evaluated by 3 experts (ie, a total of 60 streamings) to investigate feasibility of this technology in the field of craniomaxillofacial surgery. RESULTS: In the years from 1996 to 2002 a total of 50 treatments were telemedically supported. All intraoperative applications were successfully finished; 48 of 60 UMTS transmissions were finished without any interruptions in constant quality, slight interruptions were observed in 8 tests, and a complete breakdown was observed during 4 streamings that required a restart of the transmission. Resolution was sufficient to diagnose even tiny anatomic structures inside the temporomandibular joint, but orientation was hardly recognizable. CONCLUSION: In many applications telecommunication technology can contribute to a quality improvement in cranio- and maxillofacial surgery because of the global availability of specialized knowledge. The required technical expenditure for teleconsultation crucially depends on the infrastructure that is already available at the clinic and the remote site. UMTS is a promising technology with the potential to be valuable in numerous craniomaxillofacial applications.

Arthroscopy↗

PubMed2005

Robot-assisted biopsy using computed tomography-guidance: initial results from in vitro tests.

PURPOSE: We sought to develop a robotic system for computed tomography (CT)-guided biopsy to validate the feasibility, accuracy, and efficacy of the system using phantom tests. MATERIALS AND METHODS: Ten peas (mean diameter 9.9+/-0.4 mm) embedded within a gel phantom were selected for biopsy. Once the best access was defined on CT images, the position of the phantom was recorded by an optical tracking system. Positional data about the phantom and the corresponding CT image was transferred to the robot planning system (Linux-based industrial PC equipped with video capture card). Once the appropriate position, angulation, and pitch were calculated, the robotic arm moved automatically with 7 degrees-of-freedom to the planned insertion path, aiming the needle-trajectory at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured and short cut pieces of a guidewire were pushed into the target to evaluate the deviation of the actual needle track from the target. RESULTS: In all targets, biopsy specimens (mean length 5.6+/-1.4 mm) were harvested with only 1 needle pass required. The mean deviation of the needle tip from the center of the target in the x and z axes was 1.2+/-0.9 mm and 0.6+/-0.4 mm, respectively. CONCLUSIONS: Robotic-assisted biopsies in vitro, using CT guidance, were feasible and provided high accuracy.

Biopsy↗

PubMed2005

A fully automated calibration method for an optical see-through head-mounted operating microscope with variable zoom and focus.

Ever since the development of the first applications in image-guided therapy (IGT), the use of head-mounted displays (HMDs) was considered an important extension of existing IGT technologies. Several approaches to utilizing HMDs and modified medical devices for augmented reality (AR) visualization were implemented. These approaches include video-see through systems, semitransparent mirrors, modified endoscopes, and modified operating microscopes. Common to all these devices is the fact that a precise calibration between the display and three-dimensional coordinates in the patient's frame of reference is compulsory. In optical see-through devices based on complex optical systems such as operating microscopes or operating binoculars-as in the case of the system presented in this paper-this procedure can become increasingly difficult since precise camera calibration for every focus and zoom position is required. We present a method for fully automatic calibration of the operating binocular Varioscope M5 AR for the full range of zoom and focus settings available. Our method uses a special calibration pattern, a linear guide driven by a stepping motor, and special calibration software. The overlay error in the calibration plane was found to be 0.14-0.91 mm, which is less than 1% of the field of view. Using the motorized calibration rig as presented in the paper, we were also able to assess the dynamic latency when viewing augmentation graphics on a mobile target; spatial displacement due to latency was found to be in the range of 1.1-2.8 mm maximum, the disparity between the true object and its computed overlay represented latency of 0.1 s. We conclude that the automatic calibration method presented in this paper is sufficient in terms of accuracy and time requirements for standard uses of optical see-through systems in a clinical environment.

Algorithms↗

PubMed2004

Robot-assisted biopsy using ultrasound guidance: initial results from in vitro tests.

The purpose of this study was to develop a robotic system for ultrasound (US)-guided biopsy and to validate the feasibility, accuracy and efficacy using phantom tests. Twenty peas (mean diameter 9.3+/-0.1 mm) embedded within a gel-phantom were selected for biopsy. Once the best access was defined, the position of the US transducer was recorded by an optical tracking system. Positional data of the transducer and the corresponding US image were transferred to the roboter planning system (LINUX-based industrial PC equipped with video capture card). Once the appropriate position, angulation and pitch were calculated, the robotic arm moved automatically with seven degrees-of-freedom to the planned insertion path, aiming the needle-positioning unit at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured, and the deviation of the actual needle tract from the center of the target was evaluated sonographically. In all targets, the biopsy specimen (mean length 5+/-1.2 mm) was harvested with only one needle pass required The mean deviation of the needle tip from the center of the target was 1.1+/-0.8 mm. Robotic assisted biopsies in-vitro using US-guidance were feasible and provided high accuracy.

Biopsy↗

PubMed2004

Computer-aided navigation in dental implantology: 7 years of clinical experience.

PURPOSE: This long-term study gives a review over 7 years of research, development, and routine clinical application of computer-aided navigation technology in dental implantology. Benefits and disadvantages of up-to-date technologies are discussed. MATERIALS AND METHODS: In the course of the current advancement, various hardware and software configurations are used. In the initial phase, universally applicable navigation software is adapted for implantology. Since 2001, a special software module for dental implantology is available. Preoperative planning is performed on the basis of prosthetic aspects and requirements. In clinical routine use, patient and drill positions are intraoperatively registered by means of optoelectronic tracking systems; during preclinical tests, electromagnetic trackers are also used. RESULTS: In 7 years (1995 to 2002), 55 patients with 327 dental implants were successfully positioned with computer-aided navigation technology. The mean number of implants per patient was 6 (minimum, 1; maximum, 11). No complications were observed; the preoperative planning could be exactly realized. The average expenditure of time for the preparation of a surgical intervention with navigation decreased from 2 to 3 days in the initial phase to one-half day in clinical routine use with software that is optimized for dental implantology. CONCLUSIONS: The use of computer-aided navigation technology can contribute to considerable quality improvement. Preoperative planning is exactly realized and intraoperative safety is increased, because damage to nerves or neighboring teeth can be avoided.

Computer Systems↗

PubMed2003

Computer-enhanced stereoscopic vision in a head-mounted operating binocular.

Based on the Varioscope, a commercially available head-mounted operating binocular, we have developed the Varioscope AR, a see through head-mounted display (HMD) for augmented reality visualization that seamlessly fits into the infrastructure of a surgical navigation system. We have assessed the extent to which stereoscopic visualization improves target localization in computer-aided surgery in a phantom study. In order to quantify the depth perception of a user aiming at a given target, we have designed a phantom simulating typical clinical situations in skull base surgery. Sixteen steel spheres were fixed at the base of a bony skull, and several typical craniotomies were applied. After having taken CT scans, the skull was filled with opaque jelly in order to simulate brain tissue. The positions of the spheres were registered using VISIT, a system for computer-aided surgical navigation. Then attempts were made to locate the steel spheres with a bayonet probe through the craniotomies using VISIT and the Varioscope AR as a stereoscopic display device. Localization of targets 4 mm in diameter using stereoscopic vision and additional visual cues indicating target proximity had a success rate (defined as a first-trial hit rate) of 87.5%. Using monoscopic vision and target proximity indication, the success rate was found to be 66.6%. Omission of visual hints on reaching a target yielded a success rate of 79.2% in the stereo case and 56.25% with monoscopic vision. Time requirements for localizing all 16 targets ranged from 7.5 min (stereo, with proximity cues) to 10 min (mono, without proximity cues). Navigation error is primarily governed by the accuracy of registration in the navigation system, whereas the HMD does not appear to influence localization significantly. We conclude that stereo vision is a valuable tool in augmented reality guided interventions.

Depth Perception↗

PubMed2002

Evaluation of accuracy of computer-aided intraoperative positioning of endosseous oral implants in the edentulous mandible.

The overall accuracy of a novel surgical computer-aided navigation system for placement of endosseous implants was evaluated. Five dry cadaver mandibles were scanned using high resolution computed tomography (HRCT). The position of four interforaminal dental implants was planned on the computer screen and transferred to the cadaver mandibles using VISIT, a surgical navigation software developed at the Vienna General Hospital. The specimens were HRCT-scanned again to compare the position of the implants with the preoperative plan on reformatted slices after matching of the pre- and postoperative data sets using the mutual information technique. The overall accuracy was 0.96 +/- 0.72 mm (range 0.0-3.5 mm). No perforation of the mandibular cortex or damage to the mandibular canal occurred. We conclude that computer-aided implant surgery can reach a level of accuracy where further clinical developments are feasible.

Cadaver↗

PubMed2002

Computer-enhanced stereoscopic vision in a head-mounted display for oral implant surgery.

We developed a head-mounted display (HMD) with integrated computer-generated stereoscopic projection of target structures and integrated it into visit, a specific oral implant planning and navigation software. The HMD is equipped with two miniature computer monitors that project computer-generated graphics stereoscopically into the optical path. Its position is tracked by the navigation system's optical tracker and target structures are displayed in their true position over the operation site. In order to test this system's accuracy and spatial perception of the viewer, five interforaminal implants in three dry human mandibles were planned with visit and executed using the stereoscopic projection through the HMD. The deviation between planned and achieved position of the implants was measured on corresponding computed tomography (CT) scan images recorded post-operatively. The deviation between planned and achieved implant position at the jaw crest was 0.57 +/- 0.49 mm measured from the lingual, and 0.58 +/- 0.4 mm measured from the buccal cortex. At the tip of the implants the deviation was 0.77 +/- 0.63 mm at the lingual and 0.79 +/- 0.71 mm at the buccal cortex. The mean angular deviation between planned and executed implant position was 3.55 +/- 2.07 degrees. The present in vitro experiment indicates that the concept of preoperative planning and transfer to the operative field by an HMD allows us to achieve an average precision within 1 mm (range up to 3 mm) of the implant position and within 3 degrees deviation for the implant inclination (range up to 10 degrees ). Control during the drilling procedure is significantly improved by stereoscopic vision through the HMD resulting in a more accurate inclination of the implants.

Computer Graphics↗

PubMed2002

A head-mounted operating binocular for augmented reality visualization in medicine--design and initial evaluation.

Computer-aided surgery (CAS), the intraoperative application of biomedical visualization techniques, appears to be one of the most promising fields of application for augmented reality (AR), the display of additional computer-generated graphics over a real-world scene. Typically a device such as a head-mounted display (HMD) is used for AR. However, considerable technical problems connected with AR have limited the intraoperative application of HMDs up to now. One of the difficulties in using HMDs is the requirement for a common optical focal plane for both the realworld scene and the computer-generated image, and acceptance of the HMD by the user in a surgical environment. In order to increase the clinical acceptance of AR, we have adapted the Varioscope (Life Optics, Vienna), a miniature, cost-effective head-mounted operating binocular, for AR. In this paper, we present the basic design of the modified HMD, and the method and results of an extensive laboratory study for photogrammetric calibration of the Varioscope's computer displays to a real-world scene. In a series of 16 calibrations with varying zoom factors and object distances, mean calibration error was found to be 1.24 +/- 0.38 pixels or 0.12 +/- 0.05 mm for a 640 x 480 display. Maximum error accounted for 3.33 +/- 1.04 pixels or 0.33 +/- 0.12 mm. The location of a position measurement probe of an optical tracking system was transformed to the display with an error of less than 1 mm in the real world in 56% of all cases. For the remaining cases, error was below 2 mm. We conclude that the accuracy achieved in our experiments is sufficient for a wide range of CAS applications.

Calibration↗

PubMed2002

Evaluation of a miniature electromagnetic position tracker.

The advent of miniaturized electromagnetic digitizers opens a variety of potential clinical applications for computer aided interventions using flexible instruments; endoscopes or catheters can easily be tracked within the body. With respect to the new applications, the systematic distortions induced by various materials such as closed metallic loops, wire guides, catheters, and ultrasound scan heads were systematically evaluated in this paper for a new commercial tracking system. We employed the electromagnetic tracking system Aurora (Mednetix/CH, NDI/Can); data were acquired using the serial port of a PC running SuSE Linux 7.1 (SuSE, Gmbh, Nürnberg). Objects introduced into the digitizer volume included wire loops of different diameters, wire guides, optical tracking tools, an ultrasonic (US) scan head, an endoscope with radial ultrasound scan head and various other objects used in operating rooms and interventional suites. Beyond this, we determined the influence of a C-arm fluoroscopy unit. To quantify the reliability of the system, the miniaturized sensor was mounted on a nonmetallic measurement rack while the transmitter was fixed at three different distances within the digitizer range. The tracker was shown to be more sensitive to distortions caused by materials close to the emitter (average distortion error 13.6 mm +/- 16.6 mm for wire loops positioned at a distance between 100 mm and 200 mm from the emitter). Distortions caused by materials near the sensor (distances smaller than 100 mm) are small (typical error 2.2 mm +/- 1.9 mm). The C-arm fluoroscopy unit caused considerable distortions and limits the reliability of the tracker (distortion error 18.6 mm +/- 24.9 mm). Distortions resulting from the US scan head are high at distances smaller than about 100 mm from the emitter. The distortions also increase when the scan head is positioned horizontally and close to the sensor (average error 4.1 mm +/- 1.5 mm when the scan head is positioned within a distance of 100 mm from the sensor). The distortions are slightly higher when the ultrasound machine is switched on. We also evaluated the influence of common medical instruments on distance measurements. For these measurements the average deviation from the known distance of 200 mm amounted to 3.0 mm +/- 1.5 mm (undistorted distance measurement 1.5 mm +/- 0.3 mm). The deviations also depend on the relative orientation between emitter and sensor. The results demonstrate that the miniature tracking system opens up new perspectives with regard to surgery applications where a flexible instrument is to be tracked within the body. Significant distortions caused by metallic objects only occur in the worst cases, for example, in the presence of a closed, unisiolated wire loop or a C-arm fluorescence unit close to the emitter and which can be avoided by suitable usage.

Calibration↗

PubMedDate not supplied

Measurement of volume changes after sinus floor augmentation with a phycogenic hydroxyapatite.

PURPOSE: The purpose of this study was the determination of time-dependent volumetric changes of particulate sinus inlay grafts. A mixture of phycogenic hydroxyapatite (Algipore/C-Graft) and autologous bone collected from the surgical access area was used as the grafting material. MATERIALS AND METHODS: Thirty-three sinus floor augmentations using phycogenic hydroxyapatite combined with autologous bone collected at the augmentation site and venous blood were performed on 18 patients aged 57.4 +/- 12.5 years (mean +/- SD) with severe atrophy of the posterior maxilla. Graft volume was measured 1 to 14 days postoperatively and before the placement of dental implants 6.1 +/- 2.1 months later (mean +/- SD; range, 4 to 11 months) to evaluate the amount of time-dependent resorption of the implanted material on computerized tomographic (CT) images of the augmented region. The images were put into Digital Imaging and Communications in Medicine (DICOM) format and evaluated using the software library Analyze. The implanted bone replacement material was plotted manually on each CT slice, and the volume of the implanted material was calculated. RESULTS: The average volume loss of the bone replacement material during the observation period was 13.9% +/- 1.9% (mean +/- SEM). All sinus floor augmentations healed without complications except for delayed membrane exposure in 2 cases. DISCUSSION: The results indicate that the graft material, a mixture of Algipore, bone chips from the access area, and venous blood, exhibited a small volume loss over a period of approximately 6 months, thus providing predictable height for second-stage implant surgery. CONCLUSION: Further investigations are needed to evaluate long-term stability and implant success.

Adult↗