Biomedical subjects

T A Nagelhus Hernes

Publications and source records attributed to T A Nagelhus Hernes.

7 recordsLinked to original sources

PubMed2005

Intra-operative 3D ultrasound in neurosurgery.

In recent years there has been a considerable improvement in the quality of ultrasound (US) imaging. The integration of 3D US with neuronavigation technology has created an efficient and inexpensive tool for intra-operative imaging in neurosurgery. In this review we present the technological background and an overview of the wide range of different applications. The technology has so far mostly been applied to improve surgery of tumours in brain tissue, but it has also been found to be useful in other procedures such as operations for cavernous haemangiomas, skull base tumours, syringomyelia, medulla tumours, aneurysms, AVMs and endoscopy guidance.

Brain↗

PubMed2005

Ability of navigated 3D ultrasound to delineate gliomas and metastases--comparison of image interpretations with histopathology.

BACKGROUND: The objective of the study was to test the ability of a 3D ultrasound (US) based intraoperative imaging and navigation system to delineate gliomas and metastases in a clinical setting. The 3D US data is displayed as reformatted 2D image slices. The quality of the displayed 3D data is affected both by the resolution of the acquired data and the reformatting process. In order to investigate whether or not 3D US could be used for reliable guidance in tumour surgery, a study was initiated to compare interpretations of imaged biopsy sites with histopathology. The system also enabled concomitant comparison of navigated preoperative MR with histopathology. METHOD: Eighty-five biopsies were sampled between 2-7 mm from the tumour border visible in the ultrasound images. Biopsies were collected from 28 operations (7 low-grade astrocytomas, 8 anaplastic astrocytomas, 7 glioblastomas and 6 metastases). Corresponding cross-sections of preoperative MR T1, MR T2 and intraoperative US were concomitantly displayed, steered by the biopsy forceps equipped with a positioning sensor. The surgeons' interpretation of the images at the electronically indicated biopsy sites were compared with the histopathology of the samples. FINDINGS: The ultrasound findings were in agreement with histopathology in 74% (n = 31) for low-grade astrocytomas, 83% (n = 18) for anaplastic astrocytomas, 77% (n = 26) for glioblastomas and 100% (n = 10) for metastases. Excluding irradiated patients, the results for glioblastomas improved to 80% concurrence (n = 20). As expected tumour cells were found in biopsies outside the US visible tumour border, especially in low-grade gliomas. Navigated 3D US have a significantly better agreement with histopathology than navigated MR T1 for low-grade astrocytomas. CONCLUSION: Reformatted images from 3D US volumes give a good delineation of metastases and the solid part of gliomas before starting the resection. Navigated 3D US is at least as reliable as navigated 3D MR to delineate gliomas and metastases.

Adult↗

PubMed2005

Image-guided laparoscopic surgery. Review and current status.

The main drawback with laparoscopic surgery is that the surgeon is unable to palpate vessels, tumours and organs during surgery. Further-more, the laparoscope only provides a surface view of organs. There is a need for more advanced visualizations techniques that can enhance the display presented to the surgeon so that important information below the surface of the organs is included when planning the procedure as well as for guidance and control during treatment. In this paper, we present a review of the literature and the state of art within image-guided laparoscopic surgery. We describe our own experience using a prototype navigation system for advanced visualizations and guidance during laparoscopic procedures in the retroperitoneum. Furthermore, we show sample images from the Future Operating Room for laparoscopic surgery in Trondheim, where this technology is being further developed and tested in clinical studies. Our system is based on three-dimensional navigation technology, i.e. preoperatively acquired magnetic resonance or computed tomography data used in combination with tracked instruments, allowing the surgeon to interactively control the display of images prior to and during surgery with normal use of the instruments. In summary, we believe that abdominal image navigation using tracked instruments and advanced visualizations has a large potential for improving future laparoscopic surgery, especially in cases where vessels and anatomical relations beyond surfaces is difficult to identify using only a laparoscope. The technology helps the surgeon to better understand the anatomy and locate blood vessels. Accordingly, we believe that this new technology could increase safety and make it easier for the surgeon to perform successful laparoscopic surgery.

Diagnostic Imaging↗

PubMed2004

Laparoscopic navigation pointer for three-dimensional image-guided surgery.

BACKGROUND: The main drawback with the laparoscopic approach is that the surgeon is unable to palpate vessels, tumors, and organs during surgery. Furthermore, the laparoscope provides only surface view of organs. There is a need for more advanced visualizations that can enhance the view to include information below the surface of the organs for planning of the procedure and for control and guidance during treatment. METHODS: We propose three-dimensional (3D) navigation technology based on preoperatively acquired magnetic resonance or computed tomography data used in combination with a laparoscopic navigation pointer (LNP). The LNP has an attached position tracker that allows the surgeon to control the display of images interactively before and during surgery. This study evaluated the patient registration accuracy, the feasibility of image-based navigation and, qualitatively, the navigation precision in the retroperitoneum during laparoscopic surgery. RESULTS: This technology was used during the treatment of six patients (involving adrenalectomies and a neuroma protruding into the pelvis). An average patient registration accuracy of 6.90 mm was achieved. The precision during navigation in the retroperitoneum was, in some cases, better than the patient registration accuracy suggested. The technology helped the surgeons to understand better the anatomy and to locate blood vessels. CONCLUSIONS: In the reported cases, the LNP was a useful tool for image guidance in laparoscopic surgery, both for planning the surgical approach in detail and for guidance. The authors believe that adominal 3D image guidance using an LNP has a large potential for improving laparoscopic surgery, especially when vessels and anatomic relations may be difficult to identify using only a laparoscope. Accordingly, they believe this new technology could increase safety and make it easier for the surgeon to perform successful laparoscopic surgery.

Adenoma↗

PubMed2003

3D ultrasound-based navigation for radiofrequency thermal ablation in the treatment of liver malignancies.

BACKGROUND: The aim of the study was to compare three methods for ultrasound-based guidance of a radiofrequency probe into liver tumors in a model setup. METHODS: The liver model tumors were placed inside excised calf livers, and the radiofrequency probe was guided into the center using either a new 3D navigation method or two conventional 2D methods-freehand scanning and a method based on a biopsy guide. We performed 54 experiments, measuring the physical distance (all methods) and image distance (3D method only) from the tip of the probe to the center of the tumors. RESULTS: Based on the physical measurements alone, the biopsy-based guiding performed better than both the 2D freehand and the 3D navigation method. However, the 3D image measurements showed that the tip of the probe was better positioned in the center of the model tumors for the 3D navigation method as compared to the physical measurement results for the 2D methods. CONCLUSION: Although it was easier to position the radiofrequency probe accurately using the 3D image display technique, movement of the model tumor during 3D navigation is a challenge.

Animals↗

PubMed2003

Stereoscopic navigation-controlled display of preoperative MRI and intraoperative 3D ultrasound in planning and guidance of neurosurgery: new technology for minimally invasive image-guided surgery approaches.

OBJECTIVE: This paper demonstrates a method that brings together three essential technologies for surgery planning and guidance: neuronavigation systems, 3D visualization techniques and intraoperative 3D imaging technologies. We demonstrate the practical use of an in-house interactive stereoscopic visualization module that is integrated with a 3D ultrasound based neuronavigation system. MATERIALS AND METHODS: A stereoscopy volume visualization module has been integrated with a 3D ultrasound based neuronavigation system, which also can read preoperative MR and CT data. The various stereoscopic display modalities, such as "cut plane visualization" and "interactive stereoscopic tool guidance" are controlled by a pointer, a surgical tool or an ultrasound probe. Interactive stereoscopy was tested in clinical feasibility case studies for planning and guidance of surgery procedures. RESULTS: By orientating the stereoscopic projections in accordance to the position of the patient on the operating table, it is easier to interpret complex 3D anatomy and to directly take advantage of this 3D information for planning and surgical guidance. In the clinical case studies, we experienced that the probe-controlled cut plane visualization was promising during tumor resection. By combining 2D and 3D display, interpretation of both detailed and geometric information may be achieved simultaneously. The possibilities of interactively guiding tools in a stereoscopic scene seemed to be a promising functionality for use during vascular surgery, due to specific location of certain vessels. CONCLUSION: Interactive stereoscopic visualization improves perception and enhances the ability to understand complex 3D anatomy. The practical benefit of 3D display is increased considerably when integrated with surgical navigation systems, since the orientation of the stereoscopic projection corresponds to the orientation of the patient on the operating table. Stereoscopic visualizations work well on MR and CT images, although volume rendering techniques are especially suitable for intraoperative 3D ultrasound image data.

Brain Neoplasms↗

PubMedDate not supplied

Three-dimensional ultrasound-based navigation combined with preoperative CT during abdominal interventions: a feasibility study.

PURPOSE: Three-dimensional (3D) intraoperative ultrasound may be easier to interpret when used in combination with less noisy preoperative image data such as CT. The purpose of this study was to evaluate the use of preoperative image data in a 3D ultrasound-based navigation system specially designed for minimally invasive abdominal surgery. A prototype system has been tested in patients with aortic aneurysms undergoing clinical assessment before and after abdominal aortic stent-graft implantation. METHODS: All patients were first imaged by spiral CT followed by 3D ultrasound scanning. The CT volume was registered to the patient using fiducial markers. This enabled us to compare corresponding slices from 3D ultrasound and CT volumes. The accuracy of the patient registration was evaluated both using the external fiducial markers (artificial landmarks glued on the patient's skin) and using intraoperative 3D ultrasound as a measure of the true positioning of anatomic landmarks inside the body. RESULTS: The mean registration accuracy on the surface was found to be 7.1 mm, but increased to 13.0 mm for specific landmarks inside the body. CT and ultrasound gave supplementary information of surrounding structures and position of the patient's anatomy. Fine-tuning the initial patient registration of the CT data with a multimodal CT to intraoperative 3D ultrasound registration (e.g., mutual information), as well as ensuring no movements between this registration and image guidance, may improve the registration accuracy. CONCLUSION: Preoperative CT in combination with 3D ultrasound might be helpful for guiding minimal invasive abdominal interventions.

Aortic Aneurysm, Abdominal↗