Biomedical subjects

Terry M Peters

Publications and source records attributed to Terry M Peters.

At least 19 recordsLinked to original sources

PubMed2006

Segmentation of thalamic nuclei using a modified k-means clustering algorithm and high-resolution quantitative magnetic resonance imaging at 1.5 T.

Patient outcome in minimally invasive stereotactic neurosurgical procedures depends on the ability to accurately locate the desired functional region within the deep brain while avoiding the surrounding anatomy. Due to the lack of sufficient contrast within this region in pre-operatively acquired MR images, electrophysiological exploration and histological atlases are currently required to define the surgical target within the thalamus in the treatment of many motor-control disorders. In this paper we introduce a method for segmenting the individual thalamic nuclei based on high-resolution quantitative magnetic resonance images, providing improved target visualization. The method was tested using whole-brain T1 and T2 data acquired from four healthy individuals. Accuracy of the segmentation results was assessed by comparing the center-of-mass coordinates of the segmented nuclei, with coordinates obtained from a classic histological atlas registered to these images. Strong agreement was found, with an average Euclidean distance difference of less than 4.5 mm averaged across all nuclei and all individuals. Reproducibility of the method, determined by calculating the percent similarity of segmentation results derived from data acquired from repeated scan sessions, was greater than 85%. These results illustrate the ability to accurately and reliably segment the primary nuclei of the thalamus and suggest that the method may have utility in the study of individual nuclear regions in disease state as well as for planning deep-brain surgical procedures.

Adult↗

PubMed2006

Synthetic T1-weighted brain image generation with incorporated coil intensity correction using DESPOT1.

The increased use of phased-array and surface coils in magnetic resonance imaging, the push toward increased field strength and the need for standardized imaging across multiple sites during clinical trials have resulted in the need for methods that can ensure consistency of intensity both within the image and across multiple subjects/sites. Here, we describe a means of addressing these concerns through an extension of the rapid T(1) mapping technique - driven equilibrium single-pulse observation of T(1). The effectiveness of the proposed approach was evaluated using human brain T(1) maps acquired at 1.5 T with a multichannel phased-array coil. Corrected "synthetic" T(1)-weighted images were reconstructed by substituting the T(1) values back into the governing signal intensity equation while assuming a constant value for the equilibrium magnetization. To demonstrate signal normalization across a longitudinal study, we calculated synthetic T(1)-weighted images from data acquired from the same healthy subject at four different time points. Signal intensity profiles between the acquired and synthetic images were compared to determine the improvements with our proposed approach. Following correction, the images demonstrate obvious qualitative improvement with increased signal uniformity across the image. Near-perfect signal normalization was also observed across the longitudinal study, allowing direct comparison between the images. In addition, we observe an increase in contrast-to-noise ratio (compared with regular T(1)-weighted images) for synthetic images created, assuming uniform proton density throughout the volume. The proposed approach permits rapid correction for signal intensity inhomogeneity without significantly lengthening exam time or reducing image signal-to-noise ratio. This technique also provides a robust method for signal normalization, which is useful in multicenter longitudinal MR studies of disease progression, and allows the user to reconstruct T(1)-weighted images with arbitrary T(1) weighting.

Artifacts↗

PubMed2006

Image-guidance for surgical procedures.

Contemporary imaging modalities can now provide the surgeon with high quality three- and four-dimensional images depicting not only normal anatomy and pathology, but also vascularity and function. A key component of image-guided surgery (IGS) is the ability to register multi-modal pre-operative images to each other and to the patient. The other important component of IGS is the ability to track instruments in real time during the procedure and to display them as part of a realistic model of the operative volume. Stereoscopic, virtual- and augmented-reality techniques have been implemented to enhance the visualization and guidance process. For the most part, IGS relies on the assumption that the pre-operatively acquired images used to guide the surgery accurately represent the morphology of the tissue during the procedure. This assumption may not necessarily be valid, and so intra-operative real-time imaging using interventional MRI, ultrasound, video and electrophysiological recordings are often employed to ameliorate this situation. Although IGS is now in extensive routine clinical use in neurosurgery and is gaining ground in other surgical disciplines, there remain many drawbacks that must be overcome before it can be employed in more general minimally-invasive procedures. This review overviews the roots of IGS in neurosurgery, provides examples of its use outside the brain, discusses the infrastructure required for successful implementation of IGS approaches and outlines the challenges that must be overcome for IGS to advance further.

Algorithms↗

PubMed2006

High-performance medical image registration using new optimization techniques.

Optimization of a similarity metric is an essential component in intensity-based medical image registration. The increasing availability of parallel computers makes parallelizing some registration tasks an attractive option to increase speed. In this paper, two new deterministic, derivative-free, and intrinsically parallel optimization methods are adapted for image registration. DIviding RECTangles (DIRECT) is a global technique for linearly bounded problems, and multidirectional search (MDS) is a recent local method. The performance of DIRECT, MDS, and hybrid methods using a parallel implementation of Powell's method for local refinement, are compared. Experimental results demonstrate that DIRECT and MDS are robust, accurate, and substantially reduce computation time in parallel implementations.

Algorithms↗

PubMed2006

Visualization and navigation system development and application for stereotactic deep-brain neurosurgeries.

We present the development of a visualization and navigation system and its application in pre-operative planning and intra-operative guidance of stereotactic deep-brain neurosurgical procedures for the treatment of Parkinson's disease, chronic pain, and essential tremor. This system incorporates a variety of standardized functional and anatomical information, and is capable of non-rigid registration, interactive manipulation, and processing of clinical image data. The integration of a digitized and segmented brain atlas, an electrophysiological database, and collections of final surgical targets from previous patients facilitates the delineation of surgical targets and surrounding structures, as well as functional borders. We conducted studies to compare the surgical target locations identified by an experienced stereotactic neurosurgeon using multiple electrophysiological exploratory trajectories with those located by a non-expert using this system on 70 thalamotomy, pallidotomy, thalamic deep-brain stimulation (DBS), and subthalamic nucleus (STN) DBS procedures. The average displacement between the surgical target locations in both groups was 1.95 +/- 0.86 mm, 1.83 +/- 1.07 mm, 1.88 +/- 0.89 mm and 1.61 +/- 0.67 mm for each category of surgeries, respectively, indicating the potential value of our system in stereotactic deep-brain neurosurgical procedures, and demonstrating its capability for accurate surgical target initiation.

Adult↗

PubMed2005

Visualization of thalamic nuclei on high resolution, multi-averaged T1 and T2 maps acquired at 1.5 T.

The ability to differentiate noninvasively between the primary nuclear divisions of the thalamus has immediate clinical applicability for surgical planning and guidance of functional stereotactic procedures. Comparison of prior qualitative magnetic resonance imaging (MRI) studies carried out at field strengths of 1.5 and 4 Tesla have revealed contrast within the thalamus that varies with field strength, suggesting possible differences in the inherent T1 and T2 relaxation times of the constituent nuclei. We investigate this hypothesis through acquisition of high-resolution, multi-averaged deep-brain T1 and T2 maps of a healthy volunteer. Fourteen nuclei were identified using their center-of-mass coordinates (in Talairach space) and average T1 and T2 values obtained from regions of interest placed within each. Results from this analysis revealed significant differences in T1 and T2 between the nuclei with a T1 range from 700 to 1,400 ms and a T2 range from 89 to 122 ms, allowing visual discrimination between the major nuclei groups. Furthermore, the high-resolution images showed distinct borders of T1 and T2 hypointensity surrounding each nucleus, revealing structure not reported previously. These results confirm our hypothesis and demonstrate the potential high-resolution quantitative imaging for nucleus visualization and surgical planning.

Brain Mapping↗

PubMed2005

High-resolution T1 and T2 mapping of the brain in a clinically acceptable time with DESPOT1 and DESPOT2.

Variations in the intrinsic T(1) and T(2) relaxation times have been implicated in numerous neurologic conditions. Unfortunately, the low resolution and long imaging time associated with conventional methods have prevented T(1) and T(2) mapping from becoming part of routine clinical evaluation. In this study, the clinical applicability of the DESPOT1 and DESPOT2 imaging methods for high-resolution, whole-brain, T(1) and T(2) mapping was investigated. In vivo, 1-mm(3) isotropic whole-brain T(1) and T(2) maps of six healthy volunteers were acquired at 1.5 T with an imaging time of <17 min each. Isotropic maps (0.34 mm(3)) of one volunteer were also acquired (time <21 min). Average signal-to-noise within the 1-mm(3) T(1) and T(2) maps was approximately 20 and approximately 14, respectively, with average repeatability standard deviations of 46.7 ms and 6.7 ms. These results demonstrate the clinical feasibility of the methods in the study of neurologic disease.

Brain↗

PubMed2005

Development and application of functional databases for planning deep-brain neurosurgical procedures.

This work presents the development and application of a visualization and navigation system for planning deep-brain neurosurgeries. This system, which incorporates a digitized and segmented brain atlas, an electrophysiological database, and collections of final surgical targets of previous patients, provides assistance for non-rigid registration, navigation, and reconstruction of clinical image data. The fusion of standardized anatomical and functional data, once registered to individual patient images, facilitates the delineation of surgical targets. Our preliminary studies compared the target locations identified by a non-expert using this system with those located by an experienced neurosurgeon using regular technique on 8 patients who had undergone subthalamic nucleus (STN) deep-brain stimulations (DBS). The average displacement between the surgical target locations in both groups was 0.58 mm +/- 0.49 mm, 0.70 mm +/- 0.37 mm, and 0.69 mm +/- 0.34 mm in x, y, and z directions respectively, indicating the capability of accurate surgical target initiation of our system, which has also shown promise in planning and guidance for other stereotactic deep-brain neurosurgical procedures.

Artificial Intelligence↗

PubMed2005

Dynamic 3D ultrasound and MR image registration of the beating heart.

Real-time three-dimensional ultrasound (RT3D US) is an ideal imaging modality for the diagnosis of cardiac disease. RT3D US is a flexible, inexpensive, non-invasive tool that provides important diagnostic information related to cardiac function. Unfortunately, RT3D US suffers from inherent shortcomings, such as low signal-to-noise ratio and limited field of view, producing images that are difficult to interpret. Multi-modal dynamic cardiac image registration is a well-recognized approach that compensates for these deficiencies while retaining the advantages of RT3D US imaging. The clinical application of multi-modal image registration methods is difficult, and there are a number of implementation issues to be resolved. In this work, we present a method for the rapid registration of RT3D US images of the beating heart to high-resolution magnetic resonance (MR) images. This method was validated using a volunteer image set. Validation results demonstrate that this approach can achieve rapid registration of images of the beating heart with fiducial landmark and registration errors of 1.25 +/- 0.63 and 1.76 mm respectively. This technique can potentially be used to improve the diagnosis of cardiac disease by augmenting RT3D US images with high-resolution MR images and to facilitate intra-operative image fusion for minimally invasive cardio-thoracic surgical navigation.

Algorithms↗

PubMed2005

En bloc exclusion of the pulmonary vein region in the pig using off pump, beating, intra-cardiac surgery: a pilot study of minimally invasive surgery for atrial fibrillation.

BACKGROUND: Off-pump, closed, beating heart, minimally-invasive surgery in patients with lone atrial fibrillation (AF) must be effective to become the preferred alternative to catheter ablation. Because of the inherent anatomical limitations of the epicardial access, we explored the feasibility of an intracardiac approach. METHODS: We report an acute study of en bloc, cryo-exclusion of the pulmonary vein region in 7 pigs. The left atrial appendage (LAA) was approached via a left thoracotomy. Electrodes were attached to the posterior wall of the left atrium (LPA) and right atrial appendage (RAA) for pacing and electrophysiological monitoring. A modified Surgifrost probe was introduced via the LAA and positioned using transesophageal (TEE) and intracardiac (ICE) echocardiographic guidance to generate encircling cryolesions (3 minutes, -105 degrees C) of the pulmonary vein region. RESULTS: A complete two-way block was achieved in 6 pigs and an incomplete block in 1. The excluded segment had very slow idiosyncratic rhythm or was electrically silent. In all pigs before isolation, sustained AF was inducible with the most rapid rhythms and fractionated electrograms recorded from the LA. While sustained AF was induced before exclusion, it was not after isolation in either the exclude or non-excluded segments. All tissue samples taken along the encircling cryolesions had transmural cryolesions on pathological examination. CONCLUSIONS: We conclude that off-pump, closed heart, beating, intracardiac AF surgery is feasible, reliable and can duplicate the accuracy and precision of the open-heart approach. However, further developments are needed to make this novel approach an alternative to current approaches for catheter ablation.

Animals↗

PubMed2005

A real time finite element based tissue simulation method incorporating nonlinear elastic behavior.

This paper presents a new finite element simulation approach for surgical simulators. Based on the solution of the algebraic equations derived from a nonlinear elastic model, we propose a real time simulation rule based on the implicit relation between the displacements of contacted and free nodes. This rule is an analytic expression in the linear case, and an approximation of the implicit relation in the non-linear case. We also remove some of the restrictions on flexibility exhibited by previous linear and nonlinear approaches. In the linear case, real time reconfiguration of the contacted nodes and the boundary constraints is realized using the simulation rule, while in the nonlinear case, a similar result is obtained by employing affine mapping. These methods allow nonlinear material properties to be applied to real time tissue simulation, with an efficiency comparable to that of the tensor matrix method for linear elastic models.

Biomechanical Phenomena↗

PubMed2005

Real-time fusion of endoscopic views with dynamic 3-D cardiac images: a phantom study.

Minimally invasive robotically assisted cardiac surgical systems currently do not routinely employ 3-D image guidance. However, preoperative magnetic resonance and computed tomography (CT) images have the potential to be used in this role, if appropriately registered with the patient anatomy and animated synchronously with the motion of the actual heart. This paper discusses the fusion of optical images of a beating heart phantom obtained from an optically tracked endoscope, with volumetric images of the phantom created from a dynamic CT dataset. High quality preoperative dynamic CT images are created by first extracting the motion parameters of the heart from the series of temporal frames, and then applying this information to animate a high-quality heart image acquired at end systole. Temporal synchronization of the endoscopic and CT model is achieved by selecting the appropriate CT image from the dynamic set, based on an electrocardiographic trigger signal. The spatial error between the optical and virtual images is 1.4 +/- 1.1 mm, while the time discrepancy is typically 50-100 ms. Index Terms-Image guidance, image warping, minimally invasive cardiac surgery, virtual endoscopy, virtual reality.

Algorithms↗

PubMed2005

Enhanced pre-computed finite element models for surgical simulation.

Soft tissue modeling is an important component in effective surgical simulation systems. A pre-computed finite element method based on elastic models is well suited to modeling soft tissue deformation. This paper addresses two principal issues: the flexibility of the pre-computed FE method and the approximation approach to non-linear elastic models. We describe a dynamic mechanism of the reconfiguration of the contacted nodes and the fixed boundary, without re-computing the inverse of the global stiffness matrix. The flexibility of the pre-computed models is described for both linear and non-linear elastic models.

Canada↗

PubMed2004

Determination of optimal angles for variable nutation proton magnetic spin-lattice, T1, and spin-spin, T2, relaxation times measurement.

T1 and T2 can be rapidly determined with a combination of multiangle spoiled gradient recalled echo (SPGR) and steady-state free precession (SSFP) imaging. Previously, we demonstrated a simple method for determining the set of SPGR and SSFP angles that provided greater T1 and T2 precision than a set of uniformly spaced angles. In this article a more rigorous approach for determining angles is described. Weighted least-squares is also introduced for T1 and T2 estimation and a novel weighting function described. This new approach, suited for imaging applications where large T1 and T2 ranges are anticipated, provides high and uniform precision over a wide range of T1 and T2 values.

Algorithms↗

PubMed2004

Quantitative diffusion imaging with steady-state free precession.

The addition of a single, unbalanced diffusion gradient to the steady-state free precession (SSFP) imaging sequence sensitizes the resulting signal to free diffusion. Unfortunately, the confounding influence of both longitudinal (T1) and transverse (T2) relaxation on the diffusion-weighted SSFP (dwSSFP) signal has made it difficult to quantitatively determine the apparent diffusion coefficient (ADC). Here, a multistep method in which the T1, T2, and spin density (Mo) constants are first determined using a rapid mapping technique described previously is presented. Quantitative ADC can then be determined through a novel inversion of the appropriate signal model. The accuracy and precision of our proposed method (which we term DESPOD) was determined by comparing resulting ADC values from phantoms to those calculated from traditional diffusion-weighted echo planar imaging (dwEPI) images. Error within the DESPOD-derived ADC maps was found to be less than 3%, with good precision over a biologically relevant range of ADC values.

Algorithms↗

PubMed2004

Rapid T2 estimation with phase-cycled variable nutation steady-state free precession.

Variable nutation SSFP (DESPOT2) permits rapid, high-resolution determination of the transverse (T2) relaxation constant. A limitation of DESPOT2, however, is the presence of T2 voids due to off-resonance banding artifacts associated with SSFP images. These artifacts typically occur in images acquired with long repetition times (TR) in the presence of B0 inhomogeneities, or near areas of magnetic susceptibility difference, such that the transverse magnetization experiences a net phase shift during the TR interval. This places constraints on the maximum spatial resolution that can be achieved without artifact. Here, a novel implementation of DESPOT2 is presented incorporating RF phase-cycling which acts to shift the spatial location of the bands, allowing reconstruction of a single, reduced artifact-image. The method is demonstrated in vivo with the acquisition of a 0.34 mm3 isotropic resolution T2 map of the brain with high precision and accuracy and significantly reduced artifact.

Brain↗

PubMed2003

Rapid combined T1 and T2 mapping using gradient recalled acquisition in the steady state.

A novel, fully 3D, high-resolution T(1) and T(2) relaxation time mapping method is presented. The method is based on steady-state imaging with T(1) and T(2) information derived from either spoiling or fully refocusing the transverse magnetization following each excitation pulse. T(1) is extracted from a pair of spoiled gradient recalled echo (SPGR) images acquired at optimized flip angles. This T(1) information is combined with two refocused steady-state free precession (SSFP) images to determine T(2). T(1) and T(2) accuracy was evaluated against inversion recovery (IR) and spin-echo (SE) results, respectively. Error within the T(1) and T(2) maps, determined from both phantom and in vivo measurements, is approximately 7% for T(1) between 300 and 2000 ms and 7% for T(2) between 30 and 150 ms. The efficiency of the method, defined as the signal-to-noise ratio (SNR) of the final map per voxel volume per square root scan time, was evaluated against alternative mapping methods. With an efficiency of three times that of multipoint IR and three times that of multiecho SE, our combined approach represents the most efficient of those examined. Acquisition time for a whole brain T(1) map (25 x 25 x 10 cm) is less than 8 min with 1 mm(3) isotropic voxels. An additional 7 min is required for an identically sized T(2) map and postprocessing time is less than 1 min on a 1 GHz PIII PC. The method therefore permits real-time clinical acquisition and display of whole brain T(1) and T(2) maps for the first time.

Analysis of Variance↗

PubMed2003

Three-dimensional database of subcortical electrophysiology for image-guided stereotactic functional neurosurgery.

We present a method of constructing a database of intraoperatively observed human subcortical electrophysiology. In this approach, patient electrophysiological data are standardized using a multiparameter coding system, annotated to their respective magnetic resonance images (MRIs), and nonlinearly registered to a high-resolution MRI reference brain. Once registered, we are able to demonstrate clustering of like interpatient physiologic responses within the thalamus, globus pallidus, subthalamic nucleus, and adjacent structures. These data may in turn be registered to a three-dimensional patient MRI within our image-guided visualization program enabling prior to surgery the delineation of surgical targets, anatomy with high probability of containing specific cell types, and functional borders. The functional data were obtained from 88 patients (106 procedures) via microelectrode recording and electrical stimulation performed during stereotactic neurosurgery at the London Health Sciences Centre. Advantages of this method include the use of nonlinear registration to accommodate for interpatient anatomical variability and the avoidance of digitized versions of printed atlases of anatomy as a common database coordinate system. The resulting database is expandable, easily searched using a graphical user interface, and provides a visual representation of functional organization within the deep brain.

Brain↗