Ingmar Gergel

Standardized assessment of new electromagnetic field generators in an interventional radiology setting.

PURPOSE Two of the main challenges associated with electromagnetic (EM) tracking in computer-assisted interventions (CAIs) are (1) the compensation of systematic distance errors arising from the influence of metal near the field generator (FG) or the tracked sensor and (2) the optimized setup of the FG to maximize tracking accuracy in the area of interest. Recently, two new FGs addressing these issues were proposed for the well-established Aurora(®) tracking system [Northern Digital, Inc. (NDI), Waterloo, Canada]: the Tabletop 50-70 FG, a planar transmitter with a built-in shield that compensates for metal distortions emanating from treatment tables, and the prototypical Compact FG 7-10, a mobile generator designed to be attached to mobile imaging devices. The purpose of this paper was to assess the accuracy and precision of these new FGs in an interventional radiology setting. METHODS A standardized assessment protocol, which uses a precisely machined base plate to measure relative error in position and orientation, was applied to the two new FGs as well as to the well-established standard Aurora(®) Planar FG. The experiments were performed in two different settings: a reference laboratory environment and a computed tomography (CT) scanning room. In each setting, the protocol was applied to three different poses of the measurement plate within the tracking volume of the three FGs. RESULTS The two new FGs provided higher precision and accuracy within their respective measurement volumes as well as higher robustness with respect to the CT scanner compared to the established FG. Considering all possible 5 cm distances on the grid, the error of the Planar FG was increased by a factor of 5.94 in the clinical environment (4.4 mm) in comparison to the error in the laboratory environment (0.8 mm). In contrast, the mean values for the two new FGs were all below 1 mm with an increase in the error by factors of only 2.94 (Reference: 0.3 mm; CT: 0.9 mm) and 1.04 (both: 0.5 mm) in the case of the Tabletop FG and the Compact FG, respectively. CONCLUSIONS Due to their high accuracy and robustness, the Tabletop FG and the Compact FG could eliminate the need for compensation of EM field distortions in certain CT-guided interventions.

Particle filtering for respiratory motion compensation during navigated bronchoscopy

Although the field of a navigated bronchoscopy gains increasing attention in the literature, robust guidance in the presence of respiratory motion and electromagnetic noise remains challenging. The robustness of a previously introduced motion compensation approach was increased by taking into account the already traveled trajectory of the instrument within the lung. To evaluate the performance of the method a virtual environment, which accounts for respiratory motion and electromagnetic noise was used. The simulation is based on a deformation field computed from human computed tomography data. According to the results, the proposed method outperforms the original method and is suitable for lung motion compensation during electromagnetically guided interventions.

An electromagnetic navigation system for transbronchial interventions with a novel approach to respiratory motion compensation

PURPOSE Bronchoscopic interventions, such as transbronchial needle aspiration (TBNA), are commonly performed procedures to diagnose and stage lung cancer. However, due to the complex structure of the lung, one of the main challenges is to find the exact position to perform a biopsy and to actually hit the biopsy target (e.g., a lesion). Today, most interventions are accompanied by fluoroscopy to verify the position of the biopsy instrument, which means additional radiation exposure for the patient and the medical staff. Furthermore, the diagnostic yield of TBNA is particularly low for peripheral lesions. METHODS To overcome these problems the authors developed an image-guided, electromagnetic navigation system for transbronchial interventions. The system provides real time positioning information for the bronchoscope and a transbronchial biopsy instrument with only one preoperatively acquired computed tomography image. A twofold respiratory motion compensation method based on a particle filtering approach allows for guidance through the entire respiratory cycle. In order to evaluate our system, 18 transbronchial interventions were performed in seven ventilated swine lungs using a thorax phantom. RESULTS All tracked bronchoscope positions were corrected to the inside of the tracheobronchial tree and 80.2% matched the correct bronchus. During regular respiratory motion, the mean overall targeting error for bronchoscope tracking and TBNA needle tracking was with compensation on 10.4 ± 1.7 and 10.8 ± 3.0 mm, compared to 14.4 ± 1.9 and 13.3 ± 2.7 mm with compensation off. The mean fiducial registration error (FRE) was 4.2 ± 1.1 mm. CONCLUSIONS The navigation system with the proposed respiratory motion compensation method allows for real time guidance during bronchoscopic interventions, and thus could increase the diagnostic yield of transbronchial biopsy.

Simplified development of image-guided therapy software with MITK-IGT

Due to rapid developments in the research areas of medical imaging, medical image processing and robotics, computer assistance is no longer restricted to diagnostics and surgical planning but has been expanded to surgical and radiological interventions. From a software engineering point of view, the systems for image-guided therapy (IGT) are highly complex. To address this issue, we presented an open source extension to the well-known Medical Imaging Interaction Toolkit (MITK) for developing IGT systems, called MITK-IGT. The contribution of this paper is two-fold: Firstly, we extended MITK-IGT such that it (1) facilitates the handling of navigation tools, (2) provides reusable graphical user interface (UI) components, and (3) features standardized exception handling. Secondly, we developed a software prototype for computer-assisted needle insertions, using the new features, and tested it with a new Tabletop field generator (FG) for the electromagnetic tracking system NDI Aurora ®. To our knowledge, we are the first to have integrated this new FG into a complete navigation system and have conducted tests under clinical conditions. In conclusion, we enabled simplified development of imageguided therapy software and demonstrated the utilizability of applications developed with MITK-IGT in the clinical workflow.

Real-time motion compensation for EM bronchoscope tracking with smooth output - ex-vivo validation

Navigated bronchoscopy provides benefits for endoscopists and patients, but accurate tracking information is needed. We present a novel real-time approach for bronchoscope tracking combining electromagnetic (EM) tracking, airway segmentation, and a continuous model of output. We augment a previously published approach by including segmentation information in the tracking optimization instead of image similarity. Thus, the new approach is feasible in real-time. Since the true bronchoscope trajectory is continuous, the output is modeled using splines and the control points are optimized with respect to displacement from EM tracking measurements and spatial relation to segmented airways. Accuracy of the proposed method and its components is evaluated on a ventilated porcine ex-vivo lung with respect to ground truth data acquired from a human expert. We demonstrate the robustness of the output of the proposed method against added artificial noise in the input data. Smoothness in terms of inter-frame distance is shown to remain below 2 mm, even when up to 5 mm of Gaussian noise are added to the input. The approach is shown to be easily extensible to include other measures like image similarity.

A novel fully automatic system for the evaluation of electromagnetic tracker

Electromagnetic tracking (EMT) systems are gaining increased attention in various fields of image-guided surgery. One of the main problems related to EMT systems is their vulnerability to distortion due to metallic objects. Several methods have been introduced to evaluate electromagnetic trackers, yet, the data acquisition has to be manually performed in a time consuming procedure, which often leads to a sparse volume coverage. The aim of this work is to present a fully automatic calibration system. It consists of a novel, parallel robotic arm and has the potential to collect a very large number of tracking data while scanning the entire tracking volume of a field generator. To prove the feasibility of our system, we evaluate two electromagnetic field generators (NDI Planar and Tabletop) in an ideal metal-free environment and in a clinical setup. Our proposed calibration robot successfully performed throughout the experiments and examined 1,000 positions in the tracking volume of each field generator (FG). According to the results both FGs are highly accurate in an ideal environment. However, in the examined clinical setup, the Planar FG is strongly distorted by metallic objects. Whereas the Tabletop FG provided very robust and accurate tracking, even if metallic objects where lying directly underneath the FG.

MITK-OpenCL: Eine Erweiterung für das Medical Imaging Interaction Toolkit

Die moderne medizinische Bildgebung ermoglicht immer detailliertere Daten, deren Weiterverarbeitung sich um so zeitaufwendiger gestaltet. Von der Medizin werden jedoch immer schnellere Bildverarbeitungsalgorithmen gefordert. Um diese Forderung zu erfullen, mussen alle zur Verfugung stehenden Ressourcen genutzt werden. Die Grafikkarte ist eine dieser verfugbaren Ressourcen und kann fur die Parallelisierung von Bildverarbeitungsalgorithmen herangezogen werden. Damit die Bildverarbeitungsprozesse unkompliziert auf die Graphikkarte ausgelagert und parallel berechnet werden konnen, wird in diesem Beitrag eine Hardware-unabhangige Erweiterung des Medical Imaging Interaction Toolkit vorgestellt. Die Ergebnisse zeigen eine wesentliche Beschleunigung der Algorithmen auf der Grafikkarte.

Evaluation of electromagnetically tracked transbronchial needle aspiration in a ventilated porcine lung

Transbronchial needle aspiration (TBNA) is a common procedure to collect tissue samples from the inside of the lung for diagnostic use. However, the main drawback of the procedure is that it has to be blindly performed because the biopsy target region is behind the bronchial wall and hence not within the field of view of the bronchoscope. Thus, the diagnostic yield rate is low. To increase success rate of TBNA biopsy an electromagnetic trackable TBNA needle has been introduced. Nevertheless, the introduced prototype TBNA instrument was evaluated in a rigid rubber phantom without taking respiratory motion into account. The purpose of this study is to present a new TBNA needle where the electromagnetic sensor is directly integrated into a TBNA needle and to access its performance in a regularly ventilated lung. Using our previously presented navigation system, seven TBNA interventions were performed in a porcine lung during regular respiration lung movement; respectively a control computer tomography scan was acquired. We evaluated tracking accuracy of the electromagnetically tracked needle during the entire respiratory cycle for each intervention. The newly developed TBNA needle successfully operated throughout all seven interventions. According to the results, our electromagnetic TBNA tracking system is a promising approach to increase the TBNA biopsy success rate.

MITK-IGT: Eine Navigationskomponente für das Medical Imaging Interaction Toolkit

MITK-IGT ist eine Erweiterung des Medical Imaging Interaction Toolkits, die es ermoglicht Softwareprogramme im Bereich bildgestutzte Therapie zu erstellen. Dieser Beitrag stellt die Architektur und Designprinzipien von MITK-IGT vor und vergleicht sie mit anderen Open Source Losungen. Neben der Ansteuerung von Trackingsystemen und Visualisierungsmodulen liegt der Fokus von MITK-IGT auf einer Filterarchitektur, die das schrittweise Verarbeiten von Trackingdaten erlaubt. Zur BVM 2009 wird die erste Version von MITK-IGT als Open Source veroffentlicht.

In vitro Evaluation einer neuartigen elektromagnetischen Aspirationsnadel

Ziel dieser Arbeit ist es eine neuartige Aspirationsnadel mit integriertem elektromagnetischen Sensor vorzustellen und bezuglich ihrer Zuverlassigkeit und Genauigkeit zu evaluieren. Hierfur wurde ein Navigationssystem bestehend aus virtueller Bronchoskopie und Echtzeit Positionsangabe der Nadel entwickelt und in einer beatmeten Schweinelunge untersucht. Es wurden sieben Punktionsversuche wahrend normaler Atembewegung durchgefuhrt und die Genauigkeit des Navigationssystems fur jeden Versuch evaluiert. Den Ergebnissen zufolge ist das vorgestellte Navigationssystem performant und stellt einen vielversprechenden Ansatz dar um die Trefferrate von transbronchialen Biopsien zu erhohen.