Keno März

Surgical data science for next-generation interventions

Interventional healthcare will evolve from an artisanal craft based on the individual experiences, preferences and traditions of physicians into a discipline that relies on objective decision-making on the basis of large-scale data from heterogeneous sources.Lena Maier-Hein, Swaroop Vedula, Stefanie Speidel, Nassir Navab, Ron Kikinis, Adrian Park, Matthias Eisenmann, Hubertus Feussner, Germain Forestier, Stamatia Giannarou, Makoto Hashizume, Darko Katic, Hannes Kenngott, Michael Kranzfelder, Anand Malpani, Keno März, Thomas Neumuth, Nicolas Padoy, Carla Pugh, Nicolai Schoch, Danail Stoyanov, Russell Taylor, Martin Wagner, Gregory D. Hager, Pierre Jannin

Toward knowledge-based liver surgery: holistic information processing for surgical decision support

PurposeMalignant neoplasms of the liver are among the most frequent cancers worldwide. Given the diversity of options for liver cancer therapy, the choice of treatment depends on various parameters including patient condition, tumor size and location, liver function, and previous interventions. To address this issue, we present the first approach to treatment strategy planning based on holistic processing of patient-individual data, practical knowledge (i.e., case knowledge), and factual knowledge (e.g., clinical guidelines and studies).MethodsThe contributions of this paper are as follows: (1) a formalized dynamic patient model that incorporates all the heterogeneous data acquired for a specific patient in the whole course of disease treatment; (2) a concept for formalizing factual knowledge; and (3) a technical infrastructure that enables storing, accessing, and processing of heterogeneous data to support clinical decision making.ResultsOur patient model, which currently covers 602 patient-individual parameters, was successfully instantiated for 184 patients. It was sufficiently comprehensive to serve as the basis for the formalization of a total of 72 rules extracted from studies on patients with colorectal liver metastases or hepatocellular carcinoma. For a subset of 70 patients with these diagnoses, the system derived an average of

Towards an open-source semantic data infrastructure for integrating clinical and scientific data in cognition-guided surgery

37 \pm 15

Navigated marker placement for motion compensation in radiotherapy

37±15 assertions per patient.ConclusionThe proposed concept paves the way for holistic treatment strategy planning by enabling joint storing and processing of heterogeneous data from various information sources.

Combined modality for ultrasound imaging and electromagnetic tracking

Needle insertions are an elementary tool for diagnostic and therapeutic purposes. Critical success factors are: Precise needle placement, avoidance of critical structures and short intervention time. Navigation solutions for ultrasound-based needle insertions have been presented but did not find widespread clinical application. This can be attributed to the complexity and higher costs introduced by additional tracking related equipment. Using a new compact electromagnetic (EM) field generator (FG), we present the first navigated intervention method that combines field generator and ultrasound (US) probe into a single mobile imaging modality that enables tracking of needle and patient. In a phantom study, we applied the system for navigated needle insertion and achieving a hit rate of 92% and a mean accuracy of 3.1mm (n=24). These results demonstrate the potential of the new combined modality in facilitating US-guided needle insertion.

MITK-US: Echtzeitverarbeitung von Ultraschallbildern in MITK

In the surgical domain, individual clinical experience, which is derived in large part from past clinical cases, plays an important role in the treatment decision process. Simultaneously the surgeon has to keep track of a large amount of clinical data, emerging from a number of heterogeneous systems during all phases of surgical treatment. This is complemented with the constantly growing knowledge derived from clinical studies and literature. To recall this vast amount of information at the right moment poses a growing challenge that should be supported by adequate technology. While many tools and projects aim at sharing or integrating data from various sources or even provide knowledge-based decision support - to our knowledge - no concept has been proposed that addresses the entire surgical pathway by accessing the entire information in order to provide context-aware cognitive assistance. Therefore a semantic representation and central storage of data and knowledge is a fundamental requirement. We present a semantic data infrastructure for integrating heterogeneous surgical data sources based on a common knowledge representation. A combination of the Extensible Neuroimaging Archive Toolkit (XNAT) with semantic web technologies, standardized interfaces and a common application platform enables applications to access and semantically annotate data, perform semantic reasoning and eventually create individual context-aware surgical assistance. The infrastructure meets the requirements of a cognitive surgical assistant system and has been successfully applied in various use cases. The system is based completely on free technologies and is available to the community as an open-source package.

Navigierte ultraschallgeführte Leberpunktion mit integriertem EM Feldgenerator

Visualization of anatomical data for disease diagnosis, surgical planning, or orientation during interventional therapy is an integral part of modern health care. However, as anatomical information is typically shown on monitors provided by a radiological work station, the physician has to mentally transfer internal structures shown on the screen to the patient. To address this issue, we recently presented a new approach to on-patient visualization of 3D medical images, which combines the concept of augmented reality (AR) with an intuitive interaction scheme. Our method requires mounting a range imaging device, such as a Time-of-Flight (ToF) camera, to a portable display (e.g. a tablet PC). During the visualization process, the pose of the camera and thus the viewing direction of the user is continuously determined with a surface matching algorithm. By moving the device along the body of the patient, the physician is given the impression of looking directly into the human body. In this paper, we present and evaluate a new method for camera pose estimation based on an anisotropic trimmed variant of the well-known iterative closest point (ICP) algorithm. According to in-silico and in-vivo experiments performed with computed tomography (CT) and ToF data of human faces, knees and abdomens, our new method is better suited for surface registration with ToF data than the established trimmed variant of the ICP, reducing the target registration error (TRE) by more than 60%. The TRE obtained (approx. 4-5 mm) is promising for AR visualization, but clinical applications require maximization of robustness and run-time.

Electromagnetic tracking for US-guided interventions: standardized assessment of a new compact field generator

Radiotherapy is frequently used to treat unoperated or partially resected tumors. Tumor movement, e.g. caused by respiration, is a major challenge in this context. Markers can be implanted around the tumor prior to radiation therapy for accurate tracking of tumor movement. However, accurate placement of these markers while keeping a secure margin around the target and while taking into account critical structures is a difficult task. Computer-assisted needle insertion has been an active field of research in the past decades. However, the challenge of navigated marker placement for motion compensated radiotherapy has not yet been addressed. This work presents a system to support marker implantation for radiotherapy under consideration of safety margins and optimal marker configuration. It is designed to allow placement of markers both percutaneously and during an open liver surgery. To this end, we adapted the previously proposed EchoTrack system which integrates ultrasound (US) imaging and electromagnetic (EM) tracking in a single mobile modality. The potential of our new marker insertion concept was evaluated in a phantom study by inserting sets of three markers around dedicated targets (n=22) simultaneously spacing the markers evenly around the target as well as placing the markers in a defined distance to the target. In all cases the markers were successfully placed in a configuration fulfilling the predefined criteria. This includes a minimum distance of 18.9 ± 2.4 mm between marker and tumor as well as a divergence of 2.1 ± 1.5 mm from the planned marker positions. We conclude that our system has high potential to facilitate the placement of markers in suitable configurations for surgeons without extensive experience in needle punctions as high quality configurations were obtained even by medical non-experts.