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Assessment of registration accuracy during computer-aided oncologic limb-salvage surgery

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Computer-aided surgery is used in musculoskeletal tumor procedures to improve the surgeon’s orientation to local anatomy during tumor resection. For the navigation system to function correctly, preoperative imaging (e.g., CT, MR) must be registered to the patient in the operating room. The goals of this study were (1) to directly quantify registration accuracy in computer-aided tumor surgery and (2) to validate the “system reported error” (SRE) of the navigation system.

Methods

Registration accuracy was evaluated in eight bone sarcoma cases by determining the location of the anatomical paired-points used for registration following surface matching. Coordinates of specific intraoperative post-registration points were compared with the corresponding coordinates in preoperative CT scans to determine the measurement error (ME).

Results

The mean difference between post-registration points and planned registration points was \(12.21 \pm 6.52\,\hbox {mm}\), significantly higher than the mean SRE (\(0.68 \pm 0.15\,\hbox {mm}\); \(p=0.002\); 95 % CI 6.11–16.96 mm). The SRE poorly correlated with the calculated ME (\(R^2=0.040\)). Anatomical paired-point registration with surface matching results in a substantial shift in the post-registration coordinates of the same paired-points used for registration, and this shift is not represented by the SRE.

Conclusion

The SRE of a surgical navigation system was poorly correlated with direct measurements obtained in musculoskeletal tumor surgery. Improvement in registration accuracy is needed to better navigate tumor boundaries and ensure clear margins while maximally preserving the unaffected tissues and reducing operative morbidity.

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Abbreviations

CATS:

Computer-aided tumor surgery

CT:

Computed tomography

ME:

Measurement error

MR:

Magnetic resonance

PET:

Positron emission tomography

\(R^{2}\) :

Coefficient of determination

SD:

Standard deviation

SRE:

System reported error

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Acknowledgments

We would like to thank Seattle Children’s Hospital and the American Cancer Society for supporting this study.

Conflict of interest

Kurt Stoll, Joan Miles, Jedediah White, Stephanie Punt, Ernest Conrad, and Randal Ching declare no conflict of interest regarding the publication of this paper.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Authors and Affiliations

  1. University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Kurt E. Stoll

  2. Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA

    Joan D. Miles, Jedediah K. White & Stephanie E. W. Punt

  3. Seattle Children’s Hospital, 4800 Sand Point Way NE W-7706-Orthopedics, Seattle, WA, 98105, USA

    Ernest U. Conrad III

  4. Applied Biomechanics Laboratory, University of Washington, 501 Eastlake Ave E, Suite 102, Seattle, WA, 98109, USA

    Randal P. Ching

Authors
  1. Kurt E. Stoll
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Correspondence to Kurt E. Stoll.

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Stoll, K.E., Miles, J.D., White, J.K. et al. Assessment of registration accuracy during computer-aided oncologic limb-salvage surgery. Int J CARS 10, 1469–1475 (2015). https://doi.org/10.1007/s11548-014-1146-1

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  • DOI: https://doi.org/10.1007/s11548-014-1146-1

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