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Real-time virtual intraoperative CT in endoscopic sinus surgery

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

Abstract

Purpose

Endoscopic sinus surgery (ESS) is typically guided under preoperative computed tomography (CT), which increasingly diverges from actual patient anatomy as the surgery progresses. Studies have reported that the revision surgery rate in ESS ranges between 28 and 47%. This paper presents a method that can update the preoperative CT in real time to improve surgical completeness in ESS.

Approach

The work presents and compares three novel methods that use instrument motion data and anatomical structures to predict surgical modifications in real time. The methods use learning techniques, such as nonparametric filtering and Gaussian process regression, to correlate surgical modifications with instrument tip positions, tip trajectories, and instrument shapes. Preoperative CT image sets are updated with modification predictions to serve as a virtual intraoperative CT.

Results

The three methods were compared in eight ESS cadaver cases, which were performed by five surgeons and included the following representative ESS operations: maxillary antrostomy, uncinectomy, anterior and posterior ethmoidectomy, and sphenoidotomy. Experimental results showed accuracy metrics that were clinically acceptable with dice similarity coefficients > 86%, with F-score > 92% and precision > 89.91% in surgical completeness evaluation. Among the three methods, the tip trajectory-based estimator had the highest precision of 96.87%.

Conclusions

This work demonstrated that virtually modified intraoperative CT scans improved the consistency between the actual surgical scene and the reference model, and could lead to improved surgical completeness in ESS. Compared to actual intraoperative CT scans, the proposed method has no impact on existing surgical protocols, does not require extra hardware, does not expose the patient to radiation, and does not lengthen time under anesthesia.

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Funding

The study was partially funded by NIH 5R21EB016122-02 and support from Clinical Research Scholars Program, Center for Clinical and Translational Research, Seattle Children’s Research Institue.

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Authors and Affiliations

  1. RoCALab, Rochester Institute of Technology, Rochester, 14623, USA

    Yangming Li

  2. Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle, 98195, USA

    Neeraja Konuthula, Ian M. Humphreys, Kris Moe & Randall Bly

  3. BioRobotics Lab, University of Washington, Seattle, 98195, USA

    Blake Hannaford

  4. Seattle Children’s Hospital, Seattle, 98105, USA

    Randall Bly

Authors
  1. Yangming Li
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  2. Neeraja Konuthula
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  3. Ian M. Humphreys
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  4. Kris Moe
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  5. Blake Hannaford
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  6. Randall Bly
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Corresponding author

Correspondence to Yangming Li.

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Conflict of interest

Dr. Randall A. Bly is co-founder and holds a financial interest of ownership equity with Wavely Diagnostics, Inc. and EigenHealth, Inc. He is a co-inventor and consultant, Spiway, LLC.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Li, Y., Konuthula, N., Humphreys, I.M. et al. Real-time virtual intraoperative CT in endoscopic sinus surgery. Int J CARS 17, 249–260 (2022). https://doi.org/10.1007/s11548-021-02536-5

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  • DOI: https://doi.org/10.1007/s11548-021-02536-5

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