Auditory display for fluorescence-guided open brain tumor surgery
- 319 Downloads
Protoporphyrin (PpIX) fluorescence allows discrimination of tumor and normal brain tissue during neurosurgery. A handheld fluorescence (HHF) probe can be used for spectroscopic measurement of 5-ALA-induced PpIX to enable objective detection compared to visual evaluation of fluorescence. However, current technology requires that the surgeon either views the measured values on a screen or employs an assistant to verbally relay the values. An auditory feedback system was developed and evaluated for communicating measured fluorescence intensity values directly to the surgeon.
The auditory display was programmed to map the values measured by the HHF probe to the playback of tones that represented three fluorescence intensity ranges and one error signal. Ten persons with no previous knowledge of the application took part in a laboratory evaluation. After a brief training period, participants performed measurements on a tray of 96 wells of liquid fluorescence phantom and verbally stated the perceived measurement values for each well. The latency and accuracy of the participants’ verbal responses were recorded. The long-term memorization of sound function was evaluated in a second set of 10 participants 2–3 and 7–12 days after training.
The participants identified the played tone accurately for 98% of measurements after training. The median response time to verbally identify the played tones was 2 pulses. No correlation was found between the latency and accuracy of the responses, and no significant correlation with the musical proficiency of the participants was observed on the function responses. Responses for the memory test were 100% accurate.
The employed auditory display was shown to be intuitive, easy to learn and remember, fast to recognize, and accurate in providing users with measurements of fluorescence intensity or error signal. The results of this work establish a basis for implementing and further evaluating auditory displays in clinical scenarios involving fluorescence guidance and other areas for which categorized auditory display could be useful.
KeywordsFluorescence-guided resection (FGR) Spectroscopy 5-Aminolevulinic acid (5-ALA) Protoporphyrin (PpIX) Surgical navigation Neurosurgery Human–computer interaction User interfaces Sonification LabVIEW
The authors would like to thank Johan Richter, neurosurgeon at the Department of Neurosurgery in Linköping University and the participants for feedback on the sound system.
Funding The study was supported by Swedish Childhood Cancer foundation (Grant No. MT 2013-0043), the Cancer network at Linköping University (LiU-cancer), and National Institutes of Health Grants P41 EB015902, P41 EB015898, R01EB014955, and U24CA180918.
Compliance with ethical standards
Conflict of interest
The authors state that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
Supplementary material 1 (mp4 5384 KB)
- 1.Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen H-J (2006) Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 7(5):392–401. doi: 10.1016/S1470-2045(06)70665-9 CrossRefPubMedGoogle Scholar
- 10.Voormolen E, Woerdeman P, van Stralen M, Noordmans H, Viergever M, Regli L, van der Sprenkel J (2012) Validation of exposure visualization and audible distance emission for navigated temporal bone drilling in phantoms. PLoS ONE 7(7):e41262. doi: 10.1371/journal.pone.0041262 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Bork F, Fuerst B, Schneider A, Pinto F, Graumann C, Navab N (2015) Auditory and visio-temporal distance coding for 3-dimensional perception in medical augmented reality. In: Proceedings of 2015 IEEE international symposium on mixed and augmented reality (ISMAR), pp 7–12. doi: 10.1109/ISMAR.2015.16
- 17.Wright M, Freed A, Momeni A (2003) OpenSound Control: state of the Art 2003. In: Proceedings of 2003 international conference on new interfaces for musical expression (NIME), pp 153–159Google Scholar
- 20.DuBois T (1983) Christian Friedrich Daniel Schubart’s Ideen Zu Einer sthetik Der Tonkunst: An Annotated Translation. Doctoral Dissertation, University of Southern California, Los Angeles. pp 1–33Google Scholar
- 21.Puckette M (1996) Pure data: another integrated computer music environment. In: Second intercollege computer music concerts, 1996, pp 37–41Google Scholar
- 22.Haahr M. (2016) Website, School of Computer Science and Statistics at Trinity College, Dublin. http://www.random.org/sequences/. Accessed Dec 2016
- 23.Kim A, Khurana M, Moriyama Y, Wilson B (2010) Quantification of in vivo fluorescence decoupled from the effects of tissue optical properties using fiber-optic spectroscopy measurements. J Biomed Opt 15(6):067006. doi: 10.1117/1.3523616
- 24.Aalders M, Sterenborg H, Stewart F, van der Vange N (2000) Photodetection with 5-aminolevulinic acid-induced protoporphyrin IX in the rat abdominal cavity: drug-dose-dependent fluorescence kinetics. Photochem Photobiol 72(4):521–525. doi: 10.1562/0031-8655(2000)0720521pwaaip2.0.co2 CrossRefPubMedGoogle Scholar
- 25.Stummer W, Tonn J, Goetz C, Ullrich W, Stepp H, Bink A, Pietsch T, Pichlmeier U (2014) 5-Aminolevulinic acid-derived tumor fluorescence: the diagnostic accuracy of visible fluorescence qualities as corroborated by spectrometry and histology and postoperative imaging. Neurosurgery 74(3):310–320. doi: 10.1227/NEU.0000000000000267 CrossRefPubMedGoogle Scholar
- 26.Eljamel S, Petersen M, Valentine R, Buist R, Goodman C, Moseley H, Eljamel S (2013) Comparison of intraoperative fluorescence and MRI image guided neuronavigation in malignant brain tumours, a prospective controlled study. Photodiagn Photodyn Ther 10(4):356–361. doi: 10.1016/j.pdpdt.2013.03.006 CrossRefGoogle Scholar
- 28.Parseihian G, Ystad S, Aramaki M, Kronland-Martinet R (2015) The process of sonification design for guidance tasks. J Mob Med 9(2)Google Scholar
- 33.Haj-Hosseini N, Richter J, Milos P, Hallbeck, Wårdell K (2017) Optical guidance for stereotactic brain tumor procedures—preliminary clinical evaluation. PhotonicsWestGoogle Scholar
- 34.Markwardt N, von Berg A, Fiedler S, Goets M, Haj-Hosseini N, Polzer C, Stepp H, Zelenkov P, Rühm A (2015) Optical Spectroscopy for Stereotactic Biopsy of Brain Tumors. Proc. SPIE 9542, Medical Laser Applications and Laser-Tissue Interactions VII, 954208. doi: 10.1117/12.2183741