The accuracy of image-based safety analysis for robotic cochlear implantation
- 229 Downloads
To evaluate the accuracy and reliability of image-based safety analysis for robotic cochlear implantation (RCI) in an ex vivo assessment.
The accuracy was evaluated in a study on 23 human temporal bones. For image analysis, a computer-assisted safety analysis based on intraoperative cone beam computed tomography was implemented. The method automatically segments the drill tunnel and predicts the distance between the tunnel and the facial nerve. In addition, the drilling error at the target is predicted. The predicted distances were compared with the actually drilled distances measured in postoperative high-resolution micro-computed tomography scans. The automatic method was compared to accuracies associated with a manual analysis of the image data.
The presented computerized image-based analysis enabled the proximity of the facial nerve to the drill trajectory to be predicted with an accuracy of 0.22 ± 0.15 mm and drilling error at the target to be predicted with an accuracy of 0.11 mm ± 0.08 during N = 19 RCI procedures. The manual assessment of facial nerve proximity was performed with an accuracy of 0.34 ± 0.20 mm by a trained clinical expert.
The assessment of intraoperative CT-based imaging presents multiple benefits over alternative safety mechanisms including early detection and applicability even in cases of malformation of the mastoid. This work presents a computer-assisted approach to image analysis that enables procedure safety measurements to be reliably performed with superior accuracy to other proposed safety methodologies, at a safe distance from the facial nerve. Its application must, however, be considered in relation to associated costs (time, cost, irradiation) and the dependence of the measure on a reliable preoperative segmentation.
KeywordsRobotic cochlear implantation Intraoperative imaging Safety mechanism
This study was funded by the Commission for Technology and Innovation KTI, Switzerland (176181).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The ex vivo study was approved by the local institutional review board (KEK-BE 2016-00887).
- 1.Caversaccio M, Gavaghan K, Wimmer W, Williamson T, Ansò J, Mantokoudis G, Gerber N, Rathgeb C, Feldmann A, Wagner F, Scheidegger O, Kompis M, Weisstanner C, Zoka-Assadi M, Roesler K, Anschuetz L, Huth M, Weber S (2017) Robotic cochlear implantation: surgical procedure and first clinical experience. Acta Otolaryngol 6489(March):1–11Google Scholar
- 5.Ansó J, Dür C, Gavaghan K, Rohrbach H, Gerber N, Williamson T, Calvo EM, Balmer TW, Precht C, Ferrario D, Dettmer MS, Rösler KM, Caversaccio MD, Bell B, Weber S (2016) A neuromonitoring approach to facial nerve preservation during image-guided robotic cochlear implantation. Otol Neurotol 37(1):89–98CrossRefGoogle Scholar
- 6.Labadie RF, Balachandran R, Noble JH, Blachon GS, Mitchell JE, Reda FA, Dawant BM, Fitzpatrick JM (2013) Minimally invasive image-guided cochlear implantation surgery: first report of clinical implementation. Laryngoscope 124:1–8Google Scholar
- 10.Studholme C (1997) Measures of 3D medical image alignment. PhD thesis, University of London, LondonGoogle Scholar
- 13.Chu C, Geber N, Gavaghan K, Zheng G (2016) Automated facial nerve segmentation : a validation study. In: CURAC, Deutsche Gesellschaft für Computer- und Roboterassistierte Chirurgie, pp 135–136Google Scholar
- 15.Xoran Technologies LLC (2017) xCAT IQ user manualGoogle Scholar
- 16.Lechuga L, Weidlich GA (2016) Cone beam CT vs. fan beam CT: a comparison of image quality and dose delivered between two differing CT imaging modalities. Cureus 8:e778Google Scholar