Coffee: the key to safer image-guided surgery—a granular jamming cap for non-invasive, rigid fixation of fiducial markers to the patient

  • Patrick S. Wellborn
  • Neal P. Dillon
  • Paul T. Russell
  • Robert J. WebsterIII
Original Article



Accurate image guidance requires a rigid connection between tracked fiducial markers and the patient, which cannot be guaranteed by current non-invasive attachment techniques. We propose a new granular jamming approach to firmly, yet non-invasively, connect fiducials to the patient.


Our granular jamming cap surrounds the head and conforms to the contours of the patient’s skull. When a vacuum is drawn, the device solidifies in a manner conceptually like a vacuum-packed bag of ground coffee, providing a rigid structure that can firmly hold fiducial markers to the patient’s skull. By using the new Polaris Krios optical tracker, we can also use more fiducials in advantageous configurations to reduce registration error.


We tested our new approach against a clinically used headband-based fiducial fixation device under perturbations that could reasonably be expected to occur in a real-world operating room. In bump testing, we found that the granular jamming cap reduced average TRE at the skull base from 2.29 to 0.56 mm and maximum TRE at the same point from 7.65 to 1.30 mm. Clinically significant TRE reductions were also observed in head repositioning and static force testing experiments.


The granular jamming cap concept increases the robustness and accuracy of image-guided sinus and skull base surgery by more firmly attaching fiducial markers to the patient’s skull.


Registration Image-guided surgery Endonasal surgery Skull base surgery Granular jamming 



This work was funded by the National Institutes of Health: Grant R01 EB017467. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship under Grant No. 144519.

Compliance with ethical standards

Conflict of interest

Patrick Wellborn, Neal Dillon, Paul Russell, and Robert Webster III declare that they have no conflict of interest.

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. This article does not contain any studies with animals performed by any of the authors.

Informed consent

This article does not contain patient data.


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Copyright information

© CARS 2017

Authors and Affiliations

  1. 1.Department of Mechanical EngineeringVanderbilt UniversityNashvilleUSA
  2. 2.Department of OtolaryngologyVanderbilt University Medical CenterNashvilleUSA

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