PhD Thesis by Joerg Traub

Title

New Concepts for Design and Workflow Driven Evaluation of Computer Assisted Surgery Solutions

Committee

• Prof. Bernd Bruegge, PhD
• Prof. Dr. Ekkehard Euler
• Prof. Pierre Jannin, PhD
• Prof. Dr. Nassir Navab

Time and Location

November 12, 2008; 11:30; Seminarraum 1, Klinikum Innenstadt, Nussbaumstr. 20, München

Further Information

Joerg Traub's CAMP Homepage.

Abstract

Image guided orthopedic intervention has seen rapid development in the past two decades. In many applications, the intraoperative use of medical imaging data has increased the safety and robustness of the surgical outcome. However it has also increased the applied radiation dose. Navigation systems were introduced in order to reduce the invasiveness of such procedures, while increasing the accuracy and safety of the procedures. The clinical procedures are often complex. Newly introduced systems often add more complexity and are not smoothly integrated into the clinical workflow. This thesis introduces two new concepts for computer aided surgery. Based on these concepts, it proposes innovative solutions satisfying the application specific requirements of the exemplary application for computer assisted spine surgery.

The first concept is based on a head mounted display for in-situ visualization. Initial clinical tests have shown that standard visualization methods based on volume and simple slice rendering are not sufficient for successfully performing surgical tasks. Therefore, a novel and promising alternative for in-situ guidance was designed, developed and evaluated, comprising a hybrid combination of standard slice-based visualization (commonly used during navigated procedures) with in-situ visualization. The second system is based on a mobile C-arm extended by a rigidly attached video camera originally proposed by Navab et al. The basic system enables image overlay of video and X-ray image without online calibration or registration. The newly designed and implemented extensions of this system facilitate guided instrumentation and a smooth integration into the surgical workflow.

During the technical evaluation and preclinical phantom and cadaver studies, both newly introduced concepts proved to offer promising support during image guided spine interventions. In addition to the traditional assessment of image guided surgery systems, a methodology is proposed for a reference-based assessment and a comparison between state-of-the-art, clinically used procedures and procedures based on the newly proposed systems. This methodology is based on the analysis of the clinical workflow, the design of simulated procedures, and their structured analysis. This model was applied to compare the newly developed camera augmented mobile C-arm system with the clinically applied fluoro CT guidance for vertebroplasty interventions.