Development of modules for NeuroTable

Thesis by: Alina Roitberg
Advisor: Prof. Dr. Nassir Navab
Supervision by: Patrick Wucherer, Philipp Stefan

Overview

Topic

Among stereotactic operations, the most frequently performed procedure is a biopsy. Stereotactic biopsies have evolved as a powerful and safe tool providing tissue diagnoses with minimal disruption of anatomical structures. The method combines stereotactic localization and image-guided surgery using computed tomography (CT) and magnetic resonance imaging (MRI) as well as Fluoroethyl-L-tyrosine positron emission tomography (FET-PET). For conducting stereotactic biopsies, the patient’s head is fixed in a stereotactic frame using an invasive fixation system. A computed tomography (CT) scan is performed with 0.6 mm slice thickness. The imaging data is transferred to a workstation for planning. After localization of the correct head position, the CT-images are fused together with MRI images (T1 + KM, T2, contrast enhanced MRA). The target point is defined within the pathological lesion and an instrument entry point on the patient’s skull is cautiously chosen, trying to avoid affecting risk structures e.g. neural or vascular structures. As visualization method a multiplanar reconstruction is available to get a three-dimensional impression of the planned trajectory in relation to anatomical structures and the pathological lesion. Additionally, the distance to anatomical structures at risk, as well as the biopsy tract can be examined in horizontal, sagittal, coronal and oblique section planes. Unlike most procedures, stereotactic biopsies are conducted in an environment where the surgeon does not visualize the anatomical structures directly, but must rely on the adjunctive technologies for guidance. The lack of a direct line of sight to the target limits the ability to recognize and correct mistakes during the procedure. A small error at any stage of the procedure will make accurate lesion targeting impossible, and may lead to severe complications. Therefore it is essential that the surgeon has an apprehension of three-dimensional space for optimally conducting stereotactic biopsies. However the current planning system does not provide a real-time volumetric visualization neither of the trajectory nor of the pathological lesion. The neurosurgeon has to repeatedly compute multiplanar reconstructions to achieve a three-dimensional view of the trajectory. In particular for residents of the neurosurgical clinic or for students the planning system limits the apprehension of anatomical features to quickly get a mental three dimensional model of the operating site. Another key issue is the time-consuming user interface the system provides. For analyzing the trajectory in relation to neural and vascular structures, the neurosurgeon has to use the mouse as input device to navigate slice by slice through the axial slices or probe view cross sections by manually clicking the mouse button. The third major limitation of the planning system is the combination of the monitor as output device and the mouse as input device. Only one person can directly interact with the system while the other participants are constrained to be passive spectators. The lack of a collaborative workspace limits information sharing and knowledge transfer between senior experts and junior experts during a stereotactic biopsy treatment planning. The aim of the NeuroTable project is to design and develop a novel co-located collaborative neurosurgical workspace with latest visualization techniques enabling time-efficient stereotactic biopsy treatment planning meanwhile ensuring treatment quality and knowledge transfer to residents.

Initial step towards co-located collaborative neurosurgical planning workspace

Integration of various imaging modalities (X-Ray, DTI, FMRI)
Integration of haptic device tracking
Integration of multitouch
Visualization of surgical instrument

What do we offer

Experience different fields of research in computer science: Visualization, Software Engineering, Real-time Simulation, GPU Programming
Submission to prestigious conferences/journals depending on performance
We offer an intensive supervision, but initiative is very welcome. Working environment will be provided at the NARVIS lab.

Requirements

Knowledge of a programming environment (for example Matlab or Python or C++) is required

Contact

ProjectForm
Title:	Development of modules for NeuroTable
Abstract:	Among stereotactic operations, the most frequently performed procedure is a biopsy. Stereotactic biopsies have evolved as a powerful and safe tool providing tissue diagnoses with minimal disruption of anatomical structures. The method combines stereotactic localization and image-guided surgery using computed tomography (CT) and magnetic resonance imaging (MRI) as well as Fluoroethyl-L-tyrosine positron emission tomography (FET-PET). For conducting stereotactic biopsies, the patient’s head is fixed in a stereotactic frame using an invasive fixation system. A computed tomography (CT) scan is performed with 0.6 mm slice thickness. The imaging data is transferred to a workstation for planning. After localization of the correct head position, the CT-images are fused together with MRI images (T1 + KM, T2, contrast enhanced MRA). The target point is defined within the pathological lesion and an instrument entry point on the patient’s skull is cautiously chosen, trying to avoid affecting risk structures e.g. neural or vascular structures. As visualization method a multiplanar reconstruction is available to get a three-dimensional impression of the planned trajectory in relation to anatomical structures and the pathological lesion. Additionally, the distance to anatomical structures at risk, as well as the biopsy tract can be examined in horizontal, sagittal, coronal and oblique section planes (see figure 1). Unlike most procedures, stereotactic biopsies are conducted in an environment where the surgeon does not visualize the anatomical structures directly, but must rely on the adjunctive technologies for guidance. The lack of a direct line of sight to the target limits the ability to recognize and correct mistakes during the procedure. A small error at any stage of the procedure will make accurate lesion targeting impossible, and may lead to severe complications. Therefore it is essential that the surgeon has an apprehension of three-dimensional space for optimally conducting stereotactic biopsies. However the current planning system does not provide a real-time volumetric visualization neither of the trajectory nor of the pathological lesion. The neurosurgeon has to repeatedly compute multiplanar reconstructions to achieve a three-dimensional view of the trajectory. In particular for residents of the neurosurgical clinic or for students the planning system limits the apprehension of anatomical features to quickly get a mental three dimensional model of the operating site. Another key issue is the time-consuming user interface the system provides. For analyzing the trajectory in relation to neural and vascular structures, the neurosurgeon has to use the mouse as input device to navigate slice by slice through the axial slices or probe view cross sections by manually clicking the mouse button. The third major limitation of the planning system is the combination of the monitor as output device and the mouse as input device. Only one person can directly interact with the system while the other participants are constrained to be passive spectators. The lack of a collaborative workspace limits information sharing and knowledge transfer between senior experts and junior experts during a stereotactic biopsy treatment planning. The aim of the NeuroTable project is to design and develop a novel co-located collaborative neurosurgical workspace with latest visualization techniques enabling time-efficient stereotactic biopsy treatment planning meanwhile ensuring treatment quality and knowledge transfer to residents.
Student:	Alina Roitberg
Director:	Prof. Dr. Nassir Navab
Supervisor:	Patrick Wucherer, Philipp Stefan
Type:	IDP
Area:
Status:	finished
Start:
Finish:
Thesis (optional):
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		Chair for Computer Aided Medical Procedures & Augmented Reality Lehrstuhl für Informatikanwendungen in der Medizin & Augmented Reality
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