IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Image-Guided SurgeryApplications

Julien JomierThe University of North Carolina

at Chapel Hill

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Outline

● TIPS ProcedureCASILab

● NeuroSurgery Application BrainLab

● Liver Transplant Planning● RF Liver Tumor Ablation

CADDLab

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

TIPS Procedure• Transjugular Intrahepatic

Portosystemic Shunt• CASILab @ UNC (Dr. Bullitt)

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

TIPS procedure• Biplane Fluoroscopic Images• 3D/2D Model-to-Image Registration• Real-time tracking

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

TIPS : Registration

FluoroImages

3D Vascular

Model

Model-to-Image

Registration

Balloon Tracking

Needle Tracking

3DDisplay

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

NeuroSurgery• BrainLab• VectorVision/VVLink• VTK / CMake• Brain/Spine surgery• Intra-Operative Ultrasound• Optical Tracker (NDI)

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

NeuroSurgery• VVCranial• MR/Patient registration:

- Surface matching of the skull

• Surgical Navigation• Tool tracking• Head tracking

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

MR/US Fusion

• Manual alignment of tumor margins

• Add automatic non-rigid registration

• Model-to-Image registration

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Liver Transplant Planning

• Define optimal cutting path preoperatively.

• Open-Surgery• Bring the path in the OR• Deformable Registration• Ultrasound Annotation

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Liver Transplant Planning

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Liver Transplant Planning

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

RF Liver Tumor Ablation• 40-50% of all lesions not

seen using ultrasound.• Options:

- Open Surgery- CT/MR guided RFA- wait until lesion enlarges

• Ideal: Percutaneous treatment using US

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

RF Liver Tumor Ablation

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

RF Liver Tumor Ablation

• US Probe tracking via Ascension Flock of Birds

• Needle segmentation from US

• 3 Displays:- 3D- Needle pointof view- Slice based

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

RFA Results• US/MR model-to-

image affine registration

• About 2 seconds• Accuracy:

- < 2mm translation- < 0.06rad rotation

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

3D US Reconstruction

• Reconstruct 3D Ultrasound volume from 2D tracked images

• Breathing/Heart beating• Calibration needed

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

3D US CalibrationTtracker

z

y

x O

Tracker

US Probe

US Image

TTrackerToProbe

y

-z

-x

Tmodel

TProbeToImage

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

US Reconstruction Results

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Acknowledgments• Dr. Sue Weeks• Dr. Friedman• Dr. Elizabeth Bullitt• Stephen Aylward• Amael Delaunoy

IGT Meeting – CADDLab – November, 2005IGT Meeting – CADDLab – November, 2005

Tools• Open Source

Toolkits• ITK/VTK• IGSTK• CMake• SOViewers• FLTK/Qt