GroupT: Technical 1

Intraoperative Imaging and Image Fusion

Image-Guided Therapy (IGT)

http://ncigt.org/brain-tumor-resection
[5]

In case a surgery or radiotherapy uses advanced imaging instead of or complimenting visualization, this procedure can be called Image-Guided Therapy (IGT). Main reasons to use intraoperative imaging are better targeting, less invasiveness and improved outcomes [1]

Medical images are acquired before the intervention, mostly for diagnostic reasons. They are then pre-processed and converted into models that can be used before and during the procedure for planning, navigation and decision making. To accomplish these tasks, elaborate IGT delivery systems are used and constantly developed and include high-performance computing, image processing, as well as complex visualization, sometimes even in real time. [1]

Intraoperative Imaging

Several modalities can be used for imaging during a surgery. They can improve navigation, that is difficult due to brainshift and detect possible residual tumor that needs to be removed. This can, for example reduce the reoperation rate significantly and thus be beneficial for survival rates [10].

CT

MRI

intraoperative MRI (iMRI) [2] [11]

Good for identifying residual tumor, but expensive and time-consuming [12]

US

Recent advances in ultrasound imaging make it possible, to delineate tumor margins as well as in MRI [13].

Fluorescence

[3]

Image Registration / Fusion

In order to take advantage of information from multiple imaging modalities, images can be put into the same reference frame (co-registered). By aligning them in the best possible way, anatomical, functional and metabolic information can be correlated [1]. There are several possibilities to register the data:

image based
fiducial/marker based
feature based
learning based
simulation based (biomechanical models)

Intraoperative Imaging and Image Fusion

Image-Guided Therapy (IGT)

http://ncigt.org/brain-tumor-resection
[5]

In case a surgery or radiotherapy uses advanced imaging instead of or complimenting visualization, this procedure can be called Image-Guided Therapy (IGT). Main reasons to use intraoperative imaging are better targeting, less invasiveness and improved outcomes [1]

Medical images are acquired before the intervention, mostly for diagnostic reasons. They are then pre-processed and converted into models that can be used before and during the procedure for planning, navigation and decision making. To accomplish these tasks, elaborate IGT delivery systems are used and constantly developed and include high-performance computing, image processing, as well as complex visualization, sometimes even in real time. [1]

Intraoperative Imaging

Several modalities can be used for imaging during a surgery. They can improve navigation, that is difficult due to brainshift and detect possible residual tumor that needs to be removed. This can, for example reduce the reoperation rate significantly and thus be beneficial for survival rates [10].

CT

MRI

intraoperative MRI (iMRI) [2] [11]

Good for identifying residual tumor, but expensive and time-consuming [12]

US

Recent advances in ultrasound imaging make it possible, to delineate tumor margins as well as in MRI [13].

Fluorescence

[3]

Image Registration / Fusion

In order to take advantage of information from multiple imaging modalities, images can be put into the same reference frame (co-registered). By aligning them in the best possible way, anatomical, functional and metabolic information can be correlated [1]. There are several possibilities to register the data:

image based
fiducial/marker based
feature based
learning based
simulation based (biomechanical models)

Augmented Reality

Adds information to the scene, does not completely replace it with artificial information.

Overview / reviews of AR in neurosurgery: [6][7]

VR and AR based on iMRI [8]

AR and VR for surgical training [9]

Robotics

State of the art in robotical neurosurgery [15] [18] [19] (https://www.intechopen.com/books/medical_robotics/robotic_neurosurgery)

Maybe interesting to read and follow the direction, although not brain tumor treatment: [14]

VR and Robotics in Neurosurgery [20]

Can robots replace stereotactic frames? [16]

What about safety in robotic neurosurgery? Who is responsible if the system fails? (Maybe talk about it later in Ethics...) [17]

Bibliography

[1] Jolesz, Ferenc, ed. Intraoperative imaging and image-guided therapy. Springer Science & Business Media, 2014.

[2] Jolesz FA. Intraoperative Imaging in Neurosurgery: Where Will the Future Take Us? Acta neurochirurgica Supplement. 2011;109:21-25. doi:10.1007/978-3-211-99651-5_4.

[3] Li, Yiping, et al. "Intraoperative fluorescence-guided resection of high-grade gliomas: a comparison of the present techniques and evolution of future strategies." World neurosurgery 82.1 (2014): 175-185.

[4] Zausinger, Stefan, et al. "Intraoperative CT in neurosurgery." Intraoperative Imaging and Image-Guided Therapy. Springer New York, 2014. 529-536.

[5] Peters, Terry M., and Cristian A. Linte. "Image-guided interventions and computer-integrated therapy: Quo vadis?." (2016): 56-63.

[6] Guha, Daipayan, et al. "Augmented Reality in Neurosurgery: A Review of Current Concepts and Emerging Applications." Canadian Journal of Neurological Sciences 44.3 (2017): 235-245.

[7] Meola, Antonio, et al. "Augmented reality in neurosurgery: a systematic review." Neurosurgical review (2016): 1-12.

[8] Sun, Guo-chen, et al. "Impact of Virtual and Augmented Reality Based on Intraoperative Magnetic Resonance Imaging and Functional Neuronavigation in Glioma Surgery Involving Eloquent Areas." World Neurosurgery 96 (2016): 375-382.

[9] Pelargos, Panayiotis E., et al. "Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery." Journal of Clinical Neuroscience 35 (2017): 1-4.

[10] Choudhri, A. F., et al. "3T intraoperative MRI for management of pediatric CNS neoplasms." American Journal of Neuroradiology 35.12 (2014): 2382-2387.

[11] Coburger, Jan, et al. "Low-grade glioma surgery in intraoperative magnetic resonance imaging: results of a multicenter retrospective assessment of the German study group for intraoperative magnetic resonance imaging." Neurosurgery 78.6 (2016): 775-786.

[12] Fahlbusch, R. & Samii, A. "Editorial: Intraoperative MRI" Neurosurgical Focus, 2016, 40, E3

[13] Moiyadi, Aliasgar V., and Prakash Shetty. "Direct navigated 3D ultrasound for resection of brain tumors: a useful tool for intraoperative image guidance." Neurosurgical focus 40.3 (2016): E5.

[14] Madhavan, Karthik, et al. "Augmented-reality integrated robotics in neurosurgery: are we there yet?." Neurosurgical Focus 42.5 (2017): E3.

[15] Doulgeris, James J., S. MSME, and A. MSBE. "Robotics in neurosurgery: evolution, current challenges, and compromises." Cancer Control 22.3 (2015): 352-360.

[16] Faria, Carlos, et al. "A Simple Control Approach for Stereotactic Neurosurgery Using a Robotic Manipulator." CONTROLO 2016. Springer International Publishing, 2017. 397-408.

[17] Fei, Baowei, et al. "The safety issues of medical robotics." Reliability Engineering & System Safety 73.2 (2001): 183-192.

[18] Mattei, Tobias A., et al. "Current state-of-the-art and future perspectives of robotic technology in neurosurgery." Neurosurgical review 37.3 (2014): 357-366.

[19] Faria, Carlos, et al. "Review of robotic technology for stereotactic neurosurgery." IEEE reviews in biomedical engineering 8 (2015): 125-137.

[20] Sekhar, Laligam N., et al. "Commentary: virtual reality and robotics in neurosurgery." Neurosurgery 72 (2013): A1-A6.

Bibliography for Technical Topics 1 and 2