• World Neurosurg · Jul 2020

    A phantom study of the spatial precision and accuracy of stereotactic localization using computed tomographic imaging with the Leksell stereotactic system.

    • Ali R Tafreshi, Terrance Peng, Cheng Yu, Daniel R Kramer, Angad S Gogia, Morgan B Lee, Michael F Barbaro, Rinu Sebastian, Roberto Martin Del Campo-Vera, Kuang-Hsuan Chen, Spencer S Kellis, and Brian Lee.
    • Department of Neurological Surgery, Keck School of Medicine of USC, Los Angeles, California, USA. Electronic address: tafreshi@usc.edu.
    • World Neurosurg. 2020 Jul 1; 139: e297-e307.

    BackgroundStereotactic localization of neurosurgical targets traditionally relies on computed tomography (CT), which is considered the optimal imaging modality for geometric accuracy. However, in-depth investigations that characterize the precision and accuracy of CT images are lacking. We used a CT phantom to examine interscanner precision and interprotocol accuracy in coordinate localization.MethodsA polymethylacrylate phantom was scanned with Toshiba Aquilion 64 and GE Healthcare LightSpeed 16 CT scanners, using both helical and incremental single-slice (SS) image acquisition protocols. The X, Y, and Z coordinates of 94 points across 6 surfaces of the phantom were physically measured. The CT scan-derived coordinates were compared with the phantom coordinates and with each other to determine accuracy and precision, respectively.ResultsUsing the SS imaging protocol, the mean (SD) interscanner disparity in localization was 0.93 (0.39) mm, given by the average Euclidean distance between the coordinates of the 2 scanners. This discrepancy significantly varied by axis and surface, with the greatest discrepancy in the Z-axis of 0.30 mm (95% confidence interval, 0.25-0.35; P = 0.05) and on the superior surface of 1.30 mm (95% confidence interval, 1.15-1.45; P = 0.05). SS acquisition was significantly more accurate than the helical protocol.ConclusionsWe found evidence of clinically relevant inconsistency between 2 CT scanners used for stereotactic localization. SS image acquisition was superior to helical scanning with respect to localization accuracy. Interscanner consistency cannot be assumed. Institutions would benefit from identifying the errors inherent in their CT scanners.Copyright © 2020 Elsevier Inc. All rights reserved.

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