Computer aided surgery : official journal of the International Society for Computer Aided Surgery
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Comput. Aided Surg. · Mar 2008
Comparative StudyElectromagnetic navigation improves minimally invasive robot-assisted lung brachytherapy.
Recent advances in minimally invasive thoracic surgery have renewed an interest in the role of interstitial brachytherapy for lung cancer. Our previous work has demonstrated that a minimally invasive robot-assisted (MIRA) lung brachytherapy system produced results that were equal to or better than those obtained with standard video-assisted thoracic surgery (VATS) and comparable to results with open surgery. The purpose of this project was to evaluate the performance of an integrated system for MIRA lung brachytherapy that incorporated modified electromagnetic navigation and ultrasound image guidance with robotic assistance. ⋯ A modified integrated system for performing minimally invasive robot-assisted lung brachytherapy was developed that incorporated electromagnetic navigation and an improved robotic controller. The MIRA IV system performed significantly better than standard VATS and better than MIRA III.
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Comput. Aided Surg. · Nov 2007
Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation.
A commonly adopted surgical target in deep brain stimulation (DBS) procedures, the subthalamic nucleus (STN) is located deep within the brain and is surrounded by delicate deep-brain structures. Symptoms of Parkinson's disease can be reduced by precisely implanting a multi-electrode stimulator at a specific location within the STN and delivering the appropriate signal to the target. A number of techniques have recently been proposed to facilitate STN DBS surgical targeting and thereby improve the surgical outcome. ⋯ The surgical target locations determined using each of the six targeting methods were compared with the "gold standards". The average displacement between the actual surgical targets and those planned with targeting approaches was 3.0 +/- 1.3 mm, 3.0 +/- 1.3 mm, 3.0 +/- 1.0 mm, 2.6 +/- 1.1 mm, 2.5 +/- 0.9 mm, and 1.7 +/- 0.7 mm for approaches based on T2-weighted MRI, a brain atlas, T1 and T2 maps, an electrophysiological database, a collection of final surgical targets from previous patients, and the combination of these functional and anatomical data, respectively. The technique incorporating both anatomical and functional data provides the most reliable and accurate target position for STN DBS.
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Comput. Aided Surg. · Sep 2007
Rapid prototype patient-specific drill template for cervical pedicle screw placement.
To assess the feasibility and accuracy of a drill template for the placement of a cervical pedicle screw in a single vertebral level. ⋯ The potential use of drill templates to place cervical pedicle screws is promising. Our initial methodology appears to provide an accurate technique and trajectory for pedicle screw placement in the cervical spine.
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Comput. Aided Surg. · Sep 2007
Early results of CyberKnife image-guided robotic stereotactic radiosurgery for treatment of lung tumors.
To determine if image-guided robotic stereotactic radiosurgery (IGR-SRS) by CyberKnife achieves acceptable local control in resectable but medically inoperable patients with non-small cell lung cancer (NSCLC) or pulmonary metastasis, and to evaluate control rates and toxicity. ⋯ The delivery of precisely targeted high radiation doses with surgical precision to lung tumors in a hypo-fractionated fashion is feasible and safe. Image-guided robotic stereotactic radiosurgery (IGR-SRS) of lung tumors with the CyberKnife achieves excellent rates of local disease control with limited toxicity to surrounding tissues, and in many cases may be curative for patients for whom surgery is not an option.
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Comput. Aided Surg. · Jul 2007
Comparative StudyIntraoperative cone-beam CT for image-guided tibial plateau fracture reduction.
A mobile isocentric C-arm was modified in our laboratory in collaboration with Siemens Medical Solutions to include a large-area flat-panel detector providing multi-mode fluoroscopy and cone-beam CT (CBCT) imaging. This technology is an important advance over existing intraoperative imaging (e.g., Iso-C(3D)), offering superior image quality, increased field of view, higher spatial resolution, and soft-tissue visibility. The aim of this study was to assess the system's performance and image quality in tibial plateau (TP) fracture reconstruction. ⋯ This study demonstrated a clear advantage of intraoperative CBCT over 2D fluoroscopy and Iso-C(3D) in TP fracture fixation. CBCT imaging provided benefits in fracture type diagnosis, localization of fracture fragments, and intraoperative 3D confirmation of anatomic reduction.