Evaluating clinical near-infrared surgical camera systems with a view to optimizing operator and computational signal analysis.

Significance: As clinical evidence on the colorectal application of indocyanine green (ICG) perfusion angiography accrues, there is also interest in computerizing decision support. However, user interpretation and software development may be impacted by system factors affecting the displayed near-infrared (NIR) signal. Aim: We aim to assess the impact of camera positioning on the displayed NIR signal across different open and laparoscopic camera systems. Approach: The effects of distance, movement, and target location (center versus periphery) on the displayed fluorescence signal of different systems were measured under electromagnetic stereotactic guidance from an ICG-albumin model and in vivo during surgery. Results: Systems displayed distinct fluorescence performances with variance apparent with scope optical lens configuration (0 deg versus 30 deg), movement, target positioning, and distance. Laparoscopic system readings fitted inverse square function distance-intensity curves with one device and demonstrated a direction dependent sigmoid curve. Laparoscopic cameras presented central targets as brighter than peripheral ones, and laparoscopes with angled optical lens configurations had a diminished field of view. One handheld open system also showed a distance-intensity relationship, whereas the other maintained a consistent signal despite distance, but both presented peripheral targets brighter than central ones. Conclusions: Optimal clinical use and signal computational development requires detailed appreciation of system behaviors.

A Radiolucent Electromagnetic Tracking System for Use with Intraoperative X-ray Imaging.

In recent times, the use of electromagnetic tracking for navigation in surgery has quickly become a vital tool in minimally invasive surgery. In many procedures, electromagnetic tracking is used in tandem with X-ray technology to track a variety of tools and instruments. Most commercially available EM tracking systems can cause X-ray artifacts and attenuation due to their construction and the metals that form them. In this work, we provide a novel solution to this problem by creating a new radiolucent electromagnetic navigation system that has minimal impact on -ray imaging systems. This is a continuation of our previous work where we showed the development of the Anser open-source electromagnetic tracking system. Typical electromagnetic tracking systems operate by generating low frequency magnetic fields from coils that are located near the patient. These coils are typically made from copper, steel, and other dense radiopaque materials. In this work, we explore the use of low density aluminum to create these coils and we demonstrate that the effect on X-ray images is significantly reduced as a result of these novel changes in the materials used. The resulting field generator is shown to give at least a 60% reduction in the X-ray attenuation in comparison to our earlier designs. We verify that the system accuracy of approximately 1.5 mm RMS error is maintained with this change in design.

Planar Body-Mounted Sensors for Electromagnetic Tracking.

Electromagnetic tracking is a safe, reliable, and cost-effective method to track medical instruments in image-guided surgical navigation. However, patient motion and magnetic field distortions heavily impact the accuracy of tracked position and orientation. The use of redundant magnetic sensors can help to map and mitigate for patient movements and magnetic field distortions within the tracking region. We propose a planar inductive sensor design, printed on PCB and embedded into medical patches. The main advantage is the high repeatability and the cost benefit of using mass PCB manufacturing processes. The article presents new operative formulas for electromagnetic tracking of planar coils on the centimetre scale. The full magnetic analytical model is based on the mutual inductance between coils which can be approximated as being composed by straight conductive filaments. The full model is used to perform accurate system simulations and to assess the accuracy of faster simplified magnetic models, which are necessary to achieve real-time tracking in medical applications.

Anser EMT: the first open-source electromagnetic tracking platform for image-guided interventions.

PURPOSE: Electromagnetic tracking is the gold standard for instrument tracking and navigation in the clinical setting without line of sight. Whilst clinical platforms exist for interventional bronchoscopy and neurosurgical navigation, the limited flexibility and high costs of electromagnetic tracking (EMT) systems for research investigations mitigate against a better understanding of the technology's characterisation and limitations. The Anser project provides an open-source implementation for EMT with particular application to image-guided interventions. METHODS: This work provides implementation schematics for our previously reported EMT system which relies on low-cost acquisition and demodulation techniques using both National Instruments and Arduino hardware alongside MATLAB support code. The system performance is objectively compared to other commercial tracking platforms using the Hummel assessment protocol. RESULTS: Positional accuracy of 1.14 mm and angular rotation accuracy of [Formula: see text] are reported. Like other EMT platforms, Anser is susceptible to tracking errors due to eddy current and ferromagnetic distortion. The system is compatible with commercially available EMT sensors as well as the Open Network Interface for image-guided therapy (OpenIGTLink) for easy communication with visualisation and medical imaging toolkits such as MITK and 3D Slicer. CONCLUSIONS: By providing an open-source platform for research investigations, we believe that novel and collaborative approaches can overcome the limitations of current EMT technology.

Electropermanent magnetic anchoring for surgery and endoscopy.

The use of magnets for anchoring of instrumentation in minimally invasive surgery and endoscopy has become of increased interest in recent years. Permanent magnets have significant advantages over electromagnets for these applications; larger anchoring and retraction force for comparable size and volume without the need for any external power supply. However, permanent magnets represent a potential hazard in the operating field where inadvertent attraction to surgical instrumentation is often undesirable. The current work proposes an interesting hybrid approach which marries the high forces of permanent magnets with the control of electromagnetic technology including the ability to turn the magnet OFF when necessary. This is achieved through the use of an electropermanent magnet, which is designed for surgical retraction across the abdominal and gastric walls. Our electropermanent magnet, which is hand-held and does not require continuous power, is designed with a center lumen which may be used for trocar or needle insertion. The device in this application has been demonstrated successfully in the porcine model where coupling between an intraluminal ring magnet and our electropermanent magnet facilitated guided insertion of an 18 Fr Tuohy needle for guidewire placement. Subsequent investigations have demonstrated the ability to control the coupling distance of the system alleviating shortcomings with current methods of magnetic coupling due to variation in transabdominal wall thicknesses. With further refinement, the magnet may find application in the anchoring of endoscopic and surgical instrumentation for minimally invasive interventions in the gastrointestinal tract.

Evaluation of a novel tracking system in a breathing lung model.

We present the evaluation of an electromagnetic position tracking system for use with virtual bronchoscopy systems. Our system utilises a planar magnetic coil array and commercially available search coil sensors. Experimental results show the EM tracking accuracy to be in the range of 11.5mm, which is comparable to both commercial and research systems. The use of a bench-top breathing lung model is used to verify system operation in the in vitro setting. A novel fiducial-free registration method is implemented to reduce errors resulting from inaccurate landmark identification commonly associated with point-based registration. After registration, there is good agreement between the measured position of the sensor probe during endoscopic navigation and the lung airways as visualised in a 3D model of the phantom.