Designing optically tracked instruments for image-guided surgery.

Most image-guided surgery (IGS) systems track the positions of surgical instruments in the physical space occupied by the patient. This task is commonly performed using an optical tracking system that determines the positions of fiducial markers such as infrared-emitting diodes or retroreflective spheres that are attached to the instrument. Instrument tracking error is an important component of the overall IGS system error. This paper is concerned with the effect of fiducial marker configuration (number and spatial distribution) on tip position tracking error. Statistically expected tip position tracking error is calculated by applying results from the point-based registration error theory developed by Fitzpatrick et al. Tracking error depends not only on the error in localizing the fiducials, which is the error value generally provided by manufacturers of optical tracking systems, but also on the number and spatial distribution of the tracking fiducials and the position of the instrument tip relative to the fiducials. The theory is extended in two ways. First, a formula is derived for the special case in which the fiducials and the tip are collinear. Second, the theory is extended for the case in which there is a composition of transformations, as is the situation for tracking an instrument relative to a coordinate reference frame (i.e., a set of fiducials attached to the patient). The derivation reveals that the previous theory may be applied independently to the two transformations; the resulting independent components of tracking error add in quadrature to give the overall tracking error. The theoretical results are verified with numerical simulations and experimental measurements. The results in this paper may be useful for the design of optically tracked instruments for image-guided surgery; this is illustrated with several examples.

Implementation, calibration and accuracy testing of an image-enhanced endoscopy system.

This paper presents a new method for image-guided surgery called image-enhanced endoscopy. Registered real and virtual endoscopic images (perspective volume renderings generated from the same view as the endoscope camera using a preoperative image) are displayed simultaneously; when combined with the ability to vary tissue transparency in the virtual images, this provides surgeons with the ability to see beyond visible surfaces and, thus, provides additional exposure during surgery. A mount with four photoreflective spheres is rigidly attached to the endoscope and its position and orientation is tracked using an optical position sensor. Generation of virtual images that are accurately registered to the real endoscopic images requires calibration of the tracked endoscope. The calibration process determines intrinsic parameters (that represent the projection of three-dimensional points onto the two-dimensional endoscope camera imaging plane) and extrinsic parameters (that represent the transformation from the coordinate system of the tracker mount attached to the endoscope to the coordinate system of the endoscope camera), and determines radial lens distortion. The calibration routine is fast, automatic, accurate and reliable, and is insensitive to rotational orientation of the endoscope. The routine automatically detects, localizes, and identifies dots in a video image snapshot of the calibration target grid and determines the calibration parameters from the sets of known physical coordinates and localized image coordinates of the target grid dots. Using nonlinear lens-distortion correction, which can be performed at real-time rates (30 frames per second), the mean projection error is less than 0.5 mm at distances up to 25 mm from the endoscope tip, and less than 1.0 mm up to 45 mm. Experimental measurements and point-based registration error theory show that the tracking error is about 0.5-0.7 mm at the tip of the endoscope and less than 0.9 mm for all points in the field of view of the endoscope camera at a distance of up to 65 mm from the tip. It is probable that much of the projection error is due to endoscope tracking error rather than calibration error. Two examples of clinical applications are presented to illustrate the usefulness of image-enhanced endoscopy. This method is a useful addition to conventional image-guidance systems, which generally show only the position of the tip (and sometimes the orientation) of a surgical instrument or probe on reformatted image slices.