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Accuracy evaluation of a mitral valve surgery assistance system based on optical tracking

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Mitral valve reconstruction is a widespread surgical method to repair incompetent mitral valves, which usually includes implantation of a ring prosthesis. To date, intraoperative analysis of the mitral valve is merely based on visual assessment using simple surgical tools, which might not allow for accurate assessment of the complex anatomy.

Methods

We propose a novel intraoperative computer-based assistance system, which combines passive optical tracking technology with tailored measurement strategies applicable during different phases of the intraoperative workflow. Based on the assessment of the valvular apparatus by customized tracked instruments, the system (1) generates an enhanced three-dimensional visualization, which (2) incorporates accurate quantifications and (3) provides assistance, e.g., in terms of virtual prosthesis selection.

Results

Phantom experiments in a realistic environment revealed a high system accuracy (mean precision \(0.12 \pm 0.09\) mm and mean trueness \(0.77 \pm 0.39\) mm) and a low user error (mean precision \(0.18 \pm 0.10 \) mm and mean trueness \(0.81 \pm 0.36\) mm). The assistance system was successfully applied five times during open and minimally invasive reconstructive surgery in patients having mitral valve insufficiency. The measurement steps integrate well into the traditional workflow, enhancing the surgeon’s three-dimensional perception and generating a suggestion for an appropriate prosthesis.

Conclusion

The proposed assistance system provides a novel, accurate, and reproducible method for assessing the valvular geometry intraoperatively.

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References

  1. (1998) ISO 5725–1: Accuracy (trueness and precision) of measurement methods and results-Part 1: General principles and definitions

  2. Bauer MA (2007) Tracking Error in Augmented Reality. PhD thesis, Technical University Munich

  3. Besl PJ, McKay ND (1992) A method for registration of 3-D shapes. IEEE Trans Pattern Anal 14(2):239–256. doi:10.1109/34.121791

    Article  Google Scholar 

  4. Birkfellner W, Hummel J, Wilson E, Cleary K (2008) Tracking devices. In: Peters T, Cleary K (eds) Image-guided interventions, 1st edn. Springer, New York, pp 23–44

    Chapter  Google Scholar 

  5. Bothe W, Miller DC, Doenst T (2013) Sizing for mitral annuloplasty: where does science stop and voodoo begin? Ann Thorac Surg 95(4):1475–1483. doi:10.1016/j.athoracsur.2012.10.023

    Article  PubMed  Google Scholar 

  6. Carpentier A (1983) Cardiac valve surgery: the ’French’ correction. J Thorac Cardiovasc Surg 86:323–337

    CAS  PubMed  Google Scholar 

  7. Carpentier A, Adams D, Filsoufi F (2010) Carpentier’s reconstructive valve surgery. Saunders/Elsevier, Missouri

    Google Scholar 

  8. Chassat F, Lavalle S (1998) Experimental protocol of accuracy evaluation of 6-D localizers for computer-integrated surgery: application to four optical localizers. Med Image Comput Computer-Assisted Interv Lect Notes Computer Sci 1496:277–284. doi:10.1007/BFb005621

    Google Scholar 

  9. Elfring R, de la Fuente M, Radermacher K (2010) Assessment of optical localizer accuracy for computer aided surgery systems. Computer Aided Surg 15(1–3):1–12. doi:10.3109/10929081003647239

    Article  Google Scholar 

  10. Engelhardt S, De Simone R, Nabers D, Zimmermann N, Al Maisary S, Beller CJ, Karck M, Meinzer HP, Wolf I (2014a) Intraoperative measurements on the mitral apparatus using optical tracking: a feasibility study. In: Proc SPIE, Medical Imaging, vol 9036, pp 90361L–90367L. doi:10.1117/12.2043391

  11. Engelhardt S, De Simone R, Zimmermann N, Al-Maisary S, Nabers D, Karck M, Meinzer HP, Wolf I (2014b) Augmented reality-enhanced endoscopic images for annuloplasty ring sizing. Augmented Environ Computer-Assisted Interv Lect Notes Computer Sci 8678:128–137. doi:10.1007/978-3-319-10437-9_14

    Google Scholar 

  12. Engelhardt S, Graser B, Simone RD, Zimmermann N, Karck M, Meinzer HP, Nabers D, Wolf I (2014c) Vermessung des Mitralapparats mit einem optisch getrackten Zeigeinstrument für die virtuelle Annuloplastie. In: Bildverarbeitung für die Medizin 2014. doi:10.1007/978-3-642-54111-7_48

  13. Engelhardt S, Wolf I, Al-Maisary S, Schmidt H, Meinzer HP, Karck M, De Simone R (2016) Intraoperative quantitative mitral valve analysis using optical tracking technology. Ann Thorac Surg (accepted). doi:10.1016/j.athoracsur.2016.01.018

  14. Fitzpatrick J, West J, Maurer JCR (1998) Predicting error in rigid-body point-based registration. IEEE Trans Med Imaging 17(5):694–702. doi:10.1109/42.736021

    Article  CAS  PubMed  Google Scholar 

  15. Frantz DD, Wiles AD, Leis SE, Kirsch SR (2003) Accuracy assessment protocols for electromagnetic tracking systems. Phys Med Biol 48(14):2241–2251. doi:10.1088/0031-9155/48/14/314

    Article  CAS  PubMed  Google Scholar 

  16. Frantz DD, Kirsch SR, Wiles AD (2004) Specifying 3D tracking system accuracy one manufacturer’s views. Bildverarbeitung für die Medizin 2004:234–238. doi:10.1007/978-3-642-18536-6_48

    Google Scholar 

  17. Franz AM, Seitel A, Servatius M, Zöllner C, Gergel I, Wegner I, Neuhaus J, Zelzer S, Nolden M, Gaa J, Mercea P, Yung K, Sommer CM, Radeleff BA, Schlemmer HP, Kauczor HU, Meinzer HP, Maier-Hein L (2012) Simplified development of image-guided therapy software with MITK-IGT. In: Proc SPIE, Medical Imaging, vol 8316, pp 83162J–83168J. doi:10.1117/12.911421

  18. Graser B, Wald D, Al-Maisary S, Grossgasteiger M, Simone RD, Meinzer HP, Wolf I (2013) Using a shape prior for robust modeling of the mitral annulus on 4D ultrasound data. Int J Comp Assist Radiol Surg 9(4):635–644. doi:10.1007/s11548-013-0942-3

    Google Scholar 

  19. Grunert P, Darabi K, Espinosa J, Filippi R (2003) Computer-aided navigation in neurosurgery. Neurosurg Rev 26(2):73–99. doi:10.1007/s10143-003-0262-0

    Article  CAS  PubMed  Google Scholar 

  20. Horn B (1987) Closed-form solution of absolute orientation using unit quaternions. J Opt Soc Am A 4(4):629–642. doi:10.1364/JOSAA.4.000629

    Article  Google Scholar 

  21. Jannin P, Korb W (2008) Assessment of image-guided interventions. In: Peters T, Cleary K (eds) Image-guided interventions, 1st edn. Springer, New York, pp 531–549

    Chapter  Google Scholar 

  22. Khadem R, Yeh CC, Sadeghi-Tehrani M, Bax MR, Johnson JA, Welch JN, Wilkinson EP, Shahidi R (2000) Comparative tracking error analysis of five different optical tracking systems. Computer Aided Surg 5(2):98–107. doi:10.1002/1097-0150(2000)5:2<98:AID-IGS4>3.0.CO;2-H

  23. Maisano F, Skantharaja R, Denti P, Giacomini A, Alfieri O (2009) Mitral annuloplasty. MMCTS 2009(0918):mmcts.2008.003,640, doi:10.1510/mmcts.2008.003640

  24. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J, Collaboration Balliol, Aronson JK, Barkun JS, Blazeby JM, Boutron IC, Campbell WB, Clavien PA, Cook JA, Ergina PL, Feldman LS, Flum DR, Maddern GJ, Nicholl J, Reeves BC, Seiler CM, Strasberg SM, Meakins JL, Ashby D, Black N, Bunker J, Burton M, Campbell M, Chalkidou K, Chalmers I, de Leval M, Deeks J, Ergina PL, Grant A, Gray M, Greenhalgh R, Jenicek M, Kehoe S, Lilford R, Littlejohns P, Loke Y, Madhock R, McPherson K, Meakins J, Rothwell P, Summerskill B, Taggart D, Tekkis P, Thompson M, Treasure T, Trohler U, Vandenbroucke J (2009) No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374(9695):1105–1112. doi:10.1016/S0140-6736(09)61116-8

    Article  PubMed  Google Scholar 

  25. Menditto A, Patriarca M, Magnusson B (2006) Understanding the meaning of accuracy, trueness and precision. Accredit Qual Assur 12(1):45–47. doi:10.1007/s00769-006-0191-z

    Article  Google Scholar 

  26. NDI (2007) IL-1070071: Polaris Tool Design Guide, Rev. 004. Tech. rep., Nothern Digital Inc

  27. NDI (2008) IL-1070116: Passive Polaris Spectra User Guide, Rev. 004. Tech. rep., Nothern Digital Inc

  28. NDI (2015) Polaris Optical Tracking Systems. http://www.ndigital.com/medical/products/polaris-family/, Accessed 15 Oct 2015, Nothern Digital Inc

  29. Nolden M, Zelzer S, Seitel A, Wald D, Müller M, Franz AM, Maleike D, Fangerau M, Baumhauer M, Maier-Hein L, Maier-Hein KH, Meinzer HP, Wolf I (2013) The medical imaging interaction toolkit: challenges and advances. Int J Comput Assist Radiol Surg 8(4):607–620. doi:10.1007/s11548-013-0840-8

    Article  PubMed  Google Scholar 

  30. Perier P, Hohenberger W, Lakew F, Batz G, Diegeler A (2013) Rate of repair in minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2(6):751–757. doi:10.3978/j.issn.2225-319X.2013.10.12

    PubMed  PubMed Central  Google Scholar 

  31. Seeburger J, Noack T, Winkfein M, Ender J, Mohr FW (2010) Loop technique. MMCTS 2010(0809):mmcts.2010.004,523. doi:10.1510/mmcts.2010.004523

  32. West J, Maurer JCR (2004) Designing optically tracked instruments for image-guided surgery. IEEE Trans Med Imaging 23(5):533–545. doi:10.1109/TMI.2004.825614

    Article  PubMed  Google Scholar 

  33. Wiles AD, Thompson DG, Frantz DD (2004) Accuracy assessment and interpretation for optical tracking systems. In: Proc SPIE, Medical Imaging 5367:421–432. doi:10.1117/12.536128

  34. Yaniv Z (2015) Which pivot calibration? In: Proc SPIE, Medical Imaging, vol 9415, p 941527. doi:10.1117/12.2081348

  35. Yaniv Z, Cleary K (2006) CAIMR TR-2006-3: Image-guided procedures: A Review. Tech. rep. Georgetown University

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Acknowledgments

This work was carried out with support of the German Research Foundation (DFG) as part of project B01, SFB/TRR 125 Cognition-Guided Surgery. We thank the Division of fine mechanics for manufacturing the instruments and Jörg Rodrian for his technical support.

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Authors and Affiliations

  1. Medical and Biological Informatics, German Cancer Research Center (DKFZ), Heidelberg, Germany

    Sandy Engelhardt, Silvio Kolb, Hans-Peter Meinzer & Ivo Wolf

  2. Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany

    Raffaele De Simone, Sameer Al-Maisary & Matthias Karck

  3. Department of Computer Science, Mannheim University of Applied Science, Mannheim, Germany

    Ivo Wolf

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  1. Sandy Engelhardt
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  2. Raffaele De Simone
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  6. Hans-Peter Meinzer
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Correspondence to Sandy Engelhardt.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or National Research Committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Engelhardt, S., De Simone, R., Al-Maisary, S. et al. Accuracy evaluation of a mitral valve surgery assistance system based on optical tracking. Int J CARS 11, 1891–1904 (2016). https://doi.org/10.1007/s11548-016-1353-z

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  • DOI: https://doi.org/10.1007/s11548-016-1353-z

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