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1.
Cureus ; 14(8): e28387, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36176855

RESUMO

Frame-based stereotactic localization is an important step for targeting during a surgical procedure. The motion may cause artifacts in this step reducing the accuracy of surgical targeting. While modeling of motion in real-life scenarios may be difficult, herein we analyzed the case where motion was suspected to impact the localization step. In this case, a scan with and without motion was performed with a 3N localizer, allowing for a thorough analysis. Pseudo-bending of straight rods was seen when analyzing the data. This pseudo-bending appears to occur because head-frame motion during imaging acquisition decreases the accuracy of the subsequent reconstruction, which depends on Digital Imaging and Communications in Medicine (DICOM) metadata to specify the slice-to-slice location that assumes embedded object stability. Comparison of single-slice and multi-slice stereotactic localization allowed for comparative errors for each slice in a volume. This comparative error demonstrated low error when the patient was under general anesthesia and presumed not to have moved, whereas a higher error was present during the scan with motion. Pseudo-bending can be corrected by using only localizer fiducial-based information to reorient the pixels in the volume, thus creating a reoriented localizer scan. Finally, targeting demonstrated a low error of 0.1 mm (+/- 0.1 mm) using this reoriented localizer scan, signifying that this method could be used to improve or recover from motion problems. Finally, it is concluded that stability and elimination of motion for all images utilized for stereotactic surgery are critical to ensure the best possible accuracy for the procedure.

2.
Cureus ; 14(3): e23279, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35449621

RESUMO

Frame-based stereotactic localization generally assumes that all required fiducials are present in a single-slice image which can then be used to form targeting coordinates. Previously, we have published the use of novel localizers and mathematics that can improve stereotactic localization. As stereotactic procedures include numerous imaging slices, we sought to investigate, develop, and test techniques that utilize multiple slices for stereotactic localization and provide a solution for a parallel bipanel N-localizer.  Several multi-slice equations were tested. Specifically, multi-slice stereotactic matrices (ms-SM) and multi-slice normal to parallel planes (ms-nPP) were of particular interest. Bipanel (2N) and tripanel (3N) localizer images were explored to test approaches for stereotactic localization. In addition, combination approaches using single-slice stereotactic matrices (ss-SM) and multi-slice methods were tested. Modification of ss-SM to form ms-SM was feasible. Likewise, a method to determine ms-nPP was developed. For the special case of the parallel bipanel N-localizer, single-slice and multi-slice methods fail, but a novel non-linear solution is a robust solution for ms-nPP. Several methods for single-slice and multi-slice stereotactic localization are described and can be adapted for nearly any stereotactic system. It is feasible to determine ms-SM and ms-nPP. In particular, these methods provide an overdetermined means to calculate the vertical z, which is determined for a tripanel system using single-slice methods. In addition, the multi-slice methods can be used for extrapolation outside of the localizer space. Importantly, a novel non-linear solution can be used for parallel bipanel N-localizer systems, where other methods fail. Finally, multi-slice stereotactic localization assumes strict patient and imaging system stability, which should be carefully assessed for each case.

3.
Cureus ; 13(9): e17905, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34660100

RESUMO

Image guidance for frame-based stereotaxis is facilitated by incorporating three to four Sturm-Pastyr (SP) localizers into a stereotactic frame. Typically, each SP localizer enables the calculation of one set of [Formula: see text] coordinates in the three-dimensional coordinate system of the stereotactic frame, given three sets of [Formula: see text] coordinates created by the SP localizer in the two-dimensional coordinate system of a computed tomography (CT) image. Bouza and Brown propose formulas to calculate three sets of [Formula: see text] coordinates for each SP localizer. Monte Carlo (MC) simulation compares the accuracy of the new formulation to the accuracy of the original SP formulation that calculates only one set of [Formula: see text] coordinates for each SP localizer. Monte Carlo simulation reveals that the calculation of three sets of [Formula: see text] coordinates instead of only one set improves the accuracy of image guidance.

4.
Cureus ; 13(6): e15620, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34277238

RESUMO

INTRODUCTION: The N-localizer is generally utilized in a 3-panel or, more rarely, a 4-panel system for computing stereotactic positions. However, a stereotactic frame that incorporates a 2-panel (bipanel) N-localizer system with panels affixed to only the left and right sides of the frame offers several advantages: improved ergonomics to attach the panels, reduced claustrophobia for the patient, mitigation of posterior panel contact with imaging systems, and reduced complexity. A bipanel system that comprises two standard N-localizer panels yields only two three-dimensional (3D) coordinates, which are insufficient to solve for the stereotactic matrix without further information. While additional information to determine the stereotactic positions could include scalar distances from Digital Imaging and Communications in Medicine (DICOM) metadata or 3D regression across the imaging volume, both have risks related to noise and error propagation. Therefore, we sought to develop new stereotactic localizers that comprise only lateral fiducials (bipanel) that leave the front and back regions of the patient accessible but that contain enough information to solve for the stereotactic matrix using each image independently.  Methods: To solve the stereotactic matrix, we assumed the need to compute three or more 3D points from a single image. Several localizer options were studied using Monte Carlo simulations to understand the effect of errors on the computed target location. The simulations included millions of possible combinations for computing the stereotactic matrix in the presence of random errors of 1mm magnitude. The matrix then transformed coordinates for a target that was placed 50mm anterior, 50mm posterior, 50mm lateral, or 50mm anterior and 50mm lateral to the centre of the image. Simulated cross-sectional axial images of the novel localizer systems were created and converted into DICOM images representing computed tomography (CT) images.  Results: Three novel models include the M-localizer, F-localizer, and Z-localizer. For each of these localizer systems, optimized results were obtained using an overdetermined system of equations made possible by more than three diagonal bars. In each case, the diagonal bar position was computed using standard N-localizer mathematics. Additionally, the M-localizer allowed adding a computation using the Sturm-Pastyr method. Monte Carlo simulation demonstrated that the Z-localizer provided optimal results. CONCLUSION: The three proposed novel models meet our design objectives. Of the three, the Z-localizer produced the least propagation of error. The M-localizer was simpler and had slightly more error than the Z-localizer. The F-localizer produced more error than either the Z-localizer or M-localizer. Further study is needed to determine optimizations using these novel models.

5.
Cureus ; 13(7): e16535, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34327109

RESUMO

Image-guidance for frame-based stereotaxis is facilitated by incorporating three to four N-localizers or Sturm-Pastyr localizers into a stereotactic frame. An extant frame that incorporates only two N-localizers violates the fundamental principle of the N-localizer, which requires three non-colinear points to define a plane in three-dimensional space. Hence, this two N-localizer configuration is susceptible to error. The present article proposes the V-localizer that comprises multiple diagonal bars to provide four or more non-colinear points to minimize error.

6.
Med Phys ; 48(7): 4038-4052, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33797098

RESUMO

PURPOSE: Small animal irradiators are equipped with x-ray beams and cone collimators with millimeter dimensions to be used in preclinical research. The use of small fields in the kV energy range may require the application of energy-dependent, field size-dependent, or depth-dependent correction factors to the dosimetric data acquired for treatment planning system (TPS) commissioning purposes to obtain accurate dose values. Considering that these corrections are also detector dependent, the suitability of a synthetic single-crystal diamond detector for small-field relative dosimetry in a preclinical irradiator (220-kVp) was evaluated to avoid the necessity of applying correction factors during TPS commissioning. METHODS: The detector response was assessed during the transition for field sizes ranging from 20 × 20 mm2 to 3 × 3 mm2 , using the small animal radiation research platform (SARRP). The percentage depth dose distributions (PDDs), lateral profiles and output factors (OFs) were measured. The PDDs for the synthetic diamond detector were compared to the distributions acquired using a small-volume microchamber (0.016 cm3 ) and with Monte Carlo calculations using the MC3D in-house software package. The profiles and OFs were compared to the data from a silicon solid-state detector and to radiochromic film data provided by the manufacturer; for the OF determination, measurements made using a microchamber were added for comparison. The performance of several detectors used as references was previously validated for relative dosimetry in preclinical irradiators. A commercial TPS was commissioned for the factor-based algorithm, using the data acquired with the diamond detector, and no additional correction factors were applied. To verify the performance of the TPS and the accuracy of the dosimetric methodology, radiochromic film irradiation in water was conducted, and two-dimensional (2D) dose distributions in the coronal and axial planes were compared under different gamma criteria. RESULTS: Compared with the microchamber and MC3D distributions, the agreement of the PDDs using the synthetic diamond detector was better than 2%. The profile data exhibited very good agreement compared with the data from the silicon detector, with an average and a maximum difference of 0.31 and 0.39 mm in the penumbras, respectively. Compared with the data from the radiochromic film, the average and maximum differences were equal to 0.77 and 0.89 mm, respectively. Very good agreement, within 1%, was obtained between the OFs measured with the synthetic diamond detector and the radiochromic film, compared only for the cone collimators. The validation of the TPS commissioning using gamma criteria compared to film showed an average passing rate of 100% and 93.2% with a global gamma criterion of 1 mm/3% for the coronal and axial planes, respectively, including the 3 × 3 mm2 field size and penumbra regions. CONCLUSIONS: Synthetic diamond is a suitable detector for the complete relative dosimetry of small x-ray fields. The commissioning of the TPS with its own beam dosimetric data exhibited encouraging results even in a 3 × 3 mm2 field and penumbra region. This methodology allows for the prediction of 2D dose distributions with an accuracy in water ranging from 3 to 5% compared to the 2D distribution from film dosimetry.


Assuntos
Diamante , Radiometria , Animais , Dosimetria Fotográfica , Método de Monte Carlo , Raios X
7.
Cureus ; 13(2): e13393, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33758694

RESUMO

INTRODUCTION:  Frame-based stereotaxis has been widely utilized for precise neurosurgical procedures throughout the world for nearly 40 years. The N-localizer is an integral component of most of the extant systems. Analysis of targeting errors related to the N-localizer has not been carried out in sufficient detail. We highlight these potential errors and develop methods to reduce them.  Methods: N-localizer systems comprising three and four N-localizers of various geometries were analyzed using Monte Carlo (MC) simulations. The simulations included native and altered geometric dimensions (Width [W] x Height [H]). Errors were computed using the MC simulations that included the x- and y-axes of vertically oriented rods, that altered the W/H ratio, and that added a fourth N-localizer to a three N-localizer system.  Results: The inclusion of an overdetermined system of equations and the geometries of the N-localizer systems had significant effects on target errors. Root Mean Square Errors (RMS-e) computed via millions of MC iterations for each study demonstrated that errors were reduced by (1) inclusion of the x- and y-coordinates of the vertically oriented rods, (2) a greater triangular area enclosed by the diagonal fiducials of the N-localizer system (stereotactic triangle), (3) a larger W/H ratio, and (4) an N-localizer system that comprised four N-localizers. CONCLUSION: Monte Carlo simulations of Root Mean Square error (RMS-e) is a useful technique to understand targeting while using N-localizer systems in stereotactic neurosurgery. The application of vertical rod positions enhances computational accuracy and can be performed on any N-localizer system. Keeping the target point within the stereotactic triangle enclosed by the diagonal rods can also reduce errors. Additional optimizations of N-localizer geometry may also reduce potential targeting errors. Further analysis is needed to confirm these findings which may have clinical importance.

8.
Cureus ; 12(7): e9137, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32685325

RESUMO

The N-localizer and the Sturm-Pastyr localizer are two technologies that facilitate image-guided stereotactic surgery. Both localizers enable the geometric transformation of tomographic image data from the two-dimensional coordinate system of a medical image into the three-dimensional coordinate system of the stereotactic frame. Monte Carlo simulations reveal that the Sturm-Pastyr localizer is less accurate than the N-localizer in the presence of image noise.

9.
Cureus ; 12(6): e8578, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32670714

RESUMO

All stereotactic neurosurgical procedures utilize coordinate systems to allow navigation through the brain to a target. During the surgical planning, indirect and direct targeting determines the planned target point and trajectory. This targeting allows a surgeon to precisely reach points along the trajectory while minimizing risks to critical structures. Oftentimes, once a target point and a trajectory are determined, a frame-based coordinate system is used for the actual procedure. Considerations include the use of various coordinate spaces such as the anatomical ([Formula: see text]), the frame ([Formula: see text]), the head-stage ([Formula: see text]), and an atlas. Therefore, the relationships between these coordinate systems are integral to the planning and implementation of the neurosurgical procedure. Although coordinate transformations are handled in planning via stereotactic software, critical understanding of the mathematics is required as it has implications during surgery. Further, intraoperative applications of these coordinate conversions, such as for surgical navigation from the head-stage, are not readily available in real-time. Herein, we discuss how to navigate these coordinate systems and provide implementations of the techniques with samples.

10.
Cureus ; 12(4): e7904, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32494519

RESUMO

Ray tracing (RT) and perspective projection (PP) using fiducial-based registration can be used to determine points of interest in biplanar X-ray imaging. We sought to investigate the implementation of these techniques as they pertain to X-ray imaging geometry. The mathematical solutions are presented and then implemented in a phantom and actual case with numerical tables and imaging. The X-ray imaging is treated like a Cartesian system in millimeters (mm) with a standard frame-based stereotactic system. In this space, the point source is the X-ray emitter (focal spot), the plane is the X-ray detector, and fiducials are in between the source and plane. In a phantom case, RT was able to predict locations of fiducials after moving the point source. Also, a scaled PP matrix could be used to determine imaging geometry, which could then be used in RT. Automated identification of spherical fiducials in 3D was possible using a center of mass computation with average Euclidean error relative to manual measurement of 0.23 mm. For PP, RT projection or a combinatorial approach could be used to facilitate matching 3D to 2D points. Despite being used herein for deep brain stimulation (DBS), utilization of this kind of imaging analysis has wide medical and non-medical applications.

11.
Oper Neurosurg (Hagerstown) ; 19(3): 302-312, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31858143

RESUMO

BACKGROUND: Efficacy in deep brain stimulation (DBS) is dependent on precise positioning of electrodes within the brain. Intraoperative fluoroscopy, computed tomography (CT), or magnetic resonance imaging are used for stereotactic intraoperative localization (StIL), but the utility of biplanar X-ray has not been evaluated in detail. OBJECTIVE: To determine if analysis of orthogonal biplanar X-rays using graphical analysis (GA), ray tracing (RT), and/or perspective projection (PP) can be utilized for StIL. METHODS: A review of electrode tip positions comparing postoperative CT to X-ray methods was performed for DBS operations containing orthogonal biplanar X-ray with referential spheres and pins. RESULTS: Euclidean (Re) errors for final DBS electrode position on intraoperative X-rays vs postoperative CT using GA, RT, and PP methods averaged 1.58 mm (±0.75), 0.74 mm (±0.45), and 1.07 mm (±0.64), respectively (n = 56). GA was more accurate with a ventriculogram. RT and PP predicted positions that correlated with third ventricular structures on ventriculogram cases. RT was the most stable but required knowledge of the geometric setup. PP was more flexible than RT but required well-distributed reference points. A single case using the O-arm demonstrated Re errors of 0.43 mm and 0.28 mm for RT and PP, respectively. In addition, these techniques could also be used to calculate directional electrode rotation. CONCLUSION: GA, RT, and PP can be employed for precise StIL during DBS using orthogonal biplanar X-ray. These methods may be generalized to other stereotactic procedures or instances of biplanar imaging such as angiograms, radiosurgery, or injection therapeutics.


Assuntos
Estimulação Encefálica Profunda , Cirurgia Assistida por Computador , Eletrodos Implantados , Humanos , Imageamento Tridimensional , Tomografia Computadorizada por Raios X , Raios X
12.
Cureus ; 10(1): e2126, 2018 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-29607274

RESUMO

Stereotactic surgery planning software has been created for use with the Brown-Roberts-Wells (BRW) stereotactic frame. This software replaces the Hewlett-Packard calculator originally supplied with the BRW frame and provides modern tools for surgery planning to the BRW frame, which facilitate its potential use as a low-cost alternative to the Cosman-Roberts-Wells (CRW) frame in developing countries.

13.
Artigo em Espanhol | LILACS | ID: lil-97487

RESUMO

Se expone en este trabajo la utilidad del empleo de sistemas de adquisición y procesamiento de datos en el diagnóstico por imágenes en Medicina Nuclear, así como la experiencia alcanzada en el Instituto Nacional de Oncología y Radiobiología en los últimos 8 años en la explotación de uno de estos sistemas acoplados a una cámara gamma. También se expone la utilidad de la computación en la planificación y optimización de tratamientos radioterapéuticos, se hace énfasis en la descripción del sistema RTP diseñado con este propósito en la Institución, para ser empleado en microcomputadoras NEC PC 9801F o IBM compatibles. Este sistema fue desarrollado en lenguaje Turbo Pascal versión 4.0


Assuntos
Diagnóstico por Imagem , Microcomputadores , Neoplasias , Neoplasias/radioterapia , Medicina Nuclear
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