Comparison of Elastic and Rigid Registration during Magnetic Resonance Imaging/Ultrasound Fusion-Guided Prostate Biopsy: A Multi-Operator Phantom Study.

PURPOSE: The relative value of rigid or elastic registration during magnetic resonance imaging/ultrasound fusion guided prostate biopsy has been poorly studied. We compared registration errors (the distance between a region of interest and fiducial markers) between rigid and elastic registration during fusion guided prostate biopsy using a prostate phantom model. MATERIALS AND METHODS: Four gold fiducial markers visible on magnetic resonance imaging and ultrasound were placed throughout 1 phantom prostate model. The phantom underwent magnetic resonance imaging and the fiducial markers were labeled as regions of interest. An experienced user and a novice user of fusion guided prostate biopsy targeted regions of interest and then the corresponding fiducial markers on ultrasound after rigid and then elastic registration. Registration errors were compared. RESULTS: A total of 224 registration error measurements were recorded. Overall elastic registration did not provide significantly improved registration error over rigid registration (mean ± SD 4.87 ± 3.50 vs 4.11 ± 2.09 mm, p = 0.05). However, lesions near the edge of the phantom showed increased registration errors when using elastic registration (5.70 ± 3.43 vs 3.23 ± 1.68 mm, p = 0.03). Compared to the novice user the experienced user reported decreased registration error with rigid registration (3.25 ± 1.49 vs 4.98 ± 2.10 mm, p <0.01) and elastic registration (3.94 ± 2.61 vs 6.07 ± 4.16 mm, p <0.01). CONCLUSIONS: We found no difference in registration errors between rigid and elastic registration overall but rigid registration decreased the registration error of targets near the prostate edge. Additionally, operator experience reduced registration errors regardless of the registration method. Therefore, elastic registration algorithms cannot serve as a replacement for attention to detail during the registration process and anatomical landmarks indicating accurate registration when beginning the procedure and before targeting each region of interest.

Phantom with multiple active points for ultrasound calibration.

Accurate tracking and localization of ultrasound (US) images are used in various computer-assisted interventions. US calibration is a preoperative procedure to recover the transformation bridging the tracking sensor and the US image coordinate systems. Although many calibration phantom designs have been proposed, a limitation that hinders the resulted calibration accuracy is US elevational beam thickness. Previous studies have proposed an active-echo (AE)-based calibration concept to overcome this limitation by utilizing dynamic active US feedback from a single PZT element-based phantom, which assists in placing the phantom within the US elevational plane. However, the process of searching elevational midplane is time-consuming and requires dedicated hardware to enable "AE" functionality. Extending this active phantom, we present a US calibration concept and associated mathematical framework enabling fast and accurate US calibration using multiple "active" points. The proposed US calibration can simplify the calibration procedure by minimizing the number of times midplane search is performed and shortening calibration time. This concept is demonstrated with a configuration mechanically tracking a US probe using a robot arm. We validated the concept through simulation and experiment, and achieved submillimeter calibration accuracy. This result indicates that the multiple active-point phantom has potential to provide superior calibration performance for applications requiring high tracking accuracy.

Photoacoustic-based catheter tracking: simulation, phantom, and in vivo studies.

Catheters are commonly used in many procedures and tracking and localizing them is critical to patient safety and surgical success. The standard of care for catheter tracking is with the use of fluoroscopy. Alternatives using conventional tracking technologies such as electromagnetic trackers have been previously explored. This work explores the use of an emerging imaging modality, photoacoustics, as a means for tracking. A piezoelectric (PZT) sensor is placed at the tip of the catheter, allowing it to receive the acoustic signals generated from photoacoustic markers due to the photoacoustic effect. The locations of these photoacoustic markers are determined by a stereo-camera and the received acoustic signals are converted into distances between the PZT element and the photoacoustic markers. The location of the PZT sensor can be uniquely determined following a multilateration process. This work validates this photoacoustic tracking method in phantom, simulation, and in vivo scenarios using metrics including reconstruction precision, relative accuracy, estimated accuracy, and leave-out accuracy. Submillimeter tracking results were achieved in phantom experiments. Simulation studies evaluated various physical parameters relating to the photoacoustic source and the PZT sensor. In vivo results showed feasibility for the eventual deployment of this technology.

Active phantoms: a paradigm for ultrasound calibration using phantom feedback.

In ultrasound (US)-guided medical procedures, accurate tracking of interventional tools is crucial to patient safety and clinical outcome. This requires a calibration procedure to recover the relationship between the US image and the tracking coordinate system. In literature, calibration has been performed on passive phantoms, which depend on image quality and parameters, such as frequency, depth, and beam-thickness as well as in-plane assumptions. In this work, we introduce an active phantom for US calibration. This phantom actively detects and responds to the US beams transmitted from the imaging probe. This active echo (AE) approach allows identification of the US image midplane independent of image quality. Both target localization and segmentation can be done automatically, minimizing user dependency. The AE phantom is compared with a crosswire phantom in a robotic US setup. An out-of-plane estimation US calibration method is also demonstrated through simulation and experiments to compensate for remaining elevational uncertainty. The results indicate that the AE calibration phantom can have more consistent results across experiments with varying image configurations. Automatic segmentation is also shown to have similar performance to manual segmentation.

Enabling technologies for robot assisted ultrasound tomography.

Currently available ultrasound (US) tomography systems suggest utilizing cylindrical transducers that can be used for a specific organ. In this paper, our focus is on an alternative way of creating US tomographic images that could be used for other anatomies and more general applications. This system consists of two conventional US probes facing each other while one or several of the transducers in one probe can act as the transmitter and the rest as the receiver. Aligning the two US probes is a challenging task. To address this issue, we propose a robot assisted US tomography system in which one probe is operated freehanded and another by a robotic arm. In this paper, enabling technologies for this system are described. With the current prototype, a reconstruction precision of 4.12, 1.73, and 2.23 mm for the three calibrations, and an overall alignment repeatability in the range of 5-9 mm were achieved. Copyright © 2016 John Wiley & Sons, Ltd.

Synthetic tracked aperture ultrasound imaging: design, simulation, and experimental evaluation.

Ultrasonography is a widely used imaging modality to visualize anatomical structures due to its low cost and ease of use; however, it is challenging to acquire acceptable image quality in deep tissue. Synthetic aperture (SA) is a technique used to increase image resolution by synthesizing information from multiple subapertures, but the resolution improvement is limited by the physical size of the array transducer. With a large F-number, it is difficult to achieve high resolution in deep regions without extending the effective aperture size. We propose a method to extend the available aperture size for SA-called synthetic tracked aperture ultrasound (STRATUS) imaging-by sweeping an ultrasound transducer while tracking its orientation and location. Tracking information of the ultrasound probe is used to synthesize the signals received at different positions. Considering the practical implementation, we estimated the effect of tracking and ultrasound calibration error to the quality of the final beamformed image through simulation. In addition, to experimentally validate this approach, a 6 degree-of-freedom robot arm was used as a mechanical tracker to hold an ultrasound transducer and to apply in-plane lateral translational motion. Results indicate that STRATUS imaging with robotic tracking has the potential to improve ultrasound image quality.

Robot-assisted automatic ultrasound calibration.

PURPOSE: Ultrasound (US) calibration is the process of determining the unknown transformation from a coordinate frame such as the robot's tooltip to the US image frame and is a necessary task for any robotic or tracked US system. US calibration requires submillimeter-range accuracy for most applications, but it is a time-consuming and repetitive task. We provide a new framework for automatic US calibration with robot assistance and without the need for temporal calibration. METHOD: US calibration based on active echo (AE) phantom was previously proposed, and its superiority over conventional cross-wire phantom-based calibration was shown. In this work, we use AE to guide the robotic arm motion through the process of data collection; we combine the capability of the AE point to localize itself in the frame of the US image with the automatic motion of the robotic arm to provide a framework for calibrating the arm to the US image automatically. RESULTS: We demonstrated the efficacy of the automated method compared to the manual method through experiments. To highlight the necessity of frequent ultrasound calibration, it is demonstrated that the calibration precision changed from 1.67 to 3.20 mm if the data collection is not repeated after a dismounting/mounting of the probe holder. In a large data set experiment, similar reconstruction precision of automatic and manual data collection was observed, while the time was reduced by 58 %. In addition, we compared ten automatic calibrations with ten manual ones, each performed in 15 min, and showed that all the automatic ones could converge in the case of setting the initial matrix as identity, while this was not achieved by manual data sets. Given the same initial matrix, the repeatability of the automatic was [0.46, 0.34, 0.80, 0.47] versus [0.42, 0.51, 0.98, 1.15] mm in the manual case for the US image four corners. CONCLUSIONS: The submillimeter accuracy requirement of US calibration makes frequent data collections unavoidable. We proposed an automated calibration setup and showed feasibility by implementing it for a robot tooltip to US image calibration. The automated method showed a similar reconstruction precision as well as repeatability compared to the manual method, while the time consumed for data collection was reduced. The automatic method also reduces the burden of data collection for the user. Thus, the automated method can be a viable solution for applications that require frequent calibrations.

Minimally invasive registration for computer-assisted orthopedic surgery: combining tracked ultrasound and bone surface points via the P-IMLOP algorithm.

PURPOSE: We present a registration method for computer-assisted total hip replacement (THR) surgery, which we demonstrate to improve the state of the art by both reducing the invasiveness of current methods and increasing registration accuracy. A critical element of computer-guided procedures is the determination of the spatial correspondence between the patient and a computational model of patient anatomy. The current method for establishing this correspondence in robot-assisted THR is to register points intraoperatively sampled by a tracked pointer from the exposed proximal femur and, via auxiliary incisions, from the distal femur. METHODS: In this paper, we demonstrate a noninvasive technique for sampling points on the distal femur using tracked B-mode ultrasound imaging and present a new algorithm for registering these data called Projected Iterative Most-Likely Oriented Point (P-IMLOP). Points and normal orientations of the distal bone surface are segmented from ultrasound images and registered to the patient model along with points sampled from the exposed proximal femur via a tracked pointer. RESULTS: The proposed approach is evaluated using a bone- and tissue-mimicking leg phantom constructed to enable accurate assessment of experimental registration accuracy with respect to a CT-image-based model of the phantom. These experiments demonstrate that localization of the femur shaft is greatly improved by tracked ultrasound. The experiments further demonstrate that, for ultrasound-based data, the P-IMLOP algorithm significantly improves registration accuracy compared to the standard ICP algorithm. CONCLUSION: Registration via tracked ultrasound and the P-IMLOP algorithm has high potential to reduce the invasiveness and improve the registration accuracy of computer-assisted orthopedic procedures.

Active echo: a new paradigm for ultrasound calibration.

In ultrasound-guided medical procedures, accurate tracking of interventional tools with respect to the US probe is crucial to patient safety and clinical outcome. US probe tracking requires an unavoidable calibration procedure to recover the rigid body transformation between the US image and the tracking coordinate system. In literature, almost all calibration methods have been performed on passive phantoms. There are several challenges to these calibration methods including dependency on ultrasound image quality and parameters such as frequency, depth, and beam-thickness. In this work, for the first time we introduce an active echo (AE) phantom for US calibration. The phantom actively detects and responds to the US beams from the imaging probe. This active approach allows reliable and accurate identification of the ultrasound image mid-plane independent of the image quality. It also enables automatic point segmentations. Both the target localization and segmentation can be done automatically, so the user dependency is minimized. The AE phantom is compared with a gold standard crosswire (CW) phantom in a robotic US experimental setup. The result indicates that AE calibration phantom provides a localization precision of 223 µm, and an overall reconstruction error of 850 µm. Autosegmentation is also tested and proved to have the similar performance as the manual segmentation.

Direct three-dimensional ultrasound-to-video registration using photoacoustic markers.

Modern surgical procedures often have a fusion of video and other imaging modalities to provide the surgeon with information support. This requires interventional guidance equipment and surgical navigation systems to register different tools and devices together, such as stereoscopic endoscopes and ultrasound (US) transducers. In this work, the focus is specifically on the registration between these two devices. Electromagnetic and optical trackers are typically used to acquire this registration, but they have various drawbacks typically leading to target registration errors (TRE) of approximately 3 mm. We introduce photoacoustic markers for direct three-dimensional (3-D) US-to-video registration. The feasibility of this method was demonstrated on synthetic and ex vivo porcine liver, kidney, and fat phantoms with an air-coupled laser and a motorized 3-D US probe. The resulting TRE for each experiment ranged from 380 to 850 µm with standard deviations ranging from 150 to 450 µm. We also discuss a roadmap to bring this system into the surgical setting and possible challenges along the way.

An augmented reality system for epidural anesthesia (AREA): prepuncture identification of vertebrae.

We propose an augmented reality system to identify lumbar vertebral levels to assist in spinal needle insertion for epidural anesthesia. These procedures require careful placement of a needle to ensure effective delivery of anesthetics and to avoid damaging sensitive tissue such as nerves. In this system, a trinocular camera tracks an ultrasound transducer during the acquisition of a sequence of B-mode images. The system generates an ultrasound panorama image of the lumbar spine, automatically identifies the lumbar levels in the panorama image, and overlays the identified levels on a live camera view of the patient's back. Validation is performed to test the accuracy of panorama generation, lumbar level identification, overall system accuracy, and the effect of changes in the curvature of the spine during the examination. The results from 17 subjects demonstrate the feasibility and capability of achieving an error within clinically acceptable range for epidural anaesthesia.

Direct 3D ultrasound to video registration using photoacoustic effect.

Interventional guidance systems require surgical navigation systems to register different tools and devices together. Standard navigation systems have various drawbacks leading to target registration errors (TRE) of around 3mm. The aim of this work is to introduce the photoacoustic (PA) effect as a direct 3D ultrasound (US) to video registration method. We present our experimental setup and demonstrate its feasibility on both a synthetic phantom and an ex vivo tissue phantom. We achieve an average TRE of 560 microns and standard deviation of 280 microns on a synthetic phantom. Also, an average TRE of 420 microns and standard deviation of 150 microns on the ex vivo tissue phantom are obtained. We describe a roadmap to bring this system into the surgical setting and highlight possible challenges along the way.

AREA: an augmented reality system for epidural anaesthesia.

PURPOSE: Spinal needle injection procedures are used for anesthesia and analgesia, such as lumbar epidurals. These procedures require careful placement of a needle, both to ensure effective therapy delivery and to avoid damaging sensitive tissue such as the spinal cord. An important step in such procedures is the accurate identification of the vertebral levels, which is currently performed using manual palpation with a reported 30% success rate for correct identification. METHODS: An augmented reality system was developed to help identify the lumbar vertebral levels. The system consists of an ultrasound transducer tracked in real time by a trinocular camera system, an automatic ultrasound panorama generation module that provides an extended view of the lumbar vertebrae, an image processing technique that automatically identifies the vertebral levels in the panorama image, and a graphical interface that overlays the identified levels on a live camera view of the patient's back. RESULTS: Validation was performed on ultrasound data obtained from 10 subjects with different spine arching. The average success rate for segmentation of the vertebrae was 85%. The automatic level identification had an average accuracy of 6.6 mm. CONCLUSION: The prototype system demonstrates better accuracy for identifying the vertebrae than traditional manual methods.