Evaluation of a calibration rig for stereo laparoscopes.

BACKGROUND: Accurate camera and hand-eye calibration are essential to ensure high-quality results in image-guided surgery applications. The process must also be able to be undertaken by a nonexpert user in a surgical setting. PURPOSE: This work seeks to identify a suitable method for tracked stereo laparoscope calibration within theater. METHODS: A custom calibration rig, to enable rapid calibration in a surgical setting, was designed. The rig was compared against freehand calibration. Stereo reprojection, stereo reconstruction, tracked stereo reprojection, and tracked stereo reconstruction error metrics were used to evaluate calibration quality. RESULTS: Use of the calibration rig reduced mean errors: reprojection (1.47 mm [SD 0.13] vs. 3.14 mm [SD 2.11], p-value 1e-8), reconstruction (1.37 px [SD 0.10] vs. 10.10 px [SD 4.54], p-value 6e-7), and tracked reconstruction (1.38 mm [SD 0.10] vs. 12.64 mm [SD 4.34], p-value 1e-6) compared with freehand calibration. The use of a ChArUco pattern yielded slightly lower reprojection errors, while a dot grid produced lower reconstruction errors and was more robust under strong global illumination. CONCLUSION: The use of the calibration rig results in a statistically significant decrease in calibration error metrics, versus freehand calibration, and represents the preferred approach for use in the operating theater.

Dimensions of ecological validity for usability evaluations in clinical settings.

The development, evaluation, and eventual deployment of novel medical devices is a complex process involving various areas of expertise. Although the need for a User Centred Design approach to the development of both hardware and software has long been established, both current regulatory guidelines and widespread evaluation approaches fail to reflect the challenges encountered during day-to-day clinical practice. As such, the results from these evaluations may not provide a realistic account of the problems encountered by users when introduced to clinical practice. In this paper, we present a case study on designing the evaluation of a novel device to support laparoscopic liver surgery. Through a reflective account of the design of our usability evaluation, we identify and describe seven primary dimensions of ecological validity encountered in clinical usability evaluations. These dimensions are: 'user roles', 'environment', 'training', 'scenario', 'patient involvement', 'software', and 'hardware'. We analyse three recently published clinical usability evaluation articles to assess (and illustrate) the applicability and completeness of these dimensions. Finally, we discuss the compromises encountered during clinical usability evaluations and how to best report on these considerations. The framework presented here aims to further the agenda of ecologically valid evaluation practice, reflecting the constraints of medical practice.

Electromagnetic tracking in image-guided laparoscopic surgery: Comparison with optical tracking and feasibility study of a combined laparoscope and laparoscopic ultrasound system.

PURPOSE: In image-guided laparoscopy, optical tracking is commonly employed, but electromagnetic (EM) systems have been proposed in the literature. In this paper, we provide a thorough comparison of EM and optical tracking systems for use in image-guided laparoscopic surgery and a feasibility study of a combined, EM-tracked laparoscope and laparoscopic ultrasound (LUS) image guidance system. METHODS: We first assess the tracking accuracy of a laparoscope with two optical trackers tracking retroreflective markers mounted on the shaft and an EM tracker with the sensor embedded at the proximal end, using a standard evaluation plate. We then use a stylus to test the precision of position measurement and accuracy of distance measurement of the trackers. Finally, we assess the accuracy of an image guidance system comprised of an EM-tracked laparoscope and an EM-tracked LUS probe. RESULTS: In the experiment using a standard evaluation plate, the two optical trackers show less jitter in position and orientation measurement than the EM tracker. Also, the optical trackers demonstrate better consistency of orientation measurement within the test volume. However, their accuracy of measuring relative positions decreases significantly with longer distances whereas the EM tracker's performance is stable; at 50 mm distance, the RMS errors for the two optical trackers are 0.210 and 0.233 mm, respectively, and it is 0.214 mm for the EM tracker; at 250 mm distance, the RMS errors for the two optical trackers become 1.031 and 1.178 mm, respectively, while it is 0.367 mm for the EM tracker. In the experiment using the stylus, the two optical trackers have RMS errors of 1.278 and 1.555 mm in localizing the stylus tip, and it is 1.117 mm for the EM tracker. Our prototype of a combined, EM-tracked laparoscope and LUS system using representative calibration methods showed a RMS point localization error of 3.0 mm for the laparoscope and 1.3 mm for the LUS probe, the lager error of the former being predominantly due to the triangulation error when using a narrow-baseline stereo laparoscope. CONCLUSIONS: The errors incurred by optical trackers, due to the lever-arm effect and variation in tracking accuracy in the depth direction, would make EM-tracked solutions preferable if the EM sensor is placed at the proximal end of the laparoscope.

Nonrigid registration of 3-D free-hand ultrasound images of the breast.

Three-dimensional (3-D) ultrasound imaging of the breast enables better assessment of diseases than conventional two-dimensional (2-D) imaging. Free-hand techniques are often used for generating 3-D data from a sequence of 2-D slice images. However, the breast deforms substantially during scanning because it is composed primarily of soft tissue. This often causes tissue mis-registration in spatial compounding of multiple scan sweeps. To overcome this problem, in this paper, instead of introducing additional constraints on scanning conditions, we use image processing techniques. We present a fully automatic algorithm for 3-D nonlinear registration of free-hand ultrasound data. It uses a block matching scheme and local statistics to estimate local tissue deformation. A Bayesian regularization method is applied to the sample displacement field. The final deformation field is obtained by fitting a B-spline approximating mesh to the sample displacement field. Registration accuracy is evaluated using phantom data and similar registration errors are achieved with (0.19 mm) and without (0.16 mm) gaps in the data. Experimental results show that registration is crucial in spatial compounding of different sweeps. The execution time of the method on moderate hardware is sufficiently fast for fairly large research studies.

Segmentation of ultrasound B-mode images with intensity inhomogeneity correction.

Displayed ultrasound (US) B-mode images often exhibit tissue intensity inhomogeneities dominated by nonuniform beam attenuation within the body. This is a major problem for intensity-based, automatic segmentation of video-intensity images because conventional threshold-based or intensity-statistic-based approaches do not work well in the presence of such image distortions. Time gain compensation (TGC) is typically used in standard US machines in an attempt to overcome this. However this compensation method is position-dependent which means that different tissues in the same TGC time-range (or corresponding depth range) will be, incorrectly, compensated by the same amount. Compensation should really be tissue-type dependent but automating this step is difficult. The main contribution of this paper is to develop a method for simultaneous estimation of video-intensity inhomogeities and segmentation of US image tissue regions. The method uses a combination of the maximum a posteriori (MAP) and Markov random field (MRF) methods to estimate the US image distortion field assuming it follows a multiplicative model while at the same time labeling image regions based on the corrected intensity statistics. The MAP step is used to estimate the intensity model parameters while the MRF step provides a novel way of incorporating the distributions of image tissue classes as a spatial smoothness constraint. We explain how this multiplicative model can be related to the ultrasonic physics of image formation to justify our approach. Experiments are presented on synthetic images and a gelatin phantom to evaluate quantitatively the accuracy of the method. We also discuss qualitatively the application of the method to clinical breast and cardiac US images. Limitations of the method and potential clinical applications are outlined in the conclusion.