Imri

Neuro navigation system using iMRI
Seminar Report 2012-13
CHAPTER 1 INTRODUCTION
Neurosurgery is he branch the of microsurgery that uses latest les md technical ues to help the surgeons to do his work safely. Such a systems is neuronavigation system. these systems are vision based systems that use computers and qccia1 type cameras to create high tech guiding scenes that help the doctor to see what they are doing in the brain, Neuronavigationte qucshe1p to distinguish a1thy tissue from cancer tumors during brain surge the combination of information technology with mechanics allows to accurately determining the dairies between sick and healthy tissue in medical imaging, As a result, the most de seeded tumors can be removed with great precisions. A computerized imaging technique such as magnetic resonance imaging (MRI) has provided pre-and intra-operative erative image. Which are exploited to obtain information about the interior of the body? Pre-operative tin aging information employed for diagnosis and planning of the intervention. Here, an acc Rate transfer of the plan to the crating room mu t be guaranteed. Guiding systems have been developed to conncelpre-cparative images and planning data with the operating room facilities. in active guiding systems, a computer controls th position and handling of the surgical; device; in passive systems, the surgeon ontro1s the surgical devices, the actual position and orientation of which has to be tracked and related to the m...ages and the plan. To guarantee tee precise registration between the planning data and the patient in the aperatlng room, frame- based stereotaxy has been used where the frame provides good, reference points... Today high precision registration can be achieved, by frameless stereotaxy usually based optical tracking. However, the whole effort is rendered obsolete if the target tissue moves during the intervention. This applies to brain surgery where significant brain shift is reported. The problem of intra operative motion can be overcome by interventional imaging devices like the interventional magnetic resonance imaging (1MRI). 1MRI systems -with instrument trackers can provide real time images of arbitrary planes through a defined point The instrument tip can be controlled during its way along the planned trajectory towards the target tissue to notice deviations from the planned situation and to adapt the intervention accordingly.
Dept. of Medical Electronics
AWH PTC
However, the IMRI systems currently available have shortcomings. In the interactive mode, they deliver only single 2D planes which do not give the surgeon sufficient context and orientation for efficiently finding the planned access path and the target The online slices are generated with a deal of about 7 seconds which prohibits efficient interactive work, Last hut not least, the image quality of real time image is inadequate for the recognition of critical details, To bring IMRI really into practical use. We need:

High Quality real time images. of the patient for an efficient finding and detailed. Recognition of the target, .eg, a tumor; Images of the device and the actual situation around the device tip in real-time Le, 1/5 sec or better; A cognitively adequate, intuitive guiding scene which gives the surgeon efficient intra-operative guidance in performing the planned intervention; To register data, device, and patient; A solution of the brain shift problem A frameless neuronavigation system, LOAL1T tickles these issues and offers some
practical solutions, The requirements or LOCALITE have been set up after a careful on site study of surgeons and radiologists at work with an existing iMRI.
AWH PTC
CHAPTER 2 RELATED THEORY

Recent promotion of collaboration between medical science and engineering has brought about significant advancement in the development of diagnostic imaging technology and surgical assisted systems.1) Using a high-resolution microscope, the operation requires high-accuracy technique that refers to the 3D brain image displayed on the neuronavigation robot within a close tolerance of a few millimeters; it is reminiscent of repairs made to a sophisticated electronic circuit.2) On the other hand, the advancement of computer technology makes 3D virtual image technology more efficient, allowing the creation of images analogous to the clinical condition. As a result, it is becoming possible to establish a correct diagnosis of a minute lesion.3) Moreover, brain shift, the greatest weakness of a neuronavigative operation, was resolved at once due to the development of image fusion technology which utilizes intra operative MRI images for visualization of changes in brain morphology so that the navigation map can be adjusted during the surgical procedure. In a neurosurgical operation, this information integration among image, organ and function assures a good balance between maximum tumor resection for overall survival prognosis and provides a functional prognosis even for invasive malignant brain tumors4). Furthermore, this innovation provides the momentum for development of surgical devices applicable even in the microscopic field5). At present, the Department of Neurosurgery, Nagoya University Graduate School of Medicine is working on a project for development of an intelligent operation system along with the Department of Mechanical Engineering, Nagoya Institute of Technology and Department of Media Science, Nagoya University Graduate School of Technology. The goal of the project is to create the worlds first intra operative brain touch sensor and/or microsurgical device for microscopic or endoscopic management.6)
AWH PTC
Brain Theater, the integrated system of intra operative MRI and neuronavigation, was set up at Nagoya University Hospital in January of 2006 (Fig. 1). The system features new technology which provides surgical assistance information gathered through intra operative MRI and networks not only for the operation theater but to other universities and hospitals as well. Briefly, the system works as follows: 1) as a core function, an MRI (Hitachi) is situated at No. 5 operation theater at Nagoya University Hospital. 2) An intra operative functions in perfect unison with the operative microscope and peripheral equipment. 3) The secure and highneuronavigation system
performance operation theater encourages neurosurgeons to make full use of traditional surgical techniques without qualification (Fig. 2). 4) Awarded the 2007 good design award from the Japan Industrial Design Promotion Organization. Additionally, by making this available on line, it is possible to share the surgical assist system for surgical planning, sharing intra operative images, supporting tele-surgery, and developing advanced therapy outside the operation theater. With the great technical assistance of the Graduate School of Information Science, Nagoya University and the Department of Radiological Technology, Nagoya University School of Health Science, the system can develop educational and training activities for students and young neurosurgeons in terms of surgical simulation before an operation. Besides, the simulated experience of operations produced by sharing virtual images is useful to decide the strategy for clinical cases. In 2007, the brain SUITE, operation assistance equipment, similar to the Brain Theater made by Siemens, was installed at Nagoya Central Hospital in connection with the relocation of the hospital. Since it is a Nagoya University-affiliated hospital, these two systems are linked by network to exchange information so that it is now possible to assist with difficult operations mutually by remote control. It is easy to imagine that the surgical assist system brought about by 3D virtual images will show rapid progress hand in hand with the advancement of image analysis.
AWH PTC
CHAPTER 3 NEURONAVIGATION USING LOCA.LITE SYSTEM

This section examines the following questions.
a. What is interactional Magnetic Resonance imaging .(iMRI)
b. What is LOCALITE
c. What is the need fix a locality navigation system?
d. How LOCALITE achieves interactivity? e. WhatarethebenefitoftheiMRl? 3.1 What is interventional Magnetic Resonance Imaging (iMRI)? When a tumor wows in the brain, it can occur in all sorts of odd shapes and sizes. The goals removing a tumor during a surgery is to remove as many up normal cell as possible. In other parts the body where tumors grow, surgeon often remove tissue around a tumor a well as as the tumor itself to increase the chances that all known cancerous tissue is removed. In the brain, removing cordial brain tissue can effect brain tlinction3i this case we are using iMRI neurosurgery The word (i) represent intra operative or interventional.
AWH PTC
Interventional Magnetic Resonance Imaging (iMRI) systems (Figure1) are designed to enable frameless minimally invasive surgery on targets that may move during the intervention (e.g.soft tissues). An interactive locator device tracks the surgical device. Slices of the body at the current position of the device are imaged to let the surgeon control the progress of the intervention. In interactive mode, however, 1MM systems generate only single 20 planes (re-time slices) [Figure 2Ji which do not give the surgeon sufflelent context and orientation for finding efficiently the planned access path and the target. Each real time. slic is displ4yed with a delay of about. S seconds. This prohibits.h interactive work. And the image quality is inadequate for the recognition of critical details,
Fig No: 3.1 iMRI machine 3.2 Localite LOCALITE is a frameless neuronavigation system that particularly addresses a problem with current interventional magnetic resonance imaging (iMRI) system: non-
AWH PTC
Neuro navigation system using iMRI scanning sequence.
interactive response time in the interactive scan mode and poor image quality with fast
LOCALITE calculates image planes selected via handled localizer from pre-or intraoperative volume data sets. This approach provides a really interactive localizer device with high quality images. The volume data are generated after the patient has been brought into the operating room and fixed within the iMRI. Images are part of an enhanced reality scenario containing only the salient visual information for the intra-operative task rather than letting the surgeon drown in lots of images. First studies show that LOCALITE enables the surgeon to use the iMRl system intuitively and much faster. Localite Imri Navigator Locality imri is an image based navigation system for surgery using interventional magnetic resonance imaging (1MRI).the imri navigator being used neurosurgery ,ENT sub cranial surgery, orthopedic surgery and interventional radiology (minimally invasive liver surgery) Components IMR tomography produce so called real time images (slices)of the patients during the operation. The surgeon determines the orientation of the slices in 3D space by changing the position and orientation of is current instruments (pointer micro scope) that is optically tracked .the locality imri navigation system work with opening system. that are specifically distant for interventional use, but also with conventional closed mri tomography that have been retrofitted for intra operative use. the imri navigator supports build in devices. eg:tracking camera and monitor etc..., are experts are happy to design and implement customaries solution such as beamers or separate tracking system. 3.3 What is the need for a LOCALITE navigation system? Before starting the surgery, the surgeon should know the current surgical situation such as location of the tumor, access to the tumor, position of the patient, the equipments required etc Nowadays developments in the computerized imaging techniques such as 1MR.t provides pre and intra operative images which are used to obtain the information about the interior of the body. However there are some problem5 with the current IMRI systems. They are 1. Non-interactive response time
AWH PTC
Neuro navigation system using iMRI 2. Poor image quality.
The 1MRI scanner provides only single 2D planes. Which do not give the surgeon the sufficient knowledge about the target and access path. The online slices are generated with a delay of about seven seconds, which prohibits efficient interactive work. During neurosurgery the surgeon needs precise feed back in real time to perform his job. But iMRI takes several seconds to generate a single slice and to display the image on the monitor. Interactive work is significantly distributed by this delay. The next critical issue is the image quality. the surgeon must have a clear view of the tumor and its spatial with the surrounding healthy tissues. This is true for all surgeries, but it is of utmost important in the case of brain surgery, where the unwanted removal of even small parts of the brain may have disastrous consequences, 3.4 How Locality Achieves Interactivity? To solve these issues a new navigation system has been developed GERMAN NATIONAL RESEARCH CENTRE FOR IT. This is the localities navigation system.
After bringing the patient to the operation theatre a volume scan of the brain is taken Volume scanning means scanning the entire brain volume and representing it in a number of 2D layers. These layers or slices are known as volume data set. Localite system analysis these data with the help of special and high tech software such as vtkPROBE FILTER and process the scanned image slices and locates the target. After that, this software divides each slice into small frames and separate values are given to the brain cells. During operation the scanner continuously scans the brain and generates slices. But surgeon does not need whole slices, but the requires only the present situation of the slice that containing the target. The localize software (vtk PROBE FILTER) immediately selects the target slice by comparing its cell values with the values that obtained during scanning. This calculation can be done in fractions of second which is sufficient for our purposes. 3.5 What is the benefit of the iMRI Using interventional MRI helps surgeon pint point location of the tumor and lesions. Some tumor can previously considered in operable can surgically removed. Post-operative treatment, such as reactivation and chemotherapy are more effective when more of the tumor cells are removed.
AWH PTC
Patient may be able to go a longer period time without tumor recurrence or may not have a tumor recurrence to all. It provide safety operation to the patient.
CHAPTER 4 PROBLEMS TACKLED BY LOCALITE

The localities system is designed as an enabling system which supposes a surgeon to master a high tech system in an intuitive way. Some of the problems tackled by localite, they are given below. 4.1 ORIENTATION PROBLEM In the preoperative stage, a full volume of the region of interest (the brain) is scanned with a MRI and analyzed to find and locate a tumor. In an interactive mode, the iMRI produces single slices, i.e., 2D information, only. The slice position and orientation are determined using an interactive hand piece which is connected to the interventional device, e.g, a needle or catheter.
AWH PTC
Fig No: 4.1 schematic fig of a hand piece for the Flashpoint One site cognitive studies revealed that the surgeon often looses the exact spatial orientation of this angulated slice with respect to the preoperative volume data there for he doesnt know how to move the hand piece to get the the indented position .this problem is aggravated by the time delay of several second which occuire between the position of handpiece and display of respective image on iMRI monitor.even with a visualization of the planning data contest of the volume,it is complicated ,time consuming tedious task to the position the device toward the planned entry point and to obtain precious orientation along the planned path. To provide the surgeon with optimal visualization, we started with real time volume visualization enhanced with real time vision of planning data and interactively selected plans how ever we found distracting for surgeon there for during the phase of positioning and aligning the device, the LOCALITE system does not show the volume but only MRI plan orthogonal to the planned access path in combination with markers for entry and the target point and the phantom device further abstraction lead the two he scene in figure. The visualization is further simplified by looking at the scene in direction of the access path, such that the target is just behind the entry point in simple scenario finding the entry point is as simple as moving the locator device the given entry marker alignment is achieved by angulating the device about the fixed entry point until it is perpendicular to the plan and regenerate to a dot. this simple procedure could take up one hour.
10
AWH PTC
(Fig No: 4.2) (slice with marker for entry and target)
(Fig No: 4.3)(Abstract guiding scene supporting navigation)
4.2 IMAGE QUALITY It is critical for the surgeon to have a clear view of the tumor and its spatial relation with the surrounding tissues. Although this is true for all surgical interventions, it is of special importance for brain surgery where the unwanted removal of even small parts of the brain may have disastrous consequences. Therefore, the current quality of the real time images is not sufficient. LOCALITE provides the high image quality obtained from the pre-operative 3D data sets during the whole procedure. Fig. 6 shows a real time slice from the IMRI and the corresponding calculated plane from a volume scanned during the same session.
Fig No: 4.4 slices a typical real-time scan 4.3 REGISTRATION
11
AWH PTC
In current version, LOCALITE is dependent on a fixed patient position. A change of the patients position between. the acquisition of the volume data and the navigation process will invalidate the volume data. This, however, is not a insurmountable problem the scaring procedure can be repeated intra operatively if required within about 5 minutes. With this simple trick, the delicate registration problem can overcome for the cost of an acceptable interrupt time On the negative side, the surgeon. has to be aware that the calculated images shown are potentially outdated, Only the real-time planes of the 1MRI are true online images of the patient. Therefore, LOCALITE has chosen to show images, the calculated and the scanned plane, side by side for permanent comparison. It is the surgeons responsibility to observe both images and to demand new volumes when the patient might have moved, e.g., after skull opening, or before critical decisions, e.g., treatment of the tumor, The acquisition of a new volume will also invalidate the planning and positioning data which are associated with a volume to support the navigation.
CHAPTER 5 LOCALITY SYSTEM OPERATION
12
AWH PTC
Fig No5.1 schematic diagram of locality
5.1 INTRA OPERATIVE VOLOUME SCAN After bringing the patient to the operation theater a volume scan of the brain is taken volume scanning means scanning the entire brain volume an representing it in number of 2D layers. These layers are also known as volume data set.
13
AWH PTC
Fig No: 5.2 volume date sets 5.2 PLANNING-MARKING OF TARGET AND ENTRY The surgeon/radio1ogit will inspect the volume on the display to identi1 the target using visualization software. He may select any slice or any 3D volume view in real-time. When the target has been localized, a red marker will be put on that position. Then the optimal access path will be selected and a yellow marker will identify the entry point.
Fig No: 5.3 Planning-Marking 5. 3. NAVIGATION TO THE ENTRY Next, the locator device is activated. The SIGMA SP of General Electric Medical Systems is equipped with a Flash point locator system where the position and orientation of a hand piece with two or three LEDs (Fig.3) are measured via cameras. The hand piece can carry the surgical device.
14
AWH PTC
The LOCALITE system presents the surgeon with a guiding scene showing an abstract plane, the entry point on this plane and the current position of the device [Fig.l 1 (1)]. This scene is controlled by the Flashpoint locator system in a way that the phantom device always shows the correct 3D position and orientation of the locator device on the plane. The surgeons task is now to move the real device until the tip of the phantom device oints to the entry designated by a circle [Fig. 11 (3)]. Thus, the guiding scene allows to easily identify the entry position on the patients body. The result will be verified by comparing the real time images of the iMRI at the final position with the simulated images of the same slice. The skull will be opened by a TREPANATION [means that cylindrical saw used to remove the part of the skull at this point. A specially designed holder is than fixed in the trepanation aperture. The tip of the surgical device, e.g., a sheath or hollow needle, will then be fixed in this holder. Thus, the position of the tip is fixed at the entry point while the special construction of the holder still permits angulations of the device. The guiding scene should show the tip of the device pointing to the entry.
15
AWH PTC
CHAPTER 6 ANGULATING THE DEVICE TOWARDS THE TARGET

Having fixed the tip, the instrument has now to be oriented such that it points precisely to the target. The guiding scene has been constructed as a plane orthogonal to the access path, i.e., the target is straight below the entry. Therefore, the orientation can be achieved effectively just by moving the devices tail until its i projection degenerates to a point [Fig. 11(4)]. Then, the device is fixed with respect to its angulations. The result will be verified by comparing the real-time images of the iMRI with the simulated images of the same slice (Fig. 6). As the patient may have moved a little bit during the trepanation process. the surgeon has to consult the real - time images whether the position eosin with the possibly outdated planning data is still correct. He can perform slight corrections using the real-time images or ask for a fresh volume scan which will take some five minutes. 6.1 SURGIAL INTERVENTION Now the skull will be opened by a trepan at this point. A specially designed holder is then fixed at the trepanation aperture. The tip of the surgical device such as a hollow needle or catheter ill then fixed in this holder. Using this devise the tumor will be removed. Surgical needle arc shown below. On site cognitive studies revealed that the surgeon often looses the exact spatial orientation of this angulated slice with respect to the pre-operative volume data, i.e, he does not know how to move the hand piece to get to the intended position. This problem is aggravated by the time delay of several seconds whic! occurs between the positioning of the hand piece and the display of the respect image on the iMRI monitor. Even with a visualization of the planning data in the context of the volume, it is a complicated, time consuming, and tedious task to position the device towards the planned entry point and to obtain the precise orientation along the planned path. To provide the surgeon with optimal visualizations, we started with real-time volume visualization enhanced with real time fusion of planning data and interactively selected planes. However, we found distracting for the surgeon. Therefore during the phase of pos owning and aligning the device, the LOCALITE system does not show the volume but
16
AWH PTC
Only a MRI plane orthogonal to the planned access path in combination with markers for the entry and target point and a phantom device. A further abstraction lead toe he scene in figure. The visualization is further simplified by looking at the scene iii the direction of the access path such that the target is just behind the entry point. In this simple scenario, finding the entry point is as simple as moving the locator device to the given entry marker. Alignment is achieved by angulating. the device about the fixed entry point until it is perpendicular to the plane and degenerates to a dot. This simple procedure could take up to one. hour
Fig No: 6.1 Surgical needle
17
AWH PTC
Neuro navigation system using iMRI 6.2 METHODOLOGY: SCENE - BASED DESIGN
The interface of the LOCALITE has been design using a methodology we call scene based design. In this methodology, a 3D target scene is shown from different view points depending on different activities of user. Each viewpoint not only represents a particular camera viewpoint to look at the scene, but also a set of visualization parameters affecting, for example, the transparency of different structures.
Fig No: 6.2 User interface of the LOCALITE SYSTEM In this way, for each viewpoint the minimal information presentation is achieved providing the optimal information condensation at a particular stage. For example, the LOCALITI3 interface is divided in to several stages: planning, flash point navigation and real-time simulation. These stages are controlled via buttons on the right side of the window (Fig.) tach stage has an associated viewpoint controlling the information visible for this stage. The selection and design of viewpoints and the scenes in general must be based on a detailed analysis of the tasks to be performed. Only rapid prototyping ensures that the design matches the new procedure which is possibly different with a new system than the original state.
18
AWH PTC
CHAPTER 7 ADVANCED NEW NEUROSURGICAL PROCEDURE USING INTEGRATED SYSTEM OF INTRAOPERATIVE MRI AND NEURONAVIGATION WITH MULTIMODAL NEURORADIOLOGICAL IMAGES
Recent promotion of collaboration between medical science and engineering has brought about significant advancement in the development of diagnostic imaging technology and surgical assisted systems.1) Using a high-resolution microscope, the operation requires high-accuracy technique that refers to the 3D brain image displayed on the neuronavigation robot within a close tolerance of a few millimeters; it is reminiscent of repairs made to a sophisticated electronic circuit.2) On the other hand, the advancement of computer technology makes 3D virtual image technology more efficient, allowing the creation of images analogous to the clinical condition. As a result, it is becoming possible to establish a correct diagnosis of a minute lesion.3) Moreover, brain shift, the greatest weakness of a neuronavigative operation, was resolved at once due to the development of image fusion technology which utilizes intraoperative surgical MRI images In a for visualization of changes this in brain morphology so that the navigation map can be adjusted during the procedure. neurosurgical operation, information integration among image, organ and function assures a good balance between maximum tumor resection for overall survival prognosis and provides a functional prognosis even for invasive malignant brain tumors4). Furthermore, this innovation provides the momentum for development of surgical devices applicable even in the microscopic field5). At present, the Department of Neurosurgery, Nagoya University Graduate School of Medicine is working on a project for development of an intelligent operation system along with the Department of Mechanical Engineering, Nagoya Institute of Technology and Department of Media Science, Nagoya University Graduate School of Technology. The goal of
19
AWH PTC
the project is to create the worlds first intraoperative brain touch sensor and/or microsurgical device for microscopic or endoscopic management.6) Brain Theater, the integrated system of intraoperative MRI and neuronavigation, was set up at Nagoya University Hospital in January of 2006 (Fig. 1). The system features new technology which provides surgical assistance information gathered through intraoperative MRI and networks not only for the operation theater but to other universities and hospitals as well. Briefly, the system works as follows: 1) as a core function, an MRI (Hitachi) is situated at No. 5 operation theater at Nagoya University Hospital. 2) An intraoperative neuronavigation system functions in perfect unison with the operative microscope and peripheral equipment. 3) The secure and high-performance operation theater encourages neurosurgeons to make full use of traditional surgical techniques without qualification (Fig. 2). 4) Awarded the 2007 good design award from the Japan Industrial Design Promotion Organization. Additionally, by making this available on line, it is possible to share the surgical assist.
20
AWH PTC
Fig No: 7.1 Neurosurgical operation room No. 5 called the Brain Theater, equipped with open MRI unit (0.4 Tesla HITACHI Aperto) at Nagoya University Hospital. (Low magnetic field and rotation table concept; 1) safer, 2) standard-equipped with all conventional systems, 3) applicable to non-MRI operation, 4) permanent magnet with lower cost (primary as well as running cost), 5) specially designed table for easy patient transportation to scanner, and 6) sufficient image quality).
21
AWH PTC
Fig 7. 2 Setup position for intraoperative MRI during neurological surgery in Brain Theater. A: Transportation of patient to setup. B: Setup position of patient in intraoperative MRI
22
AWH PTC
system for surgical planning, sharing intraoperative images, supporting tele-surgery, and developing advanced therapy outside the operation theater. With the great technical assistance of the Graduate School of Information Science, Nagoya University and the Department of Radiological Technology, Nagoya University School of Health Science, the system can develop educational and training activities for students and young neurosurgeons in terms of surgical simulation before an operation. Besides, the simulated experience of operations produced by sharing virtual images is useful to decide the strategy for clinical cases. In 2007, the brain SUITE, operation assistance equipment, similar to the Brain Theater made by Siemens, was installed at Nagoya Central Hospital in connection with the relocation of the hospital. Since it is a Nagoya University-affiliated hospital, these two systems are linked by network to exchange information so that it is now possible to assist with difficult operations mutually by remote control. It is easy to imagine that the surgical assist system brought about by 3D virtual images will show rapid progress hand in hand with the advancement of image analysis. 7.1 PROGRESS IN DIAGNOSTIC IMAGING IN THE FIELD OF NEUROSURGERY Progress in neurosurgical diagnostics is supported by advancements in diagnostic radiology imaging. Along with advancements in diagnostic radiology, various kinds of neuroimaging are produced which are useful for preoperative diagnosis, planning operation strategy, intraoperative image assistance, and postoperative follow-up. As for MRI scans, not only standard models such as T1 weighted-image, T2 weighted-image and FLAIR images but also the emergence of new models with diffusionweighted image, ADC (Apparent Diffusion Coefficient) MAP, MR Angiography have increased the range of qualitative diagnosis and are already used in clinical settings. Such evolution foretells the near future when tissue diagnosis can be done merely by image analysis. In addition, PET as typified by FDG-PET, radionuclide scanning (e.g. SPECT),and magnetic encephalography have made qualitative diagnosis possible.7) Besides, nowadays X-ray computed tomography can be
23
AWH PTC
treated as a 3D image since multislice helical CT has become increasingly more widespread. The use of these various technologies for preoperative evaluation and intraoperative assistance has made more accurate neurosurgery feasible. Moreover, progress in computer technology makes it possible to utilize advanced 3D virtual images for more advanced image analysis.8) In particular, the Graduate School of Information Science, Nagoya University (Chief of projects: Dr. Kensaku Mori, PhD, Main Assistance:
CHAPTER 8 PROGRESS IN NEUROSURGICAL OPERATION

Neurosurgery has made steady progress, thanks to the introduction of microsurgery in the 1960s, the development of micro-operative devices in the 1970s, the spread of the head computed tomography scans in the 1980s, and the significant improvement of diagnostic techniques provided by the spread of MRI in the 1990s. Meanwhile, it is also obvious that continuous efforts by neurosurgeons have resulted in excellent progress. Brain tumors, particularly in infiltrative intraparenchymal tumors such as glioma, require delicate surgery; however, wide tumor resection might cause brain dysfunction and/or an adverse effect. Therefore, an immediate decision based on both improved resection and avoidance of dysfunction is necessary. Consequently, for the
24
AWH PTC
Fig. 8.1 Comparison of MRI image on neuronavigation display (Left: preoperative axial, coronal, and sagittal views on T1WI. Right: intraoperative axial, coronal, and sagittal view on T2WI). Note remarkable brain shift after connection of ventricle with tumor removal cavity.
Table 1 Profile of 18 recent operative cases of glioma performed in Brain Theater. Remarkably improved removal rate of tumor on postoperative MRI was achieved. (GBM: glioblastoma multiforme; CN: central neurocytoma; O: oligodendroglioma; AO: anaplastic oligodendroglioma; A: astrocytoma) success of these surgical procedures involving tumors, it is essential to combine them with imageguided surgery, a technique based on neuronavigation which first introduced in the 1990s. The neuronavigation system is a useful surgical-assisted device which can provide accurate information on the surgical site in real time. However, existing navigation functioned based on preoperative imaging has inherent fundamental problems involving the brain shift. It means change in the shape of the brain during an operation.9) For example, during surgical procedures, the removal of a space-occupying lesion or drainage of cerebrospinal fluid often causes distortion so that the
25
AWH PTC
brain surface sinks several centimeters (Fig. 3). Since this change in brain shape undermines the reliability of navigation which uses a preoperative image as a map, the appropriate adjustment for such brain shifts has become an urgent necessity. In response, using intraoperative MRI to confirm changes in brain morphology, image fusion technology enables a navigation system to adjust the images during an operation so as to resolve the problem (Table 1). Although
26
AWH PTC
Fig. 4 Ilustrative case of right frontal oligodendroglioma, primary case. A: Pre-operative MRI (T2 weighted image) before surgery revealed a relatively huge mass at the entire right frontal tip invading the corpus callusum at the bottom of this mass. B: Intraoperative MRI during surgery showed a residual tumor at the bottom of this removal cavity. C: Second intraoperative MRI revealed subtotal removal with still small residual mass at the bottom of this cavity. D: Third intraoperative MRI eventually showed total removal of this mass.
CHAPTER 9 PROGRESS IN DIAGNOSTIC IMAGING IN THE FIELD OF NEUROSURGERY

Progress in neurosurgical diagnostics is supported by advancements in diagnostic radiology imaging. Along with advancements in diagnostic radiology, various kinds of neuroimaging are produced which are useful for preoperative diagnosis, planning operation strategy, intraoperative image assistance, and postoperative follow-up. As for MRI scans, not only
27
AWH PTC
standard models such as T1 weighted-image, T2 weighted-image and FLAIR images but also the emergence of new models with diffusionweighted image, ADC (Apparent Diffusion Coefficient) MAP, MR Angiography have increased the range of qualitative diagnosis and are already used in clinical settings. Such evolution foretells the near future when tissue diagnosis can be done merely by image analysis. In addition, PET as typified by FDG-PET, radionuclide scanning (e.g. SPECT), and magnetic encephalography have made qualitative diagnosis possible.7) Besides, nowadays X-ray computed tomography can be treated as a 3D image since multislice helical CT has become increasingly more widespread. The use of these various technologies for preoperative evaluation and intraoperative assistance has made more accurate neurosurgery feasible. Moreover, progress in computer technology makes it possible to utilize advanced 3D virtual images for more advanced image analysis.8) In particular, the Graduate School of Information Science, Nagoya University (Chief of projects: Dr. Kensaku Mori, PhD, Main Assistance: Dr. Yu-ichiro Hayashi, PhD) has designed the fastest software for image analysis and collaborative research is expected to deliver optimum results.
CHAPTER 10 FUTURE PROGRESS IN NEUROSURGERY
28
AWH PTC
Neuro navigation system using iMRI To achieve minimally invasive and
Seminar Report 2012-13 accurate neurosurgical
operations, the development of more sophisticated diagnostic devices and surgical-assist devices is required. Present advances in prevention medicine enhance the opportunities for early detection by brain medical checkups and rapid cures of neurosurgical disorders, that might otherwise cause serious disability. Now We are at a major turning point for neurosurgical treatment since safer and more secure ways of providing it have been established as prevention measures in recent years. Now there is a pressing need to create a support system by promoting expertise and innovations to meet the increasing demand for neurosurgical treatment.11) In conclusion, multimodal neuroradiological images are very useful for invasive noncircumscribed brain tumors such as glioma and further progress in the field of medical technology may bring about a nextgeneration neurosurgical world.
29
AWH PTC
CHAPTER 11 CONCLUSION
Pre-operative tin aging information employed for diagnosis and planning of the intervention. Here, an acc Rate transfer of the plan to the crating room mu t be guaranteed. Guiding systems have been developed to conncelpre-cparative images and planning data with the operating room facilities. in active guiding systems, a computer controls th position and handling of the surgical; device; in passive systems, the surgeon ontro1s the surgical devices, the actual position and orientation of which has to be tracked and related to the m...ages and the plan. To guarantee tee precise registration between the planning data and the patient in the aperatlng room, frame- based stereotaxy has been used where the frame provides good, reference points... Today high precision registration can be achieved, by frameless stereotaxy usually based optical tracking. However, the whole effort is rendered obsolete if the target tissue moves during the intervention. This applies to brain surgery where significant brain shift is reported.
30
AWH PTC
REFERENCE
1) Darakchiev BJ, Tew JM Jr, Bohinski RJ, Warhick RE. Adaptation of a standard low-field (0.3-T) system to the operating room: focus on pituitary adenomas. Neurosurg Clin N Am, 2005; 16: 155164. 2) Fahlbusch R, Ganslandt O, Buchfelder M, Schott W, Nimnsky C. Intraoperative magnetic resonance imaging during transsphenoidal surgery. J Neurosurg, 2001; 95: 381390. 3) Kelly JJ, Hader WJ, Myles ST, Sutherland GR. Epilepsy surgery with intraoperative MRI at 1.5 T. Neurosurg Clin N Am, 2005; 16: 173183. 4) Matsumae M, Koizumi J, Fukuyama H, Ishizaka H, Mizokami Y, Baba T, Atsumi H, Tsugu A, Oda S, Tanaka Y, Osada T, Imai M, Ishiguro T, Yamamoto M, Tominaga J, Shimoda M, Imai Y. Worlds first magnetic resonance imaging/X-ray/operating room suite: a significant milestone in the improvement of neurosurgical diagnosis and treatment. J Neurosurg, 2007; 107: 266273. 5) Nimnsky C, Ganslandt O, Fahlbusch R. 1.5-T intraoperative imaging beyond standard anatomic imaging. Neurosurg Clin N Am, 2005; 16: 185200.
31
AWH PTC

Imri

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Imri

Uploaded by

Copyright:

Available Formats

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

CHAPTER 2 RELATED THEORY

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

CHAPTER 3 NEURONAVIGATION USING LOCA.LITE SYSTEM

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI scanning sequence.

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI 2. Poor image quality.

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

CHAPTER 4 PROBLEMS TACKLED BY LOCALITE

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

(Fig No: 4.3)(Abstract guiding scene supporting navigation)

Fig No: 4.4 slices a typical real-time scan 4.3 REGISTRATION

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

CHAPTER 5 LOCALITY SYSTEM OPERATION

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Fig No5.1 schematic diagram of locality

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

CHAPTER 6 ANGULATING THE DEVICE TOWARDS THE TARGET

Dept. of Medical Electronics

Neuro navigation system using iMRI

Seminar Report 2012-13

Fig No: 6.1 Surgical needle

Dept. of Medical Electronics

Seminar Report 2012-13

Dept. of Medical Electronics