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. 2019 Jun;15(3):e1993.
doi: 10.1002/rcs.1993. Epub 2019 Mar 20.

Feasibility study of intraoperative cone-beam CT navigation for benign bone tumour surgery

Thomas R F van Steenbergen  1 , Ingrid C M van der Geest  2 , Dennis Janssen  2 , Maroeska M Rovers  3 , Jurgen J Fütterer  1
Affiliations

Feasibility study of intraoperative cone-beam CT navigation for benign bone tumour surgery

Thomas R F van Steenbergen et al. Int J Med Robot. 2019 Jun.

Abstract

Background: Intraoperative cone-beam computed tomography (CBCT) offers the advantage of navigation on the current anatomical situation and the possibility to take a control scan. We assessed the feasibility of using intraoperative CBCT for navigated intralesional curettage.

Methods: Nine benign bone tumour patients were studied. Feasibility was assessed by describing the workflow and indications for navigation, scoring CBCT image quality and registration accuracy, and measuring scan and navigation set-up times. Short-term follow-up was described.

Results: CBCT navigation was successful in all patients. Median tumour visibility, tumour delineation, and vital structure visibility scores were good. Median registration accuracy score was very good. Median scan and verification times were 5 and 3 minutes, respectively. One patient had a tumour recurrence after 6 months.

Conclusions: Intraoperative CBCT navigation is feasible and safe. Indications for use of navigation in clinical practice are closeness to vital structures, complexly shaped tumours or bone, minimally invasive surgery, and repeated surgery.

Keywords: bone; computer assisted surgery; cone-beam CT; image guided surgery; intraoperative imaging; navigation; orthopaedic; tumor.

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Conflict of interest statement

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Figures

Figure 1
Figure 1
A‐B, The preoperative position planning for patient 9 (A), depicting how to position the patient, where to place the navigation system and camera, and where to place the reference base. The red circle indicates the lesion in the C7 vertebra; (B) shows the actual situation during surgery
Figure 2
Figure 2
This is the starting position of the C‐arm before acquiring a 3D scan. The black circles indicate the reflective calibration stickers that allow the navigation system to “see” the C‐arm. The camera needs to have a clear line of sight to these stickers when starting the 3D run, otherwise the system cannot perform an automatic image registration
Figure 3
Figure 3
A‐B, The validation and navigation view for patient 6, who had an atypical cartilaginous tumour in the proximal right humerus. A, The surgeon has to validate the automatic registration using the navigated pointer by following the bony surface and visually verifying the navigation view. B, After removing the tumour with the navigated curette, the surgeon checks the cavity for potential tumour residue
Figure 4
Figure 4
A‐B, Axial slides of the CBCT of patient 2, showing subchondral cysts in the proximal left tibia. (A) The CBCT before curettage shows two cysts, while the control scan (B) reveals incomplete removal of one of the cysts. Surgery was continued, and the remaining cyst was removed
See this image and copyright information in PMC

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