Augmented Reality In A Hybrid Or For Pulmonary Nodule Localization And Thoracoscopic Resection – Feasibility Of A Novel Technique
from the APSA 2018 Annual Meeting proceedings
AUGMENTED REALITY IN A HYBRID OR FOR PULMONARY NODULE LOCALIZATION AND THORACOSCOPIC RESECTION – FEASIBILITY OF A NOVEL TECHNIQUE
John M. Racadio, MD, Meera Kotagal, MD, Nicole A. Hilvert, RT(R)(VI), Andrew M. Racadio, BS, Daniel von Allmen, MD.
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA.
Purpose: To assess the feasibility of utilizing a novel technique of augmented reality on a hybrid operating room C-arm system for image-guided localization and thoracoscopic resection of pulmonary nodules.
Methods: After obtaining IACUC approval, silicone pulmonary nodules were created and subsequently localized in a swine model in our research lab equipped as a hybrid operating room. Four optical cameras embedded in a C-arm system allowed video co- registration with a C-arm cone beam CT. Skin marker fiducials allowed for optical tracking and motion compensation. An integrated navigation system enabled optically guided nodule localization without the need for fluoroscopy, thus reducing radiation exposure.
The optical augmented reality navigation was used to both create and localize nodules. Localization was performed with microcoils. Thoracoscopic resection of the nodules was accomplished using direct visualization and fluoroscopic guidance.
Results: As demonstrated in the video, realistic pulmonary nodules were created and imaged using the C-arm cone beam CT and an optical/image guidance system to direct placement. Lesions were accurately localized using optical/image guidance, enabling placement of microcoils at the nodules. Combined thoracoscopic and fluoroscopic guidance allowed accurate wedge resection of the nodules.
Conclusions: Injection of silicone creates a realistic pulmonary nodule model. Image guidance using emerging technology combining radiographic and optical imaging is effective in creating and localizing pulmonary nodules. Real-time imaging combined with thoracoscopic visualization facilitates wedge resection of nodules marked with microcoils. The hybrid operating room simplifies the radiographic localization and resection of pulmonary nodules by eliminating the need to move the patient from radiology to the operating room. A collaborative approach combining the skill sets and technologies of Interventional Radiology and Surgery offers new opportunities for image guided surgery.