training medical professionals to generate fluoroscopy roadmap in virtual reality

Virtual Reality-3D Modeling for Minimally Invasive Neuro-Interventional Planning

The treatment of intracranial aneurysms is a challenging aspect of neuro-interventional surgery, necessitating precise surgical planning to ensure optimal patient outcomes. In recent years, virtual reality (VR) technology has become a promising tool for enhancing surgical planning by providing surgeons access to immersive, patient-specific anatomical models in a virtual 3D environment1,2,3,4,5,6,7,8. This article presents a comprehensive protocol for the use of medical imaging and segmentation, 3D modeling, VR surgical planning, and idealized virtual roadmap generation to aid in surgical planning for the treatment of aneurysms.
The combination of these steps culminates in a virtual surgical planning approach, allowing physicians to immerse themselves in a virtual environment and gain a comprehensive understanding of a patient&#39;s unique anatomy prior to a surgical procedure. This immersive approach empowers surgeons to explore optimal positioning and simulate various procedural scenarios. Recording these scenarios can provide insight into the placement of real-world surgical equipment, such as C-arm positioning.
In addition to positioning angles, it is also possible to measure anatomy in a virtual environment using measurement tools designed for 3D space. These measurements can provide insight into the correct sizing and shape of the device to be used in an intracranial aneurysm case9.
This protocol presents a comprehensive process&#160;that seamlessly combines medical imaging, image segmentation, VR model preparation, and virtual surgical roadmap generation to enhance the surgical planning process. Using a combination of leading-edge technologies, this protocol provides opportunities to save valuable time in the operating room10, as well as a boost to surgeon confidence and understanding of complex surgical cases11,12,13.

Author Spotlight: Segmentation and VR for Advanced Neurovascular Interventions

Pioneering Patient-Specific Approaches for Precision Surgery Using Imaging and Virtual Reality

1 The aim of this retrospective case study<v>2 was to validate the accuracy of the use 3 of protractors in a virtual reality environment. 4 This was a blind study in which the surgeon's placement 5 in VR was compared to the actual positioning 6 used in surgery. 7 Currently, optimal visualization of brain aneurysms<v>8 and other intracranial vascular malformations 9 for treatment or planning requires 3D rotational angiograms 10 to be taken at the beginning of the procedure.11 This exposes the patient to radiation 12 and increases procedural times. 13 Segmentation in virtual reality boosts surgeon confidence<v>14 and increase understanding of complex surgical cases. 15 The human body exists in a 3D space and thus viewing it 16 in 3D space is much more indicative of pathological anatomy 17 than viewing a 2D CT or MRI.18 These findings impact research and medicine, 19 reducing planning time for determining 20 the imaging equipment angle in the OR.21 Currently, patients must be scanned with a 360 spin 22 so C-arm position can be determined. 23 We believe that we can reduce the time the patient 24 is sedated and their radiation exposure by offering 25 the suggestions for C-arm positioning prior to surgery. 26 Segmentation is the act of recreating 3D models<v>27 of patient-specific anatomy from medical images.28 It is the most critical step, yet it is resource-heavy 29 in both software requirements and human expertise. 30 As such, our primary research focus 31 is automating segmentation, 32 utilizing machine learning techniques 33 to decrease the barrier to entry 34 for deploying this technology at scale.

Training Medical Professionals to Generate Fluoroscopy Roadmap in Virtual Reality

1 To begin, 2 prepare patient-specific segment anatomy 3 and the VR model. 4 Import the finalized model as glTF file 5 in the Lesson Creation menu, 6 and click Confirm in the popup 7 stating that the file type is not fully supported. 8 After pressing the joystick down, 9 go to the transparency menu 10 and hide all models except the target aneurysm anatomy.11 Position the physician in VR 12 and familiarize them with the anatomy lesson. 13 Start the recording in the VR space, 14 and let the surgeon rotate the target anatomy 15 to find the preferred angles for both anteroposterior 16 and lateral fluoroscopy. 17 Then, press the stop button.18 Place an image mimicking the background 19 of a fluoroscopy image behind the model 20 in the virtual space. 21 The surgeon will appear as a set 22 of floating glasses and two controllers in VR.23 Place the camera in line with the surgeon's view, 24 pointing roughly at the center of the target anatomy. 25 Then, capture a 2D snapshot in the desired position 26 and repeat for each preferred angle.27 To acquire C-arm angles, pause the recorded lesson 28 when the surgeon declares a preferred viewing angle. 29 Click the track pad to open the quick menu 30 and select the protractor on/off checkbox. 31 Using the controller grab button, 32 select and manipulate a pointer 33 or straight edge in line with the surgeon's viewpoint 34 to pass through the origin of the protractor.35 Step back from the model 36 and view the angles from the orthographic viewpoints 37 corresponding with the C-arm motions. 38 Acquire the anteroposterior angles 39 from the sagittal and axial planes, 40 followed by the lateral angles 41 from the coronal and axial planes. 42 The axial plane corresponds with the right 43 and left angles of the C-arm, 44 while the sagittal and coronal planes 45 correspond with the cranial and caudal angles.46 The surgeon declared anteroposterior angles in VR 47 were similar to the angle measurements 48 taken during the surgery 49 and the actual surgical fluoroscopy image, 50 whereas for the same case, 51 discrepancies were observed in the lateral views.

training-medical-professionals-to-generate-fluoroscopy-roadmap

Research

JoVE Journal

Medicine

178 Views. 1 To begin, 2 prepare patient-specific segment anatomy 3 and the VR model. 4 Import the finalized model as glTF file 5 in the Lesson Creation menu, 6 and click Confirm in the popup 7 stating that the file type is not fully supported. 8 After pressing the joystick down, 9 go to the transparency menu 10 and hide all models except the target aneurysm anatomy.11 Position the physician in VR 12 and familiarize them with the anatomy lesson. 13 Start the recording in the VR space, 14 and let ...

Video: Training Medical Professionals to Generate Fluoroscopy Roadmap in Virtual Reality

Endovascular treatment of complex vascular anomalies shifts the risk of open surgical procedures to the benefit of minimally invasive endovascular procedural solutions. Complex open surgical procedures used to be the only option for the treatment of a myriad of conditions like pulmonary and aortic valve replacement as well as cerebral aneurysm repair. However, due to advancements in catheter-delivered devices and operator expertise, these procedures (along with many others) can now be performed through minimally invasive procedures delivered through a central or peripheral vein or artery. The decision to shift from an open procedure to an endovascular approach is based on multi-modal imaging, often including 3D Digital Imaging and Communications in Medicine (DICOM) imaging datasets. Utilizing these 3D images, our lab generates 3D models of the pathologic anatomy, thereby allowing the pre-procedural analysis necessary to pre-plan critical components of the catheterization lab procedure, namely, C-arm positioning, 3D measurement, and idealized road-map generation. This article describes how to take segmented 3D models of patient-specific pathology and predict generalized C-arm positions, how to measure critical two-dimensional (2D) measurements of 3D structures relevant to the 2D fluoroscopy projections, and how to generate 2D fluoroscopy roadmap analogs that can assist in proper C-arm positioning during catheterization lab procedures.

Advancements in endovascular treatment have replaced complex open surgical procedures with minimally invasive options, like valve replacement and aneurysm repair. This paper proposes using three-dimensional (3D) modeling and virtual reality to aid in C-arm positioning, angle measurements, and roadmap generation for neuro-interventional catheterization lab procedural planning, minimizing procedure time.

Endovascular treatment of complex vascular anomalies shifts the risk of open surgical procedures to the benefit of minimally invasive endovascular ...

VR Modeling Using Patient-Specific Segment Anatomy for Precision Fluoroscopy Planning

1 To begin, obtain 3D digital imaging<v>2 and communications in medicine or DICOM dataset 3 and import it into the segmentation software. 4 To create a rough mask of the target anatomy, 5 go to the segment tab, select new mask tool. 6 To set the upper and lower threshold boundaries, 7 click and drag them to capture maximum 8 of the relevant target anatomy.9 Alternatively, input the desired hounsfield unit 10 and click okay to finalize the rough mask. 11 In the segment tab, select region grow 12 to separate all voxels of the mask 13 directly connected to the desired voxel. 14 And use edit mask to add or remove voxels 15 via both the 2D and 3D windows.16 Utilizing multiple slices edit, 17 add or remove voxels through interpolation 18 between slices farther apart, 19 and use the smart fill And then fill holes 20 to fill the holes of a defined size within the mask. 21 After verifying the accuracy 22 of the 3D models from a physician, 23 convert the obtain mask to 3D parts 24 and finally export it as stl file. 25 Import all the anatomy files through file import stl.26 Using the move and rotate tools, 27 align the anatomy with the world's origin. 28 After aligning the patient's nose 29 with the perpendicular axis 30 containing the ear and skull top, 31 activate the orthographic views 32 from the top right corner widget of the Blender interface. 33 To acquire CR mangles in virtual reality, 34 import the protractor.stl file. 35 Scale the protractor quite small for ease of measurement, 36 and scale the protractor just outside for aneurysms. 37 Align zero degrees on the protractor 38 with the patient's nose, 39 and orient the gap in the protractor arms 40 towards the patient's feet, 41 and export as glb.