PhD Thesis Proposal: Ross Warner

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"Enhancing Surgical Navigation Systems for Spine and Endovascular Surgery Using Tracked Stereovision and Ultrasound"

Abstract

Surgical navigation systems enhance surgery by improving accuracy, patient outcomes, and procedural awareness while also reducing radiation. They are rapidly becoming the standard of care in neuro, dental, orthopedic, and cardiothoracic surgeries. Work presented and proposed in this Thesis Proposal aims to provide enhancements in the field of spine surgery, where navigated techniques have become the standard of care, and aims to translate these techniques to the field of endovascular surgery where navigation remains in its inception.

Spine navigation systems rely on expensive intraoperative imaging based on mobile CT units. These co-register volumetric imaging intraoperatively. However, they increase time, radiation exposure, and procedural complexity. Furthermore, the registration accuracy can deteriorate intraoperatively with the introduction of spine motion occurring after this CT acquisition. This motion stems from intraoperative surgical manipulation and hardware placement. In scoliosis procedures, this spinal pose correction is the surgical objective. This work proposes modifying an existing image updating pipeline using intraoperative stereovision imaging that currently accounts for spine motion stemming from preoperative-to-intraoperative changes. The proposed enhancements will expand the use of this pipeline to account for intraoperative-to-intraoperative motion that occurs during the surgery by providing automation and continual level-wise monitoring of the spine surface. Integration of tracked 2D ultrasound is also proposed.

In endovascular surgery, a pressing need exists for radiation-sparing, easy-to-use and low-cost guidance systems. Endovascular procedures are a minimally invasive procedure that are increasingly used for cardiovascular treatment given many patient benefits. However, these procedures are complex, require significant expertise, and expose patients and staff to radiation due to angiography use. In these procedures, standard navigation techniques are rendered unusable as they rely on a rigid relationship between a tracked object and the rest of the surgical tool or anatomy. In vascular surgery, both deformable anatomy and tools necessitate alternative solutions. Proposed work aims to leverage tracked US and computer vision algorithms to provide a navigated technique for carotid artery endovascular procedures. Specifically, components of the navigated procedure will be demonstrated in both a phantom and clinical setting and techniques from spine methods may be translated for this objective.

Thesis Committee

• Keith Paulsen (co-chair)
• Xiaoyao Fan (co-chair)
• Sohail Mirza
• Richard Powell
• Elvis Chen (Western University)

Contact

For more information, contact Thayer Registrar at thayer.registrar@dartmouth.edu.