Get access

Evaluation of intraoperative cone beam computed tomography and optical drill tracking in temporal bone surgery

Authors

  • Boban M. Erovic MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Ontario Cancer Institute, Princess Margaret Hospital
    Search for more papers by this author
  • Michael J. Daly MSc,

    1. Ontario Cancer Institute, Princess Margaret Hospital
    Search for more papers by this author
  • Harley H. L. Chan PhD,

    1. Ontario Cancer Institute, Princess Margaret Hospital
    Search for more papers by this author
  • Adrian L. James DM, FRCS (ORL-HNS),

    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
    Search for more papers by this author
  • Blake C. Papsin MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
    Search for more papers by this author
  • David D. Pothier MSc, FRCS (ORL-HNS),

    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Ontario Cancer Institute, Princess Margaret Hospital
    3. Department of Otolaryngology, Hospital for Sick Children, Toronto, Ontario, Canada
    Search for more papers by this author
  • Ben Dixon MD,

    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Ontario Cancer Institute, Princess Margaret Hospital
    Search for more papers by this author
  • Jonathan C. Irish MD

    Corresponding author
    1. Department of Otolaryngology–Head and Neck Surgery, University of Toronto
    2. Department of Surgical Oncology, University Health Network
    3. Ontario Cancer Institute, Princess Margaret Hospital
    • Send correspondence to Jonathan C. Irish, MD, 610 University Avenue, 3–954, Toronto, ON M5G 2M9, Canada. E-mail: jonathan.irish@uhn.on.ca

    Search for more papers by this author

  • The work was supported by the RACH Fund and the Kevin and Sandra Sullivan Chair in Surgical Oncology through the Princess Margaret Hospital Foundation.The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis

A prototype system for intraoperative cone beam computed tomography (CBCT) imaging has been developed and augmented with real time optical tracking of a surgical drill. We hypothesize that this system provides sufficient accuracy for guidance of temporal bone surgery.

Study Design

Basic research.

Methods

Measurements of drill localization accuracy using CBCT imaging were obtained with a custom three-dimensional calibration object. Integrated CBCT imaging and drill tracking were prospectively evaluated on 12 cadaver temporal bones. Six inexperienced and six experienced surgeons conducted four surgical tasks: cortical mastoidectomy, posterior tympanotomy, cochleostomy, and a translabyrinthine approach to the internal auditory canal. Questionnaires provided expert feedback on tracking accuracy and system usability.

Results

Target registration error measurements of drill tracking accuracy and precision yielded a mean of 0.76 mm, a maximum of 1.30 mm, and a standard deviation of 0.21 mm. Anatomical landmark identification tasks (e.g., facial nerve, incus, semicircular canals, cochlea) provided additional validation of system accuracy. The usability and utility of the guidance system were positively rated by both groups of surgeons, with further modifications underway to improve tracking line of sight and registration workflow. Experienced but in particular inexperienced surgeons indicated significant benefits in cases involving extensive disease, abnormal anatomy, and loss of anatomical landmarks.

Conclusions

The integration of intraoperative CBCT imaging with optical tracking provides sufficient accuracy to localize anatomical structures within the temporal bone using an otological drill. Future studies will explore the role of this technology in complex oncological resections, in surgery for congenital anomalies, and as a tool for teaching.

Level of Evidence

4. Laryngoscope, 123:2823–2828, 2013

Get access to the full text of this article

Ancillary