title: Increase of accuracy in intraoperative navigation through high-resolution flat-panel volume computed tomography: experimental comparison with multislice computed tomography-based navigation.
abstract: OBJECTIVE
  High-resolution imaging, as provided by flat-panel-based volume computed tomography (fpVCT), could increase navigation accuracy and could therefore improve image-guided procedures or make novel navigated surgery concepts possible.
  
  
  BACKGROUND
  Intraoperative navigation is an accepted tool in head and neck surgery. However, its use is limited in the lateral cranial base because of its low surgical accuracy. Surgical accuracy is substantially influenced by the resolution of the underlying data set. The fpVCT offers a resolution of nearly two times higher than multislice computed tomography (MSCT). Target registration error (TRE), as a measurement for surgical navigation accuracy, should decrease when navigation is based on fpVCT data sets.
  
  
  METHODS
  An acrylic glass phantom with 37 fiducial points was scanned in a current MSCT and in an experimental fpVCT. Both data sets were imported in an optical navigation system. Five fiducial points were used for registration, and seven points were used for measuring TRE. The distance between the indicated pointer tip and the corresponding fiducial point in data set was measured as TRE. Registration and TRE measurement were repeated five times for each computed tomographic data set. Average TREs were calculated, and results were compared using t-test.
  
  
  RESULTS
  The average TRE using MSCT (0.82 mm [standard deviation, 0.35 mm]) was significantly higher than that using fpVCT (0.46 mm [standard deviation, 0.22 mm]) (p < 0.01).
  
  
  CONCLUSIONS
  Submillimeter surgical navigation accuracy is possible using high-resolution fpVCT. This could be highly beneficial in cranial base surgery navigation.
authors.affiliation: Department of Neuroradiology, Hannover Medical School, Hannover, Germany. soenkebartling@gmx.de
authors.forename: Soenke H
authors.initials: SH
authors.lastname: Bartling
authors.forename: Martin
authors.initials: M
authors.lastname: Leinung
authors.forename: Johannes
authors.initials: J
authors.lastname: Graute
authors.forename: Thomas
authors.initials: T
authors.lastname: Rodt
authors.forename: Christian
authors.initials: C
authors.lastname: Dullin
authors.forename: Hartmut
authors.initials: H
authors.lastname: Becker
authors.forename: Thomas
authors.initials: T
authors.lastname: Lenarz
authors.forename: Timo
authors.initials: T
authors.lastname: Stover
authors.forename: Omid
authors.initials: O
authors.lastname: Majdani
mesh_terms: D006801:Humans; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D013517:Otorhinolaryngologic Surgical Procedures / Q000295:instrumentation*; D010256:Paranasal Sinuses / Q000601:surgery*; D019047:Phantoms, Imaging; D019291:Skull Base / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed / Q000295:instrumentation*