Integration of patient-specific paranasal sinus computed tomographic data into a virtual surgical environment.
BACKGROUND
The advent of both high-resolution computed tomographic (CT) imaging and minimally invasive endoscopic techniques has led to revolutionary advances in sinus surgery. However, the rhinologist is left to make the conceptual jump between static cross-sectional images and the anatomy encountered intraoperatively. A three-dimensional (3D) visuo-haptic representation of the patient's anatomy may allow for enhanced preoperative planning and rehearsal, with the goal of improving outcomes, decreasing complications, and enhancing technical skills.


METHODS
We developed a novel method of automatically constructing 3D visuo-haptic models of patients' anatomy from preoperative CT scans for placement in a virtual surgical environment (VSE). State-of-the-art techniques were used to create a high-fidelity representation of salient bone and soft tissue anatomy and to enable manipulation of the virtual patient in a surgically meaningful manner. A modified haptic interface device drives a virtual endoscope that mimics the surgical configuration.


RESULTS
The creation and manipulation of sinus anatomy from CT data appeared to provide a relevant means of exploring patient-specific anatomy. Unlike more traditional methods of interacting with multiplanar imaging data, our VSE provides the potential for a more intuitive experience that can replicate the views and access expected at surgery. The inclusion of tactile (haptic) feedback provides an additional dimension of realism.


CONCLUSIONS
The incorporation of patient-specific clinical CT data into a virtual surgical environment holds the potential to offer the surgeon a novel means to prepare for rhinologic procedures and offer training to residents. An automated pathway for segmentation, reconstruction, and an intuitive interface for manipulation may enable rehearsal of planned procedures.
Parikh
Sachin S
SS
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California 94305-5739, USA.
Chan
Sonny
S
Agrawal
Sumit K
SK
Hwang
Peter H
PH
Salisbury
Curt M
CM
Rafii
Benjamin Y
BY
Varma
Gaurav
G
Salisbury
Kenneth J
KJ
Blevins
Nikolas H
NH
D003198:Computer Simulation; D004724:Endoscopy / Q000379:methods*; D005626:Frontal Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000601:surgery; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D010254:Paranasal Sinus Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014584:User-Computer Interface