title: Toward (Hybrid) Navigation of a Fluorescence Camera in an Open Surgery Setting.
abstract: With the introduction of the hybrid tracer indocyanine green (ICG)-99mTc-nanocolloid, a direct relation between preoperative imaging and intraoperative fluorescence guidance was established. However, fluorescence guidance remains limited by its superficial nature. This study evaluated the feasibility of a nuclear medicine-based navigation concept that allowed intraoperative positioning of a fluorescence camera (FC) in the vicinity of preoperatively defined ICG-99mTc-nanocolloid containing sentinel nodes (SNs).
  
  
  METHODS
  Five patients with penile cancer scheduled for SN biopsy were injected with ICG-99mTc-nanocolloid followed by preoperative SPECT/CT imaging. The navigation device was used to provide a real-time augmented reality overlay of the SPECT/CT images and video output of the FC. This overlay was then used for FC navigation.
  
  
  RESULTS
  SPECT/CT identified 13 SNs in 9 groins. FC navigation was successful for all 12 intraoperatively evaluated SNs (average error, 8.8 mm; range, 0-20 mm).
  
  
  CONCLUSIONS
  This study reveals the potential benefits of FC navigation during open surgery procedures.
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Gijs H
authors.initials: GH
authors.lastname: KleinJan
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Nynke S
authors.initials: NS
authors.lastname: van den Berg
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Matthias N
authors.initials: MN
authors.lastname: van Oosterom
authors.affiliation: Institut für Informatik, Computer Aided Medical Procedures (CAMP), Technische Universität München, Munich, Germany SurgicEye GmbH, Munich, Germany; and.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wendler
authors.affiliation: Business Incubator, Development Center, Hamamatsu Photonics K.K., Hamamatsu City, Japan.
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Miwa
authors.affiliation: Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Axel
authors.initials: A
authors.lastname: Bex
authors.affiliation: Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Kees
authors.initials: K
authors.lastname: Hendricksen
authors.affiliation: Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
authors.forename: Simon
authors.initials: S
authors.lastname: Horenblas
authors.affiliation: Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands F.W.B.van_Leeuwen@lumc.nl.
authors.forename: Fijs W B
authors.initials: FW
authors.lastname: van Leeuwen
mesh_terms: D006801:Humans; D007208:Indocyanine Green / Q000737:chemistry; D064847:Multimodal Imaging / Q000295:instrumentation*; D061848:Optical Imaging / Q000295:instrumentation*; D057234:Preoperative Period; D021701:Sentinel Lymph Node Biopsy; D000072098:Single Photon Emission Computed Tomography Computed Tomography; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D013668:Technetium Tc 99m Aggregated Albumin / Q000737:chemistry
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin; C083602:technetium Tc 99m nanocolloid; D007208:Indocyanine Green
keywords: SPECT/CT; augmented reality; fluorescence imaging; navigation; sentinel node biopsy