Controlling virtual views in navigated breast conserving surgery

摘要

PURPOSE: Lumpectomy is the resection of a tumor in the breast while retaining as much healthy tissue as possible.Navigated lumpectomy seeks to improve on the traditional technique by employing computer guidance to achieve thecomplete excision of the cancer with optimal retention of healthy tissue. Setting up navigation in the OR relies on themanual interactions of a trained technician to align three-dimensional virtual views to the patient’s physical positionand maintain their alignment throughout surgery. This work develops automatic alignment tools to improve theoperability of navigation software for lumpectomies.METHODS: Preset view buttons were developed to refine view setup to a single interaction. These buttons weretested by measuring the reduction in setup time and the number of manual interactions avoided through their use. Anauto-center feature was created to ensure that three-dimensional models of anatomy and instruments were in the centerof view throughout surgery. Recorded data from 32 lumpectomy cases were replayed and the number of auto-centerview shifts was counted from the first cautery incision until the completion of the excision of cancerous tissue.RESULTS: View setup can now be performed in a single interaction compared to an average of 13 interactions(taking 83 seconds) when performed manually. The auto-center feature was activated an average of 33 times in thecases studied (n=32).CONCLUSION: The auto-center feature enhances the operability of the surgical navigation system, reducing thenumber of manual interactions required by a technician during the surgery. This feature along with preset camera viewoptions are instrumental in the shift towards a completely surgeon-operable navigated lumpectomy system.