Abstract-Mobile C-arm is an essential tool in everyday trauma and orthopedics surgery. Minimally invasive solutions, based on X-ray imaging and coregistered external navigation created a lot of interest within the surgical community and started to replace the traditional open surgery for many procedures. These solutions usually increase the accuracy and reduce the trauma. In general, they introduce new hardware into the OR and add the line of sight constraints imposed by optical tracking systems. They thus impose radical changes to the surgical setup and overall procedure. We augment a commonly used mobile C-arm with a standard video camera and a double mirror system allowing real-time fusion of optical and X-ray images. The video camera is mounted such that its optical center virtually coincides with the C-arm's X-ray source. After a one-time calibration routine, the acquired X-ray and optical images are coregistered. This paper describes the design of such a system, quantifies its technical accuracy, and provides a qualitative proof of its efficiency through cadaver studies conducted by trauma surgeons. In particular, it studies the relevance of this system for surgical navigation within pedicle screw placement, vertebroplasty, and intramedullary nail locking procedures. The image overlay provides an intuitive interface for surgical guidance with an accuracy of 1 mm, ideally with the use of only one single X-ray image. The new system is smoothly integrated into the clinical application with no additional hardware especially for down-the-beam instrument guidance based on the anteroposterior oblique view, where the instrument axis is aligned with the X-ray source. Throughout all experiments, the camera augmented mobile C-arm system proved to be an intuitive and robust guidance solution for selected clinical routines.

In this preliminary study, we could demonstrate that 3-D localization of SLNs is feasible using freehand SPECT technology. Prerequisites for acquisition of a good scan quality, most likely allowing precise SLN mapping, have been defined. This approach has high potential to allow image-guided biopsy and further standardization of SLN dissection, thus bringing 3-D nuclear imaging into the operating room.

Abstract-Electromagnetic tracking is currently one of the most promising means of localizing flexible endoscopic instruments such as flexible laparoscopic ultrasound transducers. However, electromagnetic tracking is also susceptible to interference from ferromagnetic material, which distorts the magnetic field and leads to tracking errors. This paper presents new methods for real-time online detection and reduction of dynamic electromagnetic tracking errors when localizing a flexible laparoscopic ultrasound transducer. We use a hybrid tracking setup to combine optical tracking of the transducer shaft and electromagnetic tracking of the flexible transducer tip. A novel approach of modeling the poses of the transducer tip in relation to the transducer shaft allows us to reliably detect and significantly reduce electromagnetic tracking errors. For detecting errors of more than 5 mm, we achieved a sensitivity and specificity of 91% and 93%, respectively. Initial 3-D rms error of 6.91 mm were reduced to 3.15 mm.

Abstract. Nuclear medicine imaging modalities assist commonly in surgical guidance given their functional nature. However, when used in the operating room they present limitations. Pre-operative tomographic 3D imaging can only serve as a vague guidance intra-operatively, due to movement, deformation and changes in anatomy since the time of imaging, while standard intra-operative nuclear measurements are limited to 1D or (in some cases) 2D images with no depth information. To resolve this problem we propose the synchronized acquisition of position, orientation and readings of gamma probes intra-operatively to reconstruct a 3D activity volume. In contrast to conventional emission tomography, here, in a first proof-of-concept, the reconstruction succeeds without requiring symmetry in the positions and angles of acquisition, which allows greater flexibility. We present our results in phantom experiments for sentinel node lymph node localization. The results indicate that 3D intra-operative nuclear images can be generated in such a setup up to an accuracy equivalent to conventional SPECT systems. This technology has the potential to advance standard procedures towards intra-operative 3D nuclear imaging and offers a novel approach for robust and precise localization of functional information to facilitate less invasive, image-guided surgery.

6 The virtual mirror penetrating the 3D virtual space could reflect (a) surfaces or (c) rendered volumes, providing desired views of the 3D object from any viewpoint. In augmented laparoscopic surgery, the virtual mirror could provide additional views, solving the (b) 3D ambiguities of 2D projections. It also reflects the virtual models of tracked surgical instruments further improving hand-eye coordination.

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Abstract. Several visualization methods for intraoperative navigation systems were proposed in the past. In standard slice based navigation, three dimensional imaging data is visualized on a two dimensional user interface in the surgery room. Another technology is the in-situ visualization i.e. the superimposition of imaging data directly into the view of the surgeon, spatially registered with the patient. Thus, the three dimensional information is represented on a three dimensional interface. We created a hybrid navigation interface combining an augmented reality visualization system, which is based on a stereoscopic head mounted display, with a standard two dimensional navigation interface. Using an experimental setup, trauma surgeons performed a drilling task using the standard slice based navigation system, different visualization modes of an augmented reality system, and the combination of both. The integration of a standard slice based navigation interface into an augmented reality visualization overcomes the shortcomings of both systems.

Abstract. Liver metastases are an advanced stage of several types of cancer, usually treated with surgery. Intra-operative localization of these lesions is currently facilitated by intra-operative ultrasound (IOUS) and palpation, yielding a high rate of false positives due to benign abnormal regions. In this paper we present the integration of functional nuclear information from a gamma probe with IOUS, to provide a synchronized, real-time visualization that facilitates the detection of active metastases intra-operatively. We evaluate the system in an ex-vivo setup employing a group of physicians and medical technicians and show that the addition of functional imaging improves the accuracy of localizing and identifying malignant and benign lesions significantly. Furthermore we are able to demonstrate that the inclusion of an advanced, augmented visualization provides more reliability and confidence on classifying these lesions in the presented evaluation setup. MotivationLiver metastases are a common consequence of cancer cells spreading from primary tumors. Surgical resection is the indicated therapy if possible, as it results in a cure with high probability [1]. To facilitate extraction, intra-operative localization of the tumorous regions is achieved by a combination of palpation and intra-operative ultrasound (IOUS). This technique is considered the gold standard as it has been in successful clinical practice for years already with a proved high sensitivity [2,3]. However, in the presence of benign abnormal structures, a considerable false-positive detection rate still remains. These abnormalities may be cysts, hemangiomas, scar tissue, or even metastases, which were previously diagnosed by e.g. PET/CT and treated successfully with chemotherapy or other neoadjuvant therapies [3]. This problem, although reduced, is still present when using contrast-enhanced ultrasound [2], which has a promising potential for better image quality, but still remains a mostly anatomical imaging modality.To reduce the detection rate of false-positives, the integration of a functional modality to complement the standard localization technique is a promising approach. A prime candidate for this is nuclear imaging, as there are tracers with