[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to develop a robotic system for ultrasound (US)-guided biopsy and to validate the feasibility, accuracy and efficacy using phantom tests. Twenty peas (mean diameter 9.3+/-0.1 mm) embedded within a gel-phantom were selected for biopsy. Once the best access was defined, the position of the US transducer was recorded by an optical tracking system. Positional data of the transducer and the corresponding US image were transferred to the roboter planning system (LINUX-based industrial PC equipped with video capture card). Once the appropriate position, angulation and pitch were calculated, the robotic arm moved automatically with seven degrees-of-freedom to the planned insertion path, aiming the needle-positioning unit at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured, and the deviation of the actual needle tract from the center of the target was evaluated sonographically. In all targets, the biopsy specimen (mean length 5+/-1.2 mm) was harvested with only one needle pass required The mean deviation of the needle tip from the center of the target was 1.1+/-0.8 mm. Robotic assisted biopsies in-vitro using US-guidance were feasible and provided high accuracy.
European Radiology 05/2005; 15(4):765-71. · 4.34 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We sought to develop a robotic system for computed tomography (CT)-guided biopsy to validate the feasibility, accuracy, and efficacy of the system using phantom tests.
Ten peas (mean diameter 9.9+/-0.4 mm) embedded within a gel phantom were selected for biopsy. Once the best access was defined on CT images, the position of the phantom was recorded by an optical tracking system. Positional data about the phantom and the corresponding CT image was transferred to the robot planning system (Linux-based industrial PC equipped with video capture card). Once the appropriate position, angulation, and pitch were calculated, the robotic arm moved automatically with 7 degrees-of-freedom to the planned insertion path, aiming the needle-trajectory at the center of the target. Then, the biopsy was performed manually using a coaxial technique. The length of all harvested specimens was measured and short cut pieces of a guidewire were pushed into the target to evaluate the deviation of the actual needle track from the target.
In all targets, biopsy specimens (mean length 5.6+/-1.4 mm) were harvested with only 1 needle pass required. The mean deviation of the needle tip from the center of the target in the x and z axes was 1.2+/-0.9 mm and 0.6+/-0.4 mm, respectively.
Robotic-assisted biopsies in vitro, using CT guidance, were feasible and provided high accuracy.
[Show abstract][Hide abstract] ABSTRACT: The major aim of this work was to define a protocol for evaluation of electromagnetic tracking systems (EMTS). Using this protocol we compared two commercial EMTS: the Ascension microBIRD (B) and NDI Aurora (A). To enable reproducibility and comparability of the assessments a machined base plate was designed, in which a 50 mm grid of holes is precision drilled for position measurements. A circle of 32 equispaced holes in the center enables the assessment of rotation. A small mount which fits into pairs of grid holes on the base plate is used to mount the sensor in a defined and rigid way. Relative positional/orientational errors are found by subtracting the known distances/rotations between the machined locations from the differences of the mean observed positions/rotation. To measure the influence of metallic objects we inserted rods (made of SST 303, SST 416, aluminum, and bronze) into the sensitive volume between sensor and emitter. Additionally the dynamic behavior was tested by using an optical sensor mounted on a spacer in a distance of 150 mm to the EMTS sensors. We found a relative positional error of 0.96mm +/- 0.68mm, range -0.06mm;2.23mm (A) and 1.14mm +/- 0.78mm, range -3.72mm;1.57mm (B) for a give distance of 50 mm. The positional jitter amounted to 0.14 mm(A) / 0.20mm (B). The relative rotation error was found to be 1.81 degrees(A) / 0.63 degrees(B). For the dynamic behavior we calculated an error of 1.63mm(A)/1.93mm(B). The most relevant distortion caused by metallic objects results from SST 416. The maximum error 4.2mm(A)/41.9mm(B) occurs when the rod is close to the sensor(20mm).
[Show abstract][Hide abstract] ABSTRACT: We present a simple and rapid method for generation of perspective digitally rendered radiographs (DRR) for 2D/3D registration
based on splat rendering. Suppression of discretization artefacts by means of computation of Gaussian footprints – which is
a considerable computational burden in classical splat rendering – is replaced by stochastic motion of either the voxels in
the volume to be rendered, or by simulation of a X-ray tube focal spot of finite size. The result is a simple and fast perspective
rendering algorithm using only a small subset of voxels. Our method generates slightly blurred DRRs suitable for registration
purposes at framerates of approximately 10 Hz when rendering volume images with a size of 30 MB on a standard PC.
Medical Image Computing and Computer-Assisted Intervention - MICCAI 2005, 8th International Conference, Palm Springs, CA, USA, October 26-29, 2005, Proceedings, Part II; 01/2005
[Show abstract][Hide abstract] ABSTRACT: In the last years we developed and tested a head mounted display (HMD) for augmented reality applications in computer aided surgery. This HMD was developed by adapting the Varioscope AF3 (Life Optics, Vienna), an operating binocular with variable zoom and focus. One of the drawbacks of the AF3 was the missing possibility to set the zoom and focus values automatically via a machine usable interface, necessary for automatic calibration of the device. The paper presents the successor of the Varioscope AF3, the Varioscope M5 adapted for augmented reality by our lab. This device has an interface for machine controlled setting of the zoom and focus lens groups via RS 232. This enabled us to develop an automated calibration using a calibration grid mounted on a linear positioner. The position of the grid was controlled using a stepping motor controller connected via IEEE 488. The calibration grid was equipped with automatically detectable fiducial points using varying cross values of consecutive points. The resulting point pairs were used for a camera calibration with Tsai's algorithm. Tracker probes (Traxtal, Toronto) were mounted on the HMD and onto the calibration grid to derive the transformation from the coordinate system of the HMD into the system of the displays. The error of this calibrations was measured comparing the position of the tip of a bayonet probe calculated by the algorithm and found in the image of a camera mounted at the eyepiece of the device. Averaging 16 positions of the probe this deviation was found to be 0.97 +/- 0.22 mm.
[Show abstract][Hide abstract] ABSTRACT: Due to converting losses the probe's surface itself is heated up, especially when emitting into air. Possible temperature increases in an ensemble of 15 different diagnostic and therapeutic ultrasound probes from 7 manufacturers in the frequency range between 0.05–7.5 MHz have been examined. Surface temperatures were detected by means of a calibrated IR-thermographic camera using a scheme of various power and pulse settings, as well as different imaging modalitites as used in clinical routine. Depending on the setup and the output power, the absolute surface temperatures of some of the probes emitting in air can be beyond 43 °C within 5–7 min.; a maximum surface temperature of 84 °C has been detected. Continuous mode or high pulse repetition frequencies on the therapeutic system side, small focused Doppler modes on the diagnostic system side combined with increased emitted acoustic intensities result in high surface temperatures. Within a worst case scenario a potential risk of negative skin changes (heat damage) or non-optimal therapeutic effects seems to be possible if a therapeutic system is used very often and if its emission continues unintentionally. In general the user should be aware that low emission intensities of e.g. 50 mW cm-2 could already produce hot surfaces.
Journal of Physics Conference Series 08/2004; 1(1):78.
[Show abstract][Hide abstract] ABSTRACT: We are developing an optical see through head mounted display in which preoperative planning data provided by a computer aided surgery system is overlaid to the optical image of the patient. In order to cope with head movements of the surgeon the device has to be calibrated for a wide zoom and focus range. For such a calibration accurate and robust localization of a huge amount of calibration points is of utmost importance. Because of the negligible radial distortion of the optics in our device, we were able to use projective invariants for stable detection of the calibration fiducials on a planar grid. The pattern at the planar grid was designed using a different cross ratio for four consecutive points in x respectively y direction. For automated image processing we put a CCD camera behind the eye piece of the device. The resulting image was thresholded and segmented, after deleting the artefacts a Sobel edge detector was applied and the image was Hough transformed to detect the x and y axes. Then the world coordinates of fiducial points on the grid could be detected. A series of six camera calibrations with two zoom settings was done. The mean values of the errors for the two calibrations were 0.08 mm respectively 0.3 mm.
[Show abstract][Hide abstract] ABSTRACT: With the miniaturization of electromagnetic tracking systems (EMTS) the range of possible applications in image guided therapy was extending. A diameter smaller than 1 mm allows for mounting these sensors into the working channel of flexible endoscopes for navigation within the body. Knowing the exact position of the instrument with respect to the patient"s position preoperative CT or MR images can simplify and ease navigation during various interventions. The Aurora EMTS seems to be an ideal choice for this purpose. However, using this system exhibits an important limitation: the sensor offers just 5 degrees of freedom (DOF) which means that rotations round the axis of the sensor cannot be measured. To overcome this restriction we used an additional optical tracking system (OTS) which is calibrated to deliver the missing DOF. To evaluate the suitability of our new navigation system we measured the Fiducial Registration Error (FRE) of the diverse registrations and the Target Registration Error (TRE) for the complete transformation from the US space to the CT space. The FRE for the ultrasound calibration amounted to 3.2 mm+/-2.2 mm, resulting from 10 calibration procedures. For the transformation from the OTS reference system to the EMTS emitter space we found an average FRE of 0.8 mm+/-0.2 mm. The FRE for the CT registration was 1.0 mm+/-0.3 mm. The TRE was found to be 5.5 mm+/- 3.2 mm.
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to evaluate the feasibility and accuracy of a novel surgical computer-aided navigation system for the placement of endosseous implants in patients after ablative tumour surgery. Pre-operative planning was performed by developing a prosthetic concept and modifying the implant position according to surgical requirements after high-resolution computed tomography (HRCT) scans with VISIT, a surgical planning and navigation software developed at the Vienna General Hospital. The pre-operative plan was transferred to the patients intraoperatively using surgical navigation software and optical tracking technology. The patients were HRCT-scanned again to compare the position of the implants with the pre-operative plan on reformatted CT-slices after matching of the pre- and post-operative data sets using the mutual information-technique. A total of 32 implants was evaluated. The mean deviation was 1.1 mm (range: 0-3.5 mm). The mean angular deviation of the implants was 6.4 degrees (range: 0.4 degrees - 17.4 degrees, variance: 13.3 degrees ). The results demonstrate, that adequate accuracy in placing endosseous oral implants can be delivered to patients with most difficult implantologic situations.
Clinical Oral Implants Research 07/2003; 14(3):340-8. · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies in diabetic patients suggested a relationship between delayed gastric emptying and increased ingesta retention in either proximal or distal stomach, but the determinants underlying these abnormalities remained obscure. We aimed at assessing the impact of cardiovascular autonomic neuropathy, blood glucose concentration, long-term glycemic control, and other factors in 34 type I and 43 type II diabetic patients (ages 21-67 and 34-81 years, respectively). Emptying was slower (P < 0.04) in type I diabetic patients than in 20 healthy control subjects (ages 23-63 years). Patients with autonomic neuropathy (N = 45) had slower gastric emptying (P < 0.02) and retained more in the distal stomach (P < 0.0001) than patients without neuropathy (N = 32). Multiple regression analyses revealed that slow emptying and increased distal retention were significantly associated with autonomic neuropathy (P < 0.043, P < 0.0002), whereas blood glucose, glycemic control, diabetes duration, age, and other factors had no discernible influence. Thus, both slow emptying and increased distal ingesta retention seem primarily referable to autonomic neuropathy.
Digestive Diseases and Sciences 06/2003; 48(6):1027-34. · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Based on the Varioscope, a commercially available head-mounted operating binocular, we have developed the Varioscope AR, a see through head-mounted display (HMD) for augmented reality visualization that seamlessly fits into the infrastructure of a surgical navigation system. We have assessed the extent to which stereoscopic visualization improves target localization in computer-aided surgery in a phantom study. In order to quantify the depth perception of a user aiming at a given target, we have designed a phantom simulating typical clinical situations in skull base surgery. Sixteen steel spheres were fixed at the base of a bony skull, and several typical craniotomies were applied. After having taken CT scans, the skull was filled with opaque jelly in order to simulate brain tissue. The positions of the spheres were registered using VISIT, a system for computer-aided surgical navigation. Then attempts were made to locate the steel spheres with a bayonet probe through the craniotomies using VISIT and the Varioscope AR as a stereoscopic display device. Localization of targets 4 mm in diameter using stereoscopic vision and additional visual cues indicating target proximity had a success rate (defined as a first-trial hit rate) of 87.5%. Using monoscopic vision and target proximity indication, the success rate was found to be 66.6%. Omission of visual hints on reaching a target yielded a success rate of 79.2% in the stereo case and 56.25% with monoscopic vision. Time requirements for localizing all 16 targets ranged from 7.5 min (stereo, with proximity cues) to 10 min (mono, without proximity cues). Navigation error is primarily governed by the accuracy of registration in the navigation system, whereas the HMD does not appear to influence localization significantly. We conclude that stereo vision is a valuable tool in augmented reality guided interventions.
Physics in Medicine and Biology 03/2003; 48(3):N49-57. · 2.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Endoscopic Ultrasound (EUS) features flexible endoscopes equipped with a radial or linear array scanhead allowing high resolution examination of organs adjacent to the upper gastrointestinal tract. An optical system based on fibre-glass or a CCD-chip allows additional orientation. However, 3-dimensional orientation and correct identification of the various anatomical structures may be difficult. It therefore seems desirable to merge real-time US images with high resolution CT or MR images acquired prior to EUS to simplify navigation during the intervention. The additional information provided by CT or MR images might facilitate diagnosis of tumors and, ultimately, guided puncture of suspicious lesions. We built a grid with 15 plastic spheres and measured their positions relatively to five fiducial markers placed on the top of the grid. For this measurement we used an optical tracking system (OTS) (Polaris, NDI, Can). Two sensors of an electromagnetic tracking system (EMTS) (Aurora, NDI, Can) were mounted on a flexible endoscope (Pentax GG 38 UX, USA) to enable a free hand ultrasound calibration. To determine the position of the plastic spheres in the emitter coordinate system of the EMTS we applied a point-to-point registration (Horn) using the coordinates of the fiducial markers in both coordinate systems (OTS and EMTS). For the transformation between EMTS to the CT space the Horn algorithm was adopted again using the fiducial markers. Visualization was enabled by the use of the AVW-4.0 library (Biomedical Imaging Resource, Mayo Clinic, Rochester/MN, USA). To evaluate the suitability of our new navigation system we measured the Fiducial Registration Error (FRE) of the diverse registrations and the Target Registration Error (TRE) for the complete transformation from the US space to the CT space. The FRE for the ultrasound calibration amounted to 4.3 mm +/- 4.2 mm, resulting from 10 calibration procedures. For the transformation from the OTS reference system to the EMTS emitter space we found an average FRE of 0.8 mm +/- 0.2 mm. The FRE for the CT registration was 1.0 mm +/- 0.3 mm. The TRE was found to be 3.8 mm +/- 1.3 mm if we target the same spheres which where used for the calibration procedure. A movement of the phantom results in higher TREs because of the orientation sensitivity of the sensor. In that case the TRE in the area where the biopsy is supposed to be taken place was found to be 7.9 mm +/- 3.2 mm. Our system provides the interventionist with additional information about position and orientation of the used flexible instrument. Additionally, it improves the marksmanship of biopsies. The use of the miniaturized EMTS enables for the first time the navigation of flexible instruments in this way. For the successful application of navigation systems in interventional radiology, an accuracy in the range of 5 mm is desirable. The accuracy of the localization of a point in CT space are just 3 mm too high as required. One of the possibilities to overcome this difference is to mount the two sensors in such a way that the interference of their electromagnetic fields is minimized. A considerable restraint constitutes the small characteristic volume (360mm x 600mm x 600mm), which requires for most application an additional optical system.
[Show abstract][Hide abstract] ABSTRACT: During the last few years head mounted displays (HMD) became more important in Computer assisted surgery (CAS). Rapid head movements of the surgeon enforce to change the focal plane and the zoom value without loosing the calibration. Starting from previous work in developing an optical see through head mounted display we adapted our HMD to measure the focal and zoom values. This made it possible to extend the calibration to different zoom and focus values. The case of the HMD was opened to gain access to the zoom lenses, which was necessary to measure the different zoom values. Focusing in our HMD is realized by changing the angle between the two tubes. Therefore we marked two points at the tubes to measure the focal adjustment. We made a series of planar calibrations with seven different fixed zoom and focus values using Tsai´s algorithm for camera calibration. Then we used the Polaris optical tracking system (Northern Digital, Ontario, Can) to measure the transformation from the planar calibration grid to a tracker probe rigidly mounted to the HMD. The calibration parameters transformed to this tracker probe are independent of the actual position of the calibration grid andare the parameters we want to approximate. Then least square approximating polynomial surfaces were derived for the seven calibration parameters. The coefficients of the polynomial surfaces were used as starting values for a nonlinear optimization procedure minimizing an overall error. Minimizing the object space error (which is the minimal distance of the line through the center of projection and the image point to the real world point) in the last step of the procedure described above we had a mean object space error 0.85 +/-0.5 mm. Calibration of the HMD is not lost during minor changes in zoom and focus. This is likely to be the first optical see through HMD developed for CAS with variable zoom and focus, which are typically facilities of operating microscopes. Employing an automated calibration in common with more zoom and focus steps and more accurate measurement of the position of the zoom lenses and the focal plane should reduce the error significantly, enabling the accuracy needed for CAS.
[Show abstract][Hide abstract] ABSTRACT: We developed a head-mounted display (HMD) with integrated computer-generated stereoscopic projection of target structures and integrated it into visit, a specific oral implant planning and navigation software. The HMD is equipped with two miniature computer monitors that project computer-generated graphics stereoscopically into the optical path. Its position is tracked by the navigation system's optical tracker and target structures are displayed in their true position over the operation site. In order to test this system's accuracy and spatial perception of the viewer, five interforaminal implants in three dry human mandibles were planned with visit and executed using the stereoscopic projection through the HMD. The deviation between planned and achieved position of the implants was measured on corresponding computed tomography (CT) scan images recorded post-operatively. The deviation between planned and achieved implant position at the jaw crest was 0.57 +/- 0.49 mm measured from the lingual, and 0.58 +/- 0.4 mm measured from the buccal cortex. At the tip of the implants the deviation was 0.77 +/- 0.63 mm at the lingual and 0.79 +/- 0.71 mm at the buccal cortex. The mean angular deviation between planned and executed implant position was 3.55 +/- 2.07 degrees. The present in vitro experiment indicates that the concept of preoperative planning and transfer to the operative field by an HMD allows us to achieve an average precision within 1 mm (range up to 3 mm) of the implant position and within 3 degrees deviation for the implant inclination (range up to 10 degrees ). Control during the drilling procedure is significantly improved by stereoscopic vision through the HMD resulting in a more accurate inclination of the implants.
Clinical Oral Implants Research 01/2003; 13(6):610-6. · 3.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The advent of miniaturized electromagnetic digitizers opens a variety of potential clinical applications for computer aided interventions using flexible instruments; endoscopes or catheters can easily be tracked within the body. With respect to the new applications, the systematic distortions induced by various materials such as closed metallic loops, wire guides, catheters, and ultrasound scan heads were systematically evaluated in this paper for a new commercial tracking system. We employed the electromagnetic tracking system Aurora (Mednetix/CH, NDI/Can); data were acquired using the serial port of a PC running SuSE Linux 7.1 (SuSE, Gmbh, Nürnberg). Objects introduced into the digitizer volume included wire loops of different diameters, wire guides, optical tracking tools, an ultrasonic (US) scan head, an endoscope with radial ultrasound scan head and various other objects used in operating rooms and interventional suites. Beyond this, we determined the influence of a C-arm fluoroscopy unit. To quantify the reliability of the system, the miniaturized sensor was mounted on a nonmetallic measurement rack while the transmitter was fixed at three different distances within the digitizer range. The tracker was shown to be more sensitive to distortions caused by materials close to the emitter (average distortion error 13.6 mm +/- 16.6 mm for wire loops positioned at a distance between 100 mm and 200 mm from the emitter). Distortions caused by materials near the sensor (distances smaller than 100 mm) are small (typical error 2.2 mm +/- 1.9 mm). The C-arm fluoroscopy unit caused considerable distortions and limits the reliability of the tracker (distortion error 18.6 mm +/- 24.9 mm). Distortions resulting from the US scan head are high at distances smaller than about 100 mm from the emitter. The distortions also increase when the scan head is positioned horizontally and close to the sensor (average error 4.1 mm +/- 1.5 mm when the scan head is positioned within a distance of 100 mm from the sensor). The distortions are slightly higher when the ultrasound machine is switched on. We also evaluated the influence of common medical instruments on distance measurements. For these measurements the average deviation from the known distance of 200 mm amounted to 3.0 mm +/- 1.5 mm (undistorted distance measurement 1.5 mm +/- 0.3 mm). The deviations also depend on the relative orientation between emitter and sensor. The results demonstrate that the miniature tracking system opens up new perspectives with regard to surgery applications where a flexible instrument is to be tracked within the body. Significant distortions caused by metallic objects only occur in the worst cases, for example, in the presence of a closed, unisiolated wire loop or a C-arm fluorescence unit close to the emitter and which can be avoided by suitable usage.
Medical Physics 11/2002; 29(10):2205-12. · 2.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Computer-aided surgery (CAS), the intraoperative application of biomedical visualization techniques, appears to be one of the most promising fields of application for augmented reality (AR), the display of additional computer-generated graphics over a real-world scene. Typically a device such as a head-mounted display (HMD) is used for AR. However, considerable technical problems connected with AR have limited the intraoperative application of HMDs up to now. One of the difficulties in using HMDs is the requirement for a common optical focal plane for both the realworld scene and the computer-generated image, and acceptance of the HMD by the user in a surgical environment. In order to increase the clinical acceptance of AR, we have adapted the Varioscope (Life Optics, Vienna), a miniature, cost-effective head-mounted operating binocular, for AR. In this paper, we present the basic design of the modified HMD, and the method and results of an extensive laboratory study for photogrammetric calibration of the Varioscope's computer displays to a real-world scene. In a series of 16 calibrations with varying zoom factors and object distances, mean calibration error was found to be 1.24 +/- 0.38 pixels or 0.12 +/- 0.05 mm for a 640 x 480 display. Maximum error accounted for 3.33 +/- 1.04 pixels or 0.33 +/- 0.12 mm. The location of a position measurement probe of an optical tracking system was transformed to the display with an error of less than 1 mm in the real world in 56% of all cases. For the remaining cases, error was below 2 mm. We conclude that the accuracy achieved in our experiments is sufficient for a wide range of CAS applications.
IEEE Transactions on Medical Imaging 09/2002; 21(8):991-7. · 4.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To correlate torque forces during insertion of screw-type dental implants with bone mineral density (BMD) values determined preoperatively.
Dental quantitative computed tomography (CT) was performed with simultaneous imaging of five postmortem mandibles and a calibration standard containing defined concentrations of calcium hydroxyapatite. CT numbers were converted to local BMD values by assuming a linear relationship (BMD = a x HU + b), where a and b are calibration coefficients. The a, b, P, and t values, correlation coefficients, and standard errors were calculated. Dental implants (n = 25) were set, and insertion torques were recorded. BMD was determined at the implantation site and correlated with torque forces recorded during implant insertion. Calibration coefficients derived for specimens were compared with those derived for actual patients.
Calibration coefficients (at 120 kV) for the postmortem specimens were a = 0.760 +/- 0.03 (mean +/- SD) and b = 2.8 +/- 3.7 and for the patients were a = 0.804 +/- 0.06 and b = 5.2 +/- 4.2. Calibrated BMD values at the location of dental implants exhibit a significant correlation (R(2) = 0.83, P <.001) with insertion torques on the basis of a second-order model, which yields torque = (0.0055 x BMD + 0.73)(2) for the implants used and the surgical technique applied.
Correlation exists between BMD measured with dental quantitative CT and the insertion torque of dental implants.
[Show abstract][Hide abstract] ABSTRACT: With the invention of miniaturized electromagnetic digitizers comes a
variety of potential clinical applications for computer aided
interventions using flexible instruments; it has become possible to
track endoscopes or catheters within the body. To evaluate the
reliability of a new commercial tracking system, we measured the
systematic distortions induced by various materials such as closed
metallic loops, wire guides, catheters and ultrasound scan heads. The
system under evaluation was the electromagnetic tracking system Aurora
(Mednetix/CH, NDI/Can); data were acquired using the serial port of a PC
running SuSE Linux 7.1 (SuSE, Gmbh, Nuernberg). The objects suspected to
cause distortions were brought into the digitizer volume. Beside this,
we evaluated the influence of a C-arm fluoroscopy unit. To quantify the
reliability of the system, the miniaturized sensor was mounted on a
nonmetallic measurement rack while the transmitter was fixed at three
different distances within the digitizer range. The tracker is more
sensitive to distortions caused by materials close to the emitter
(average value 13.6 mm +/- 16.6mm) for wire loops positioned at a
distance between 100 mm and 200 mm from the emitter). Distortions caused
by materials near the sensor (distances smaller than 100 mm) are small
(typical error: 2.2 mm +/- 1.9 mm) in comparison to the errors of other
electromagnetic systems published in an earlier study of our group where
we found an average error of 3.4 mm. Considerable distortions are caused
by the C-arm fluoroscopy unit and limits the reliability of the tracker
(error: 18.6 mm +/- 24.9 mm). The US scan head was found to cause
significant distortions only at a distance between the emitter and the
scan head less than 100 mm from the emitter in contrast to the average
error of 3.8 mm +/- 6.3 mm at distances greater than 100 mm. Taking into
account that significant distortions only occur in the presence of
metallic objects close to the emitter, these results indicate the
opportunities which are now available in surgical applications where
flexible instruments may need to be monitored within the patient.