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A hybrid, image-based and biomechanics-based registration approach to markerless intraoperative nodule localization during video-assisted thoracoscopic surgery

Abstract : The resection of small, low-dense or deep lung nodules during video-assisted thoracoscopic surgery (VATS) is surgically challenging. Nodule localization methods in clinical practice typically rely on the preoperative placement of markers, which may lead to clinical complications. We propose a markerless lung nodule localization framework for VATS based on a hybrid method combining intraoperative cone-beam CT (CBCT) imaging, free-form deformation image registration, and a poroelastic lung model with allowance for air evacuation. The difficult problem of estimating intraoperative lung deformations is decomposed into two more tractable sub-problems: (i) estimating the deformation due the change of patient pose from preoperative CT (supine) to intraoperative CBCT (lateral decubitus); and (ii) estimating the pneumothorax deformation, i.e. a collapse of the lung within the thoracic cage. We were able to demonstrate the feasibility of our localization framework with a retrospective validation study on 5 VATS clinical cases. Average initial errors in the range of 22 to 38 mm were reduced to the range of 4 to 14 mm, corresponding to an error correction in the range of 63 to 85%. To our knowledge, this is the first markerless lung deformation compensation method dedicated to VATS and validated on actual clinical data.
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https://hal.archives-ouvertes.fr/hal-03127302
Contributor : Jean-Louis Dillenseger <>
Submitted on : Monday, February 8, 2021 - 5:55:55 PM
Last modification on : Wednesday, April 14, 2021 - 6:44:05 PM

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Pablo Alvarez, Simon Rouzé, Michael Miga, Yohan Payan, Jean-Louis Dillenseger, et al.. A hybrid, image-based and biomechanics-based registration approach to markerless intraoperative nodule localization during video-assisted thoracoscopic surgery. Medical Image Analysis, Elsevier, 2021, 69, pp.101983. ⟨10.1016/j.media.2021.101983⟩. ⟨hal-03127302⟩

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