Zusammenfassung.
Navigation in der interventionellen Radiologie und computerassistierten Chirurgie ist visuell interaktives Zielen gestützt auf die simultane Anzeige der Instrumentenposition und zugehöriger zwei- oder dreidimensionaler Bilddatensätze. Auf diese Weise vereint sie anatomische Information und therapeutische Aktion. Medizinische Navigationssysteme (MNS) können Echzeit-Bildführung simulieren und dadurch Strahlendosis sparen sowie das ganze Spektrum der digitalen Bildverarbeitung während des Eingriffs anbieten. Navigation stützt sich auf die Verfolgung (Tracking) von Instrumenten im Raum und die Umrechnung von Bild-, Patienten- und Instrumentenkoordinaten in ein gemeinsames Referenzsystem. Wird das Patientenkoordinatensystem als gemeinsame Basis benutzt, spricht man von patientenbasierter Navigation (PBN). Ist die bildgebende Modalität im Interventionsraum verfügbar und wird deren Referenzsystem zugrunde gelegt, handelt es sich um modalitätsbasierte Navigation (MBN). MBN benötigt keine vorangehende Registrierung und bietet inhärent die Möglichkeit der intraoperativen Bildgebung. MNS sind seit Jahren in der Neurochirurgie etabliert. Sie werden hier vor allem für die rahmenlose Biopsie und die Minimierung des Zugangstraumas bei tiefliegenden Prozessen eingesetzt. Sie erleben derzeit eine rasche Verbreitung in andere chirurgische Disziplinen wie z. B. die Otorhinolaryngologie oder die Traumatologie. Die klinische Genauigkeit eines MNS ist schwierig zu messen, da intraoperativ meist keine unabhängige Messmethode zur Verfügung steht. Üblicherweise wird eine Abweichung von unter einem bis etwa 5 mm zwischen Anzeige des MNS und tatsächlicher Lage anatomischer Strukturen angegeben. Bisher liegen nur sehr wenige prospektive randomisierte klinische Studien zwischen navigierten und nicht-navigierten Verfahren vor [1]
[2]
[3].
Navigation systems for image-guided therapy: A review.
Navigation is visually interactive targeting based on the simultaneous display of instrument position and of the corresponding two- or three-dimensional image data sets. In this way it unifies anatomic information and therapeutic action. Medical navigation systems (MNS) can simulate realtime image guidance and thereby reduce radiation exposure as well as provide the full range of digital image processing during an intervention. Navigation is based on the tracking of medical instruments in space and the transformation of image, patient, and instrument coordinates into a common reference system. If the patient coordinate system is used as the common base, the process is called patient-based navigation (PBN). If, however, the imaging modality is present in the interventional suite and its reference system is used, modality-based navigation (MBN) results. MBN does not need pre-interventional registration and inherently provides intra-operative imaging. In neurosurgery MNS's have been well established since years. They are in use for frameless biopsies and for minimizing the access morbidity in deeply situated pathologies. Currently there is a fast expansion of navigation into other surgical disciplines, e.g., orthopaedic surgery. The clinical accuracy of an MNS is hard to determine since an independent method of measurement is mostly not available during surgery. Normally, a deviation of below one up to about 5 mm between the display of the MNS and the actual position of an anatomic structure is reported. So far there have been only very few prospective randomized clinical trials between conventional and navigated interventions [1]
[2]
[3].
Schlüsselwörter:
Navigation - Computerassistierte Radiologie - Computerassistierte Chirurgie - Interventionelle Radiologie - Minimal Invasive Therapie
Key words:
Therapy, image guided - Surgery, image guided - Navigation, modality based
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Dr. Augustus Ludwig Jacob
Institut für Diagnostische Radiologie, Universitätskliniken
Petersgraben 4, 4031 Basel
Schweiz
Phone: + 41-61-265-4911
Fax: + 41-61-265-5383
Email: ajacob@uhbs.ch
