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16.03.2019 | Original Article - Neurosurgery general Open Access

Current accuracy of surface matching compared to adhesive markers in patient-to-image registration

Zeitschrift:
Acta Neurochirurgica
Autoren:
Mireli A. Mongen, Peter W. A. Willems
Wichtige Hinweise
This article is part of the Topical Collection on Neurosurgery general

Comments

This is a nice study, which compares the accuracy of the registration with surface matching technique and point-pair matching (stickers/fiducials) and its influence on Target Registration Error (TRE). The authors demonstrated that the surface matching is inferior to the point-pair matching technique. Furthermore, there is no correlation of the TRE with the ERA (estimated registration accuracy). It means that low ERA provided by a neuronavigation system does not guarantee improved accuracy for the target location (TRE). There was no difference on comparison of 3 modern neuronavigation systems (S7, S8 and Curve). And, which is more disappointing - the "improvement attempt" offered by Brainlab Curve, practically worsened the TRE. Although the study was performed on small series, the data reached statistical significance.
The paper is well and clearly written. It is a very useful reminder to the neurosurgeons about hidden pitfalls which may exist in a routine and seemingly precise process such as the use of neuronavigation.
Sergey Spektor
Jerusalem, Israel

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Abstract

Object

In the past, the accuracy of surface matching has been shown to be disappointing. We aimed to determine whether this had improved over the years by assessing application accuracy of current navigation systems, using either surface matching or point-pair matching.

Methods

Eleven patients, scheduled for intracranial surgery, were included in this study after a power analysis had shown this small number to be sufficient. Prior to surgery, one additional fiducial marker was placed on the scalp, the “target marker,” where the entry point of surgery was to be expected. Using one of three different navigation systems, two patient-to-image registration procedures were performed: one based on surface matching and one based on point-pair matching. Each registration procedure was followed by the digitization of the target marker’s location, allowing calculation of the target registration error. If the system offered surface matching improvement, this was always used; and for the two systems that routinely offer an estimate of neuronavigation accuracy, this was also recorded.

Results

The error in localizing the target marker using point-pair matching or surface matching was respectively 2.49 mm and 5.35 mm, on average (p < 0.001). In those four cases where an attempt was made to improve the surface matching, the error increased to 6.35 mm, on average. For the seven cases where the system estimated accuracy, this estimate did not correlate with target registration error (R2 = 0.04, p = 0.67).

Conclusion

The accuracy of navigation systems has not improved over the last decade, with surface matching consistently yielding errors that are twice as large as when point-pair matching with adhesive markers is used. These errors are not reliably reflected by the systems own prediction, when offered. These results are important to make an informed choice between image-to-patient registration strategies, depending on the type of surgery at hand.

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