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Augmented-Reality Enhances Surgical Navigation Technology

By MedImaging International staff writers
Posted on 25 Jan 2017

A combination of three-dimensional (3D) X-ray and advanced optics provides surgeons with augmented-reality imaging during spine, cranial, and trauma surgical procedures.

The Royal Philips augmented-reality surgical navigation technology is designed to help surgeons perform image-guided open and minimally invasive spine surgery in a hybrid operating room (OR). More...

Due to the inherently reduced visibility of the spine and other structures during such procedures, surgeons rely on real-time imaging and navigation solutions in order to guide their surgical tools and implants. The same is true for minimally invasive cranial surgery and surgery on complex trauma fractures.

The new Philips technology adds additional capabilities to the company’s low-dose X-ray system, using high-resolution optical cameras mounted on the X-ray flat panel detector (FPD) to image the surface of the patient. It then combines the external view captured by the cameras and the internal 3D view of acquired by the X-ray system to construct an augmented-reality view of the patient’s external and internal anatomy, improving procedural planning, surgical tool navigation, and implant accuracy, as well as reducing procedure times.

The first pre-clinical study on the technology was undertaken as a collaboration between Philips, Karolinska University Hospital, Cincinnati Children's Hospital Medical Center, and eight other medical centers. The results showed the technology to be significantly better with respect to overall accuracy (85%), when compared to pedicle screw placement without the technology (64%). The study was published in the November 2016 issue of Spine.

“This new technology allows us to intraoperatively make a high-resolution 3D image of the patient’s spine, plan the optimal device path, and subsequently place pedicle screws using the system’s fully-automatic augmented-reality navigation,” said study co-author Stefan Skúlason, MD, of Landspitali University Hospital (Reykjavik, Iceland). “We can also check the overall result in 3D in the OR without the need to move the patient to a CT scanner. And all this can be done without any radiation exposure to the surgeon and with minimal dose to the patient.”

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63 (118.01719665527): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

64 (511.88468933105): SELECT fid FROM jos_deeppockets WHERE id=294767855 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294767855 AND published='1' LIMIT 1

65 (71.048736572266): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

66 (58.889389038086): select jos_twitters.link from jos_twitters where cat=10

67 (32.186508178711): select jos_facebook.link from jos_facebook where cat=10

68 (30.994415283203): select jos_google_plus.link from jos_google_plus where cat=10

69 (30.040740966797): select jos_linkedin.link from jos_linkedin where cat=10

70 (32.901763916016): SELECT fid FROM jos_deeppockets WHERE id=294767855 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294767855 AND published='1' LIMIT 1

71 (95.129013061523): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

72 (398.15902709961): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (272.03559875488): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (41.007995605469): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

75 (50.783157348633): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (44.107437133789): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (31.948089599609): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (35.04753112793): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

92 (49.829483032227): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

107 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

108 (49.114227294922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294767855 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (46.014785766602): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294767855 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

111 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

112 (50.783157348633): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294767855 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (587.94021606445): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294767855 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (696.89750671387): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

115 (514.98413085938): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

116 (178.81393432617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

117 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

118 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

119 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

120 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

121 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

122 (68.187713623047): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

123 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

124 (655.8895111084): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294767855 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294767855 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 9321.928024292): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (77.962875366211): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (32.901763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (119.92454528809): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (427.0076751709): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (605.10635375977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (644.92225646973): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (59.127807617188): SELECT name FROM jos_deeppockets WHERE id=211

138 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

139 (802.04010009766): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (799.89433288574): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (185.01281738281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

142 (117.06352233887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

143 (569.10514831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

144 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

146 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

147 (!!!!! 1704.9312591553): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

148 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

149 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

150 (60.081481933594): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294767855 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294767855 AND type='deeppockets_item' AND published='1' LIMIT 1

151 (50.067901611328): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

152 (41.961669921875): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

153 (51.975250244141): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

154 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

155 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294767855 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294767855 AND published='1' LIMIT 1

156 (54.836273193359): select jos_twitters.link from jos_twitters where cat=10

157 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

158 (39.815902709961): select jos_google_plus.link from jos_google_plus where cat=10

159 (40.054321289062): select jos_linkedin.link from jos_linkedin where cat=10

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