Ultrasound Bi-dimensional Navigation Technology for Breast application

Transcription

1 Ultrasound Bi-dimensional Navigation Technology for Breast application Poster No.: C-1824 Congress: ECR 2016 Type: Scientific Exhibit Authors: A. Morresi, V. Girardi, S. de Beni, M. battaglia, L. Forzoni, A. martegani ; S. Fermo della Battaglia (CO)/IT, Brescia/IT, Genova/IT, Milano/IT, Firenze/IT, COMO/IT Keywords: Breast, Ultrasound, Diagnostic procedure, Image registration DOI: /ecr2016/C-1824 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 20

2 Aims and objectives Evaluation of the feasibility of new Ultrasound (US) Bi-dimensional navigation technology in Breast application. In vitro, ex vivo and in vivo tests were performed. Page 2 of 20

3 Methods and materials 8 female patients, in two different sites (Ospedale Valduce, Como, Italy; Istituto Clinico S. Anna, Brescia, Italy) underwent Mammography (5 patients), Breast MRI (2 patients), Breast MRI (1 patient) and US examination of breast and axilla (all the patients), using a novel electromagnetically tracked technology for 2D Navigation, that combines real-time US with pre-acquired DICOM images (BodyMap, Esaote S.p.A., Genova, Italy). BodyMap technology was used to show the real-time position of the US probe with respect to any reference image tested: Mammography (axial and sagittal views), MRI, Breast Bodymark. Breast phantom tests (both considering in vitro and ex vivo phantoms) were performed to assess technology accuracy and to evaluate and manage organ deformation. Ex vivo phantom was obtained with a chicken breast wrapped in plastic film with some inclusions obtained by two olives with pit, simulating lesions. In vitro phantom was a CIRSE Model 073 Multi-modality breast biopsy and sonographic trainer phantom. External markers were placed on in vitro and ex vivo phantoms, in order to increase the number of geometrical landmarks needed for BodyMap registration (in vivo tests such markers were not needed due to the presence of natural reference points on the patient's body). For all the examinations an Esaote MyLabTwice US system (Esaote S.p.A., Genova Italy), equipped with Virtual Navigation option, allowing BodyMap real-time image fusion of Mammography (axial and sagittal views), MRI and Breast Bodymark with 2D US scans, was employed. Moreover, Esaote LA332 and LA533 Linear Array Probes (LA332 - Operating Bandwidth: 3-11 MHz; LA533 - Operating Bandwidth: 3-13 MHz; ) with different reusable tracking brackets with sensor mounted (CIVCO for LA332 and CIVCO for LA533 - CIVCO Medical Solutions, Kalona, Iowa, USA) were used. LA332 probe has an array width of 40 mm and it was mainly used for deep scanning (useful for large breasts). LA533, 53 mm array width was mainly used for small breast volumes acquisition and 2D US examination. LA533 and LA332 probe have a dual possibility hand grip, pinch grip and palmar grip (appleprobe design), in order to provide a neutral wrist position while scanning. This resource represented an additional operator's comfort option during long examinations. BodyMap real-time fusion imaging between Mammography (axial and sagittal views), MRI and Breast Bodymark and 2D US data on the US system was possible thanks to an electromagnetic tracking system, consisting of a transmitter on a fixed position and a small receiver mounted on the US probe through a dedicated support. Page 3 of 20

4 The transmitter, whose position is considered the origin of the reference space system, was kept steady by a proper support, while the position and the orientation of the US probe in the created 3D space is provided by the receiver unit. The electromagnetic field source tip was oriented to point the target, the subject's breast, in order to address the highest intensity and the most homogeneous area of the created electromagnetic field on the US scanning area. The magnetic field produced by Virtual Navigator electromagnetic tracking system is stronger at the transmitter site and it fades with distance from the transmitter: the magnetic field is lower than the Earth's magnetic field at a distance of 78 cm from the transmitter. A non-metallic table was used to reduce as much as possible the interferences with the created electromagnetic field. Page 4 of 20

5 Images for this section: Fig. 1: In vitro breast phantom Mammography acquisition Page 5 of 20

6 Fig. 2: Ex vivo breast phantom (chicken breast) Mammography acquisition Page 6 of 20

7 Fig. 3: Phantom ex vivo (chicken breast) test set up Page 7 of 20

8 Fig. 4: Linear Array Probe (LA332) with different reusable tracking brackets with sensor mounted Page 8 of 20

9 Fig. 5: Linear Array Probe (LA533) with different reusable tracking brackets with sensor mounted Page 9 of 20

10 Results The registration phase was performed selecting some easy to be recognized natural skin markers on the reference image and on the patient body ( such as nipple, areola, axilla ). An average of 7 reference points was used in order to perform the registration between the real-time US and the reference image for 2D navigation. The pointing and selection of the reference points was done directly with the US probe, using the center of the array as pointer. The same was done on the phantom using the marker placed on the surface. It was always possible to use the 2D Navigation BodyMap Technology, with a good correspondence between the probe representation (green circle) and the real probe position during real-time US. In average the mismatch between the probe position and reference internal markers in in vivo, ex vivo and in vitro were 13±9 mm. Excessive compression during US scanning and Mammography acquisition created major distortions up to 22 mm. The use of a proper amount of gel in order to ensure the correct coupling between the transducer and the body skin or phantom surface matching was useful in order to help to avoid excessive compressions caused by the transducer itself. The registration time between US and any reference 2D image tested was 50 seconds in average. Two "Digital" tests were performed regarding the check of the BodyMap capability to manage also simple (lateral compression) or complex (axial compression and lateral enlargement plus shift) of the examined body area or phantom. The tests were performed on paper simulating one reference image and the related area to be scanned, then comparing the BodyMap capability to mark the same targets on the original drawing and the compressed reference one. The deformation was present in two dimensions (x, y plane) the z axis defamation did not influence the result of the navigation since the second image modality did not have any spatial reference in this direction. Complex distortions up to 2.5cm of compression axially and 1.7cm enlargement laterally were tested. Page 10 of 20

11 Images for this section: Fig. 6: BodyMap 2D navigation on Breast/axilla Bodymark Page 11 of 20

12 Fig. 7: BodyMap on 2D navigation on Mammography (sagittal view) Page 12 of 20

13 Fig. 8: BodyMap 2D navigation on Breast MRI (axial view) Fig. 9: BodyMap 2D navigation on ex vivo (chicken breast) phantom Mammography Page 13 of 20

14 Fig. 10: BodyMap 2D navigation on in vitro breast phantom Mammography Page 14 of 20

15 Fig. 11: BodyMap on Mammography sagittal view - 2D registration phase Page 15 of 20

16 Fig. 12: simple deformation test on paper Page 16 of 20

17 Fig. 13: Complex deformation test on paper Page 17 of 20

18 Conclusion 2D Navigation of the breast and axilla area using BodyMap technology system with a reference image as Mammography, MRI, Bodymark is feasible and it could be integrated in everyday clinical practice. The BodyMap tool was able to properly manage scanned area distortions (both regarding simple - lateral compression - and complex - lateral enlargement and axial compression). This capability was ensured by the adaptability of the navigation algorithm, enabled by the proper marker definition to extrapolate organ deformation. Major compressions during acquisition of mammograms had to be avoided, in order to maintain the BodyMap probe position mismatch between the real-time scanning results and the reference image in a reasonable range, also for a qualitative navigation as natively the 2D is. BodyMap technology seems particularly useful for improving breast examination workflow and confidence, as it allows automatic saving of pictures and clips of the US examined area with automatic probe position indication by real-time tracking. Thus having the aim to enable faster exam completion and increased confidence especially for image readability also for different operators. Page 18 of 20

19 Personal information Leonardo Forzoni Page 19 of 20

20 References [1] "Virtual Navigator 3D Panoramic for Breast Examination", Leonardo Forzoni, Stefano De Beni, Sara D'Onofrio, Maria Marcella Laganà, Jacopo Nori, 35th Annual International Conference of the IEEE EMBS Osaka, Japan, 3-7 July, 2013, [2] "Virtual Biopsy and 3DPan Fusion Imaging for Breast Core Biopsy", E. Giannotti, J. Nori, D. Abdulcadir, G. Bicchierai, L. Forzoni, S. de Beni, S. D'onofrio, G. Scaperrotta, epos ECR 2014, DOI: /ecr2014/C-0219 Page 20 of 20