Image-guided Surgery and Therapy: Current Status and Future Directions

Image-guided surgery and therapy is assuming an increasingly important role, particularly considering the current emphasis on minimally-invasive surgical procedures. Volumetric CT and MR images have been used now for some time in conjunction with stereotactic frames, to guide many neurosurgical procedures. With the development of systems that permit surgical instruments to be tracked in space, image-guided surgery now includes the use of “frame-less” procedures, and the application of the technology has spread beyond neurosurgery to include orthopedic applications and therapy of various softtissue organs such as the breast, prostate and heart. Since tracking systems allow image-guided surgery to be undertaken without frames, a great deal of effort has been spent on image-to-image and image-to-patient registration techniques, and upon the means of combining real-time intra-operative images with images acquired pre-operatively. As image-guided surgery systems have become increasingly sophisticated, the greatest challenges to their successful adoption in the operating room of the future relate to the interface between the user and the system. To date, little effort has been expended to ensure that the human factors issues relating to the use of such equipment in the operating room have been adequately addressed. Such systems will only be employed routinely in the OR when they are designed to be intuitive, unobtrusive, and provide simple access to the source of the images.